The Journal of urology
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The Journal of urology · Oct 2003
Randomized Controlled Trial Comparative Study Clinical TrialA randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams).
Holmium laser enucleation of the prostate (HoLEP) is a surgical treatment for bladder outlet obstruction secondary to benign prostatic hyperplasia. HoLEP is a transurethral procedure that uses the holmium laser fiber (wavelength 2,140 nm) to dissect whole prostatic lobes off of the surgical capsule in retrograde fashion, while maintaining excellent hemostasis. The lobes are removed from the bladder by a purpose built transurethral morcellator, which means that large volume prostates can be enucleated endoscopically. We compared this procedure with transurethral prostate resection (TURP) in a randomized trial by evaluating outcomes in patients with a prostate volume of 40 to 200 ml on transrectal ultrasound. ⋯ HoLEP is superior to TURP for relieving bladder outlet obstruction in men with benign prostatic hyperplasia. It allows more rapid catheter removal and hospital discharge. It requires more time to perform than TURP but more prostate tissue is removed, resulting in similar efficiency in tissue retrieval. HoLEP is equivalent to TURP in relieving men of lower urinary tract symptoms and in improving peak urinary flow rates at 12 months of followup.
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The Journal of urology · Oct 2003
Hemodynamic and respiratory effect of pediatric urological laparoscopic surgery: a retrospective study.
We investigate the impact of extraperitoneal and intraperitoneal CO2 insufflation on cardiopulmonary variables in children undergoing laparoscopic surgery. ⋯ Our study documented significant hemodynamic and respiratory changes during pediatric laparoscopic surgeries. A similar effect on the respiratory parameters was observed in both groups. Although there were no apparent complications associated with either approach, further prospective studies are warranted to confirm the effect of laparoscopic urological surgery on cardiopulmonary function in children.
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The Journal of urology · Oct 2003
Evaluation of age and comorbidity as risk factors after laparoscopic urological surgery.
Few reports in the urological literature have focused on the growing population of elderly (65 years or older) patients. Coexistent medical conditions, which are more prevalent in elderly individuals, can confound results of outcome studies in this population. This single center, retrospective study was done to determine whether age and comorbidity are predictors of outcome in patients undergoing laparoscopic renal and adrenal surgery. ⋯ Laparoscopic renal and adrenal surgery in patients 65 years or older is well tolerated. Age 65 years or older is predictive of a significantly increased hospital stay of approximately 1 day after major renal and adrenal laparoscopic surgery and it does not appear to increase independently the risk of intraoperative, postoperative or late operative complications.
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The Journal of urology · Oct 2003
How to investigate neurovesical dysfunction in children with anorectal malformations.
Neurovesical dysfunction (NVD) is common in children with anorectal malformation (ARM). NVD is mainly related to tethered cord or iatrogenic injury but how to investigate it is still debated. We evaluate the usefulness of routine magnetic resonance imaging (MRI) and urodynamics (UDS) for ARM. ⋯ Because tethered cord occurs in children without sacral anomalies as well as in those with low ARM, we recommend evaluation of all patients using MRI. When MRI is positive UDS should be performed. We agree with a previous suggestion to evaluate all males with rectourethral fistula and females with cloaca malformations. Finally we recommend a noninvasive evaluation for all other children and UDS when neurogenic dysfunction is suspected.
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The Journal of urology · Oct 2003
Randomized Controlled Trial Clinical TrialDuloxetine versus placebo for the treatment of North American women with stress urinary incontinence.
Duloxetine, a selective serotonin and norepinephrine reuptake inhibitor, increases rhabdosphincter contractility via the stimulation of pudendal motor neuron alpha-1 adrenergic and 5-hydroxytryptamine-2 receptors. In this first phase 3 study we assessed the efficacy and safety of duloxetine in women with stress urinary incontinence (SUI). ⋯ These phase 3 data are consistent with phase 2 data and they provide further evidence for the safety and efficacy of duloxetine as a pharmacological agent for the treatment of women with SUI.