The Journal of urology
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The Journal of urology · Oct 2002
A critical analysis of the interpretation of biochemical failure in surgically treated patients using the American Society for Therapeutic Radiation and Oncology criteria.
The use of prostate specific antigen (PSA) to indicate biochemical failure has become an accepted procedure to measure the effectiveness of therapy. Because long-term randomized studies comparing radiation modalities to radical prostatectomy are not available, use of biochemical recurrence as a surrogate measure of efficacy is increasing. Unfortunately, the definition of failure is not uniform among therapies. We evaluate how the American Society for Therapeutic Radiation and Oncology (ASTRO) criteria affect the interpretation of failure when applied to radical prostatectomy. ⋯ The application of ASTRO criteria to a mature series of surgically treated patients with localized prostate cancer produced an apparent improvement in the probability of being biochemically free of disease at 15 years from 68% to 90%. Until prospective trials comparing these different therapies become available, caution should be exercised when interpreting outcomes between series due to the inherent differences in definition of biochemical failure.
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The Journal of urology · Oct 2002
Comparative StudyBladder function associated with posterior urethral valves after primary valve ablation or proximal urinary diversion in children and adolescents.
We retrospectively reviewed 2 series of patients with posterior urethral valves treated initially with valve ablation preceded by bilateral cutaneous ureterostomies or valve ablation alone to evaluate and compare bladder function behavior of each treatment group. ⋯ This retrospective study revealed that long-term bladder function of patients with posterior urethral valves treated with temporary supravesical diversion is affected more adversely than those treated with valve ablation alone.
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The Journal of urology · Oct 2002
Management of renal cell carcinoma with level III thrombus in the inferior vena cava.
Level III thrombus in the inferior vena cava poses a challenge to the surgeon due to its relative inaccessibility. We introduce a new system to redefine level III thrombus in anatomical relation to the hepatic veins and describe a technique of safe resection of these tumors through a transabdominal approach without recourse to cardiopulmonary bypass. ⋯ An aggressive surgical approach remains the mainstay of treatment to achieve cure. We believe that the extent of dissection is different in each subgroup and, therefore, the need exists to redefine level III thrombus of the inferior vena cava. The application of liver transplant techniques for mobilizing the liver off of the inferior vena cava as well as the inferior vena cava off of the posterior abdominal wall contributes to excellent exposure and enables adequate vascular control of the inferior vena cava.
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The Journal of urology · Oct 2002
Comparative StudyOutcome of laparoscopic radical and open partial nephrectomy for the sporadic 4 cm. or less renal tumor with a normal contralateral kidney.
Nephron sparing surgery provides effective therapy in patients with a solitary sporadic renal tumor 4 cm. or less and a normal contralateral kidney. Laparoscopic radical nephrectomy has been applied as a newer alternative therapy in these patients. These 2 contemporary approaches represent divergent treatment alternatives at centers where laparoscopic nephron sparing surgery is not offered. We compared the short-term and long-term impact of these 2 treatment modalities in patients with a sporadic localized solitary renal tumor 4 cm. or less and a normal opposite kidney. ⋯ Open nephron sparing surgery and laparoscopic radical nephrectomy are relatively recent and significant developments for treating patients with renal cell carcinoma and they represent accepted standards of care in those with a small renal mass and normal contralateral kidney. In patients presenting with a sporadic solitary renal tumor of 4 cm. or less and a normal contralateral kidney the significant short-term and intermediate term benefits of the laparoscopic approach must be weighed against the long-term advantage of better renal function associated with open nephron sparing surgery. The distinct advantages of these 2 approaches may ultimately be realized with the standardization of laparoscopic partial nephrectomy.
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The Journal of urology · Oct 2002
Urinary continence outcome after augmentation ileocystoplasty as a single surgical procedure in patients with myelodysplasia.
Preoperative prediction of urinary continence in patients with myelodysplasia requiring augmentation cystoplasty is uncertain. To determine reliable factors to predict postoperative urinary continence, we retrospectively analyzed preoperative videourodynamic parameters and urinary continence outcome in a group of patients with myelodysplasia who underwent augmentation ileocystoplasty. ⋯ According to our findings of the anatomical morphology of the bladder outlet (bladder neck/urethra) during the filling phase of videourodynamic studies at 20 cm. water filling detrusor pressure was the most reliable parameter to predict continence outcome after detubularized augmentation ileocystoplasty.