Urology
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Vascular air embolism (VAE) can be a lethal complication of surgical approaches, and it has been documented in various urologic procedures. A case of VAE complicating a percutaneous nephrolithotomy in a 47-year-old man is presented, well documented by immunohistochemical examination of lung samples and three-dimensional imaging of histologic sections with confocal laser scanning microscopy.
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To test the hypothesis that patients with hyperoxaluria, who modified their dietary calcium intake, would reduce their urinary oxalate excretion without raising their urinary calcium excretion. Diet is a major factor in idiopathic calcium oxalate urolithiasis, yet controversy exists regarding the ideal clinical recommendations. Approximately 20% of patients with calcium oxalate stone formation have hyperoxaluria (> or = 45 mg oxalate/d). Calcium supplements to bind dietary oxalate have been suggested, but clinical evidence of this therapy is lacking. ⋯ Gastrointestinal binding of oxalate by calcium is an effective clinical strategy for hyperoxaluria, whether mediated by calcium citrate with meals or by inclusion of calcium-containing foods with meals.
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To examine the direct renal hemodynamics during carbon dioxide pneumoperitoneum in both human and porcine models. Laparoscopic living donor nephrectomy has become widespread because of its minimally invasive nature. However, it has been clear that the renal hemodynamics and function are affected during carbon dioxide pneumoperitoneum. ⋯ The erythrocyte velocity in the CPC decreased during carbon dioxide pneumoperitoneum in all kidneys in both the human and the porcine models. However, erythrocyte velocity in the renal artery did not change during carbon dioxide pneumoperitoneum. After stopping the pneumoperitoneum, the erythrocyte velocity in the CPC recovered immediately. The findings of our study have shown that the suitable carbon dioxide pneumoperitoneal pressure for renal microcirculation is <8 mm Hg for laparoscopic surgery.
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To evaluate the midterm anatomic and functional outcome of genital prolapse repair by the vaginal route using a porcine skin implant (Pelvicol) and bilateral sacrospinous fixation. ⋯ The results of our study have shown that biologic implantation and bilateral sacrospinous fixation are effective in high-grade genital prolapse repair. Validated questionnaires are potentially useful tools to predict the postoperative outcome.
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Randomized Controlled Trial Comparative Study
Comparison of two periprostatic nerve blockade techniques for transrectal ultrasound-guided prostate biopsy: bilateral basal injection and single apical injection.
To investigate the effectiveness of a periprostatic nerve blockade technique that relies on a single apical injection of lidocaine. We compared it with bilateral injections at the base of the prostate to determine the effectiveness of pain control and to compare the technical aspects during transrectal ultrasound-guided prostate biopsy. ⋯ The results of this randomized prospective study suggest that both the single apical injection and the bilateral basal injection techniques are effective in terms of pain prevention during transrectal-ultrasound-guided prostate biopsy. The main advantage of the single apical injection technique is its ease of use and the requirement for one half the amount of local anesthetic agent.