Urology
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Randomized Controlled Trial Comparative Study Clinical Trial
Unilateral pudendal nerve blockade for relief of all pain during transrectal ultrasound-guided biopsy of the prostate: a randomized, double-blind, placebo-controlled study.
To investigate the efficacy of unilateral pudendal nerve block for the relief of all pain during transrectal ultrasound (TRUS)-guided prostate biopsy. TRUS-guided prostate biopsy is the standard procedure to diagnose or rule out prostate cancer. The pain, attributed to ultrasound probe insertion and the needle punctures into the prostate, inflicted by TRUS-guided prostate biopsy limits its effectiveness. ⋯ Unilateral pudendal nerve blockade was effective in reducing the pain at both biopsy and probe manipulation in our study.
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To review our experience with the management of high-grade (grade IV and V) renal injuries to clarify the role of conservative management. ⋯ Most children with grade IV renal injury can be treated conservatively. Patients with complete renal fracture or significant urinary extravasation on initial radiographic imaging may be less likely to undergo spontaneous resolution. Patients with a persistent urinary leak can be successfully treated with internal drainage. Grade V injuries are associated with an increased risk of requiring open operative intervention, and the renal preservation rates are low.
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Castleman's disease (angiofollicular lymphoid hyperplasia) is a rare heterogeneous group of lymphoproliferative disorders of uncertain cause. Most cases occur as mediastinal masses, although extrathoracic involvement has been reported. Castleman's disease involving the genitourinary tract, one of the most infrequent organ systems affected, has so far only been described in pararenal and retroperitoneal locations. ⋯ No evidence of concomitant lymphoma or sarcoma was found. Two years after surgical removal of the tumor, no recurrence was evident. To our knowledge, this is the first case of Castleman's disease presenting as a urachal tumor.
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Multicenter Study Clinical Trial
Intermittent androgen suppression for locally advanced and metastatic prostate cancer: preliminary report of a prospective multicenter study.
To clarify the effect of intermittent androgen suppression on the time to androgen-independent progression and changes in quality of life (QOL). ⋯ Our interim analysis indicated that QOL is remarkably improved during the off-treatment period. Intermittent androgen suppression would be a viable option for treatment of advanced prostate cancer, although a randomized controlled study is required to determine whether intermittent androgen suppression prolongs the time to androgen-independent cancer. We will continue follow-up in this study to a minimum of 3 years.
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To perform a retrospective review in patients undergoing urologic operations during a 10-year period. Patient positioning is important before surgery to avoid pressure sores and other iatrogenic injuries. The reported risk factors have included a long operative time, diabetes, and malignancy. We have noted skin breakdown in patients placed on stabilizing devices and in patients with germline von Hippel-Lindau (VHL) gene mutations (a gene important in angiogenesis). ⋯ Patients with longer operative times were at greater risk of skin breakdown and required greater care during preoperative positioning. The other factors studied were not significantly associated with skin breakdown.