The Journal of urology
-
The Journal of urology · Mar 2004
Comparative StudyHigh dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds.
We evaluated the potential for differing acute and chronic toxicities between 2 monotherapy methods of image guided conformal brachytherapy, high dose rate (HDR) brachytherapy alone and low dose rate (LDR) permanent palladium seeds. ⋯ While HDR (192 iridium) and LDR (103Pd) monotherapy maintained the same biochemical control, the use of HDR brachytherapy as monotherapy was associated with decreased rates of acute urinary frequency, urgency, dysuria and rectal pain compared to LDR. Chronic urinary frequency, urgency and grade 2 rectal toxicities were also decreased with HDR. A dramatic decrease (66%) was noted in the rate of sexual impotency with HDR. In addition, patients treated with HDR did not remain radioactive after treatment. There was a decrease in cost from not purchasing seeds per patient. HDR monotherapy as prostate cancer treatment resulted in the same biochemical control with much lower toxicity. It is an accepted, convenient, cost-effective method of prostate brachytherapy for patients with favorable risk prostate cancer.
-
The Journal of urology · Mar 2004
Urethral evoked sympathetic skin responses and viscerosensory evoked potentials as diagnostic tools to evaluate urogenital autonomic afferent innervation in spinal cord injured patients.
In most spinal cord injured (SCI) patients the objective assessment of afferent neuronal pathways from the lower urinary tract and the recording of a disturbed urethral sensation and/or desire to void are still difficult. Viscerosensory evoked potentials (VSEPs) might be helpful, but they remain technically difficult to obtain and interpretation is delicate. As a new approach, sympathetic skin response (SSR) of the hand and foot were recorded after electrical stimulation of the posterior urethral mucosa. This technique should allow assessment of the integrity or deterioration of the autonomic afferent pathway. ⋯ SSR recordings above a spinal lesion level after urethral electrostimulation might provide a useful and technically simple objective diagnostic tool to assess integrity of autonomic (visceral) afferent nerves from the lower urinary tract. Somatosensory deficits are not always paralleled by viscerosensory loss and vice versa. In this study SSRs were superior to VSEPs, the latter being more difficult to record. The subjective sensations reported by subjects during stimulation could be confirmed in an objective way in 100% of cases by positive/negative SSR findings.
-
The Journal of urology · Feb 2004
A new technique for treating forgotten indwelling ureteral stents: silk loop assisted ureterorenoscopic lithotripsy.
Treating forgotten indwelling ureteral stents is difficult because forgotten stents become encrusted and fragmented. Therefore, we developed a silk loop with which to loop the lower end of a forgotten ureteral stent during ureterorenoscopy to supply a counterforce, which fixed the stent while separating encrusted stones from the forgotten stent. We evaluated the success of the silk loop method. ⋯ Silk loop assisted URSL makes the removal of forgotten stents easier. While percutaneous nephrostolithotomy and open surgery produce successful results, the silk loop method is less invasive and expensive, and it minimizes hospital recovery time.
-
The Journal of urology · Feb 2004
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialOnce daily, extended release ciprofloxacin for complicated urinary tract infections and acute uncomplicated pyelonephritis.
We assessed the efficacy and safety of 1,000 mg extended release ciprofloxacin orally once daily vs conventional 500 mg ciprofloxacin orally twice daily, each for 7 to 14 days, in patients with a complicated urinary tract infection (cUTI) or acute uncomplicated pyelonephritis (AUP). ⋯ Extended release ciprofloxacin at a dose of 1,000 mg once daily was as safe and effective as conventional treatment with 500 mg ciprofloxacin twice daily, each given orally for 7 to 14 days in adults with cUTI or AUP. It provides a convenient, once daily, empirical treatment option.
-
The Journal of urology · Feb 2004
Impact of volume weighted mean nuclear volume on outcomes following salvage radiation therapy after radical prostatectomy.
Although salvage radiation therapy (RT) is a potentially curative treatment option for men with biochemical failure after radical prostatectomy (RP), to our knowledge there are no definitive pretreatment factors predicting patients likely to benefit from this treatment. We examined the impact of volume weighted mean nuclear volume (MNV) of biopsy specimens on disease outcomes and describe its usefulness as a new independent predictor. ⋯ Our results suggest that an estimate of MNV contributes significantly to the prediction of biochemical control after salvage RT. However, further investigation in a larger nonneoadjuvant population is needed to confirm its significance in combination with other clinical and pathological findings.