Urology
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We report the first case of direct surgical injury to a pudendal nerve branch during radical perineal prostatectomy. A 65-year-old patient presented with typical symptoms of a pudendal nerve lesion after radical perineal prostatectomy. ⋯ Urologic surgeons should be aware of the typical symptoms after iatrogenic injury to the pudendal nerve or its branches. Early diagnosis and neurosurgical intervention are important to obtain a more favorable outcome.
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To determine whether improved prostate sampling by the extended biopsy scheme also improves the accuracy of the biopsy Gleason score (bGS). Because most prostate cancer cases are now detected at an early stage with a low prostate-specific antigen level, the bGS may be the most important factor in therapeutic decision-making. Sextant biopsy schemes had poor correlation with prostatectomy Gleason scores. Extended prostate biopsies have replaced the sextant scheme because of the former's greater cancer detection rate. ⋯ The use of an extended prostate biopsy scheme significantly improves the correlation between the bGS and prostatectomy Gleason score and reduces the risk of upgrading to a worse Gleason group at prostatectomy.
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Patent urachus accounts for 10% to 15% of all reported urachal abnormalities in the literature. Treatment in the past has relied on immediate surgery. Conservative therapy with bladder catheter drainage, resulting in spontaneous closure, has not been described. ⋯ One week of urethral catheterization resulted in spontaneous closure of the patent urachus. This case suggests that initial treatment should consist of urethral catheterization for 1 to 2 weeks, followed by repeat voiding cystourethrogram. If the patent urachus still persists, one should proceed to surgical correction.
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To evaluate the relationship between pretreatment postvoid residual urine (PVR) less than 100 mL and brachytherapy-related urinary morbidity. ⋯ The selection of patients with a pretreatment PVR of less than 100 mL was associated with rapid IPSS resolution, the absence of prolonged (more than 3 days) catheter dependency, and the elimination of postbrachytherapy surgical intervention for bladder outlet obstruction.
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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.