Current opinion in urology
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Although no standard management of erectile dysfunction in prostate cancer (CaP) survivors exists, many treatment options are available. This review summarizes the current understanding of the cause and management of erectile dysfunction in CaP survivors. ⋯ To optimize recovery of erectile function and prevent loss of penile length, penile rehabilitation should be initiated expeditiously after prostatectomy or radiation. In patients with refractory erectile dysfunction, dexterous and motivated patients remain excellent candidates for first and second-line medical therapies. However, early placement of a penile prosthesis following radical prostatectomy is now a proven and viable option.
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To evaluate perioperative enhanced recovery protocols for patients undergoing radical cystectomy and urinary diversion and describe our unique protocol. ⋯ Enhanced recovery after surgery protocol includes pre, intra and postoperative evidence-based modifications for improving perioperative care of cystectomy patients. Significant shortening of hospital stay without increasing early complication or readmission rate could be achieved safely in most of the patients.
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Botulinum toxin injections into the bladder have become established in the management of refractory detrusor overactivity and overactive bladder. Mechanism of action of the toxin appears to involve both efferent and afferent nerve pathways, as well as having an antinociceptive effect. Over the years, several reports of its use in refractory bladder pain syndrome and interstitial cystitis have emerged. We review the literature with a view to assessing efficacy and adverse events in this setting. ⋯ Although botulinum neurotoxin for refractory bladder pain syndrome/interstitial cystitis appears promising, larger-scale studies with adequate follow-up and in particular randomized placebo-controlled studies are required to confirm these findings.
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Much confusion has surrounded the purpose of the psychological assessment in the context of chronic pain. For many clinicians, the psychological assessment is used to rule out psychiatric illness and to identify the nonmedical causes for pain and disability. In essence, it is used to identify the causes of pain that fall outside of the biomedical model. Supported by over 30 years of evidence, the bio-psycho-social model acknowledges that psychosocial factors are inherent in chronic pain and require assessment if meaningful diagnostics and treatments are to occur. ⋯ Informed assessment of chronic pain needs to include relevant biological, psychological, and social domains. This article describes those domains and offers suggestions of specific instruments to use in clinical or research settings.
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To define the incidence of perioperative morbidity following contemporary radical cystectomy and identify preoperative, intraoperative, and postoperative strategies to reduce complications. ⋯ Morbidity is common following radical cystectomy, but careful attention to preoperative, intraoperative, and postoperative details can help reduce this risk.