Urology
-
To determine whether prostate-specific antigen (PSA) velocity (PSAV), used as a selection criterion for salvage radiotherapy (RT) after radical prostatectomy (RP), predicts the likelihood of response to RT in men with biochemical relapse. ⋯ In the present study, PSAV accurately predicted the likelihood of response to salvage RT in men with biochemical relapse after RP. No other pathologic parameters predicted the likelihood of response to RT. Using PSAV as a sole selection criterion for salvage RT after RP may allow improvement in the historically low rates of durable response.
-
The treatment of patients presenting with severe symptoms of obstruction due to benign prostatic hyperplasia and a history of previous surgery for long urethral stricture is still a matter of discussion. We report on 3 patients in whom resection of the prostate was performed using a dilated cystostomy approach under spinal anesthesia. All men had undergone dorsal onlay urethroplasty for long urethral stricture before prostate resection. The good outcome demonstrated the feasibility and safety of prostate resection using a suprapubic approach, which may become a treatment option in this group of patients.
-
To evaluate whether using a biologic hemostatic sealant facilitates hemostasis during laparoscopic partial nephrectomy. Secure and durable parenchymal hemostasis is a critical requirement during laparoscopic partial nephrectomy. ⋯ The results of this study have shown that adjunctive use of gelatin matrix thrombin sealant substantially enhances parenchymal hemostasis and has decreased our procedural and hemorrhagic complications to levels comparable with contemporary open partial nephrectomy series. This gelatin matrix-thrombin tissue sealant is now a routine part of laparoscopic partial nephrectomy at our institution.
-
To assess whether routine postoperative chest radiography (CXR) is required after open nephrectomy for the detection and possible management of a pneumothorax. It has become the standard of care by many urologists to obtain routine postoperative CXRs after open nephrectomy to assess for the presence of a pneumothorax. However, at our institution, very few patients have developed a pneumothorax postoperatively, and, furthermore, the CXR findings almost never affected the clinical management. ⋯ Routine postoperative CXRs are not needed after open nephrectomy. Obtaining a selective CXR when a recognized intraoperative pleural tear has occurred, a central line is placed, the physical examination reveals an abnormality (ie, decreased breath sounds), or the patient experiences respiratory difficulties in the postoperative period is safe, cost-effective, and decreases the radiation exposure to patients.
-
To determine whether body mass index (BMI) and Hounsfield units (HUs) could be used as independent predictors of stone-free status after extracorporeal shock wave lithotripsy (ESWL). No detailed studies have assessed BMI as an independent predictor of ESWL outcome. Some studies have suggested that HUs of urinary calculi on noncontrast computed tomography may predict the stone-free rate after ESWL. ⋯ BMI and HUs were statistically significant independent predictors of stone-free rates after ESWL. We believe a predictive model of ESWL outcome may be formulated on the basis of these findings and may be used to select the preferred treatment option for patients with urinary calculi.