Urology
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Laparoscopic surgery of the horseshoe kidney has been limited to benign conditions, hand assistance, and retroperitoneal approaches for small tumors. In this case, we describe a pure transperitoneal approach to heminephrectomy for a large renal cell carcinoma. ⋯ Preoperative angiography may aid surgical planning. A pure transperitoneal approach to cancer surgery of the horseshoe kidney is effective.
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Randomized Controlled Trial Clinical Trial
Efficacy of continuous local anesthetic infusion for postoperative pain after radical retropubic prostatectomy.
To determine whether a subfascial continuous infusion of local anesthetic in patients undergoing radical retropubic prostatectomy would result in a reduction in postoperative opioid requirements and an improvement in pain scores. ⋯ Continuous subfascial infusion of local anesthetic did not result in a postoperative reduction in opioid requirements or an improvement in pain scores in patients undergoing radical retropubic prostatectomy.
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To evaluate, in a pilot study, the tumor control outcomes of our approach and define the pretreatment characteristics that predict a response to therapy. Patients with advanced clinically localized prostate cancer have a high likelihood of prostate-specific antigen (PSA) failure 3 to 5 years after initial treatment. We adopted trimodality therapy (neoadjuvant and adjuvant androgen ablation, external beam radiotherapy [RT], and a brachytherapy boost) to augment biochemical disease-free survival in this patient population. ⋯ Trimodality RT offers excellent tumor control in patients with poor prognosis who often relapse early. Longer follow-up will be important to determine whether these results are durable over time.
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Transitional cell carcinoma (TCC) of the bladder in children is a rare occurrence. Cyclophosphamide is a known risk factor for the development of TCC. ⋯ The role of radiotherapy in the development of secondary malignancies of the bladder remains controversial. We report a case of childhood TCC in a patient in remission from Hodgkin's lymphoma previously treated with non-cyclophosphamide chemotherapy and low-dose nodal radiotherapy.
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Case Reports
Intracavernosal etilefrine self-injection therapy for recurrent priapism: one decade of follow-up.
Recurrent idiopathic priapism is a rare condition that, if not properly treated, may lead to impaired quality of life and erectile dysfunction. Treatment can be achieved by prevention of priapism episodes with systemic therapy or by early intervention with intracavernosal self-injection of sympathomimetic agents. We describe a case of a young patient with recurrent idiopathic priapism who has used etilefrine self-injection for the past 10 years with good efficacy and libido and erectile function preservation. This report suggests that this approach may be safely indicated in selected cases, particularly when sexual function preservation is a major concern.