The Journal of urology
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The Journal of urology · Jun 2001
ReviewUpdate on pain management for advanced genitourinary cancer.
Pain is a significant problem in many patients with genitourinary malignancy at all stages of disease. Optimal pain control becomes a primary concern as disease progresses and other therapies are exhausted. The selection of the most appropriate therapy becomes difficult without an understanding of the underlying mechanisms of pain and the available therapies. ⋯ Opioid medication is the mainstay of therapy in the majority of patients but with the appropriate addition of other adjuvant drugs patients may achieve optimal pain control without unwanted side effects. A few patients benefit from more invasive techniques, including plexus blocks and neuraxial infusion therapy, and the indications for these treatments are discussed. These therapies have largely superseded neuroablative procedures that are more destructive and associated with higher morbidity.
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The Journal of urology · Jun 2001
Does every patient with ureteropelvic junction obstruction need voiding cystourethrography?
Voiding cystourethrography is routinely recommended to detect vesicoureteral reflux in children with ureteropelvic junction obstruction. Vesicouretral reflux coexisting with primary ureteropelvic junction obstruction is usually of low grade and resolves spontaneously after pyeloplasty, whereas pseudo ureteropelvic junction obstruction and obstruction secondary to high grade reflux usually present with a dilated ureter that is easily detected on real-time ultrasonography. We assessed the role of voiding cystourethrography in children with ureteropelvic junction obstruction by retrospectively evaluating the incidence and natural history of coexisting vesicourethral reflux. ⋯ Low grade reflux coexisting with ureteropelvic junction obstruction spontaneously disappeared after pyeloplasty, and all high grade reflux coexisting with obstruction was easily detected on ultrasonography using real-time mode. Therefore, we believe that indication for voiding cystourethrography in children with ureteropelvic junction obstruction should be limited to those with dilated ureters on ultrasonography.
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The Journal of urology · Jun 2001
Microsurgical denervation of the spermatic cord as primary surgical treatment of chronic orchialgia.
We evaluate the effectiveness of microsurgical denervation of the spermatic cord for treatment of chronic orchialgia. ⋯ When conservative treatment fails, microsurgical denervation of the spermatic cord should be considered first rate surgical therapy for patients with chronic orchialgia.
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The Journal of urology · Jun 2001
Extravesical ureteral reimplantations for the correction of primary reflux can be done as outpatient procedures.
Extravesical ureteral reimplantations are thought to be less morbid compared with traditional intravesical techniques. We believe a shorter length of stay can be achieved in children undergoing extravesical reimplantation for the correction of primary reflux without experiencing a reduction in quality of care. ⋯ In our experience extravesical ureteral reimplantation for the correction of primary reflux can be done on an outpatient basis in the majority of children without an increase in morbidity. Pain management and catheter placement significantly influence length of stay in children undergoing extravesical ureteral reimplantation.