Urology
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To review the incidence and the impact of pulmonary seed migration after prostate brachytherapy on lung function. Isolated reports of seed migration to the lungs after prostate brachytherapy have been published; however, the clinical consequences of this pulmonary migration have not been adequately evaluated. ⋯ Radioactive seed migration occurred in 36.2% of brachytherapy patients who had chest radiographs done in our series. Pulmonary seed migration may be influenced by the number of implanted seeds and does not appear to be influenced by the seed type. Additional study of this observed phenomenon is required. A thorough pulmonary workup failed to reveal any short-term harmful side effects; however, long-term follow-up is needed. Healthcare providers should discuss the possibility of pulmonary seed migration with patients with prostate cancer considering prostate brachytherapy.
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To describe the clinical and urodynamic features of patients with voiding dysfunction secondary to schistosomal myelopathy. Schistosomiasis mansoni is an endemic fluke infection in South America, the Caribbean, and Africa. In the United States and Europe, people may be infected mainly through travel to endemic areas and immigration of infected individuals. Clinical involvement of the spinal cord is a well-recognized complication of the disease. The typical manifestations are those of an acute transverse myelitis, with sudden onset of lower extremity neuropathy associated with bladder and bowel dysfunction. ⋯ Schistosomal myelopathy is a potential cause of severe voiding dysfunction secondary to spinal cord disease. A high index of suspicion is paramount because early medical intervention can abort the progression of neurologic deterioration.
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To report the largest series of pelvic fracture and lower genitourinary tract injury in the pediatric population to further define its incidence. The association between pelvic fractures and lower genitourinary tract injury has been well recognized in the adult population. The incidence of bladder or urethral injury is approximately 10% to 15%. Previous limited pediatric reviews placed its incidence at slightly lower levels. ⋯ The incidence of significant lower genitourinary injury in pediatric patients with pelvic fractures is lower than that reported in previous adult and pediatric reviews. Significant lower genitourinary injuries were not found in stable patients without gross hematuria or multiple associated injuries and with a normal genitourinary examination.
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To investigate the therapeutic value of sacral neuromodulation in patients with neurogenic disorders in whom conservative treatment options were unsuccessful. Neurogenic disorders may result in various forms of lower urinary tract dysfunction. ⋯ Unilateral chronic sacral neuromodulation using sacral foramen electrodes can be a valuable, but only temporary, treatment for neurogenic bladder dysfunction. The technique of chronic sacral neuromodulation should be refined to achieve the same and lasting results with implantation systems as achieved with preoperative test stimulation.