The Journal of urology
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The Journal of urology · Oct 2004
Randomized Controlled Trial Comparative Study Clinical TrialIntraoperative local anesthesia decreases postoperative parenteral opioid requirements for transperitoneal laparoscopic renal and adrenal surgery: a randomized, double-blind, placebo controlled investigation.
To determine if local anesthesia decreases discomfort following laparoscopic upper retroperitoneal surgery, we performed a randomized, double-blind, placebo controlled study in which the port sites and hand assist incision were infiltrated with bupivacaine or placebo prior to surgery. ⋯ At the outset of transperitoneal laparoscopic urological surgery in the upper retroperitoneum, port site and other incision infiltration with long acting local anesthesia decreases postoperative parenteral opioid requirements compared with placebo controls. The effect was seen with SL and HALS and it was greater than any effect of SL vs HALS.
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The Journal of urology · Oct 2004
Randomized Controlled Trial Comparative Study Clinical TrialEfficacy of continuous epidural analgesia versus single dose caudal analgesia in children after intravesical ureteroneocystostomy.
We compared the effects of single dose caudal injection and continuous epidural infusion of bupivacaine on postoperative pain intensity and supplemental opioid analgesic requirements in children undergoing intravesical ureteroneocystostomy. ⋯ Continuous epidural analgesia and single dose caudal injection of bupivacaine in conjunction with intravenous morphine PCA and ketorolac provide adequate pain control following intravesical ureteroneocystostomy. Continuous epidural analgesia reduces the need for supplemental intravenous morphine and allows children to tolerate a regular diet earlier.
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The Journal of urology · Oct 2004
Randomized Controlled Trial Comparative Study Clinical TrialThe efficacy of LMX versus EMLA for pain relief in boys undergoing office meatotomy.
We determined if a difference in pain management occurred when topical anesthetics LMX (formerly ELA-Max, lidocaine 4%) and EMLA (lidocaine 2.5% and prilocaine 2.5%) were compared in boys undergoing office meatotomy for symptomatic meatal stenosis. ⋯ There was no significant difference between LMX and EMLA when applied 45 minutes before meatotomy. When applied 30 minutes before meatotomy LMX provided significantly superior pain management than EMLA.
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The Journal of urology · Oct 2004
Comparative StudyImpact of body mass index on radical cystectomy.
Radical cystectomy has a significant rate of morbidity and it is important to elucidate the factors that contribute to this risk. Obesity is a major problem in the United States and is associated with increased health hazard. Morbid obesity may even preclude definitive surgical treatment. This study examines the impact of body mass index (BMI) on radical cystectomy. ⋯ Increased BMI independently poses a greater perioperative risk to the patient and contributes to the technical challenge of the cystectomy. This is most appreciated in the morbidly obese population and likely contributes to a greater use of incontinent diversion in this group. The increased perioperative risk associated with elevated BMI is significant but not prohibitive and should not preclude cystectomy as definitive treatment.
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The Journal of urology · Oct 2004
Incidence and management of penetrating renal trauma in patients with multiorgan injury: extended experience at an inner city trauma center.
Patients with penetrating trauma often have multiorgan involvement that may complicate the management of any single organ system. Here we review the incidence of associated injuries in patients with penetrating renal trauma and our extended experience treating these patients at a busy inner city trauma center. ⋯ Isolated penetrating trauma to the kidney is rare. The majority of patients with penetrating renal trauma have associated adjacent organ injuries that may complicate treatment. In the absence of an expanding hematoma with hemodynamic instability, associated multiorgan injuries did not increase the risk of nephrectomy. With appropriate radiographic and/or surgical staging, it is possible to repair and salvage many of these kidneys despite extensive associated intraabdominal trauma.