Can J Urol
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Urinary obstruction (UO) or failure to void has been observed during several episodes of short-duration spaceflight, necessitating bladder catheterization. It should be considered a possible medical condition in long-duration space missions as well. Antiemetics used early in space flight add to the risk and severity of voiding problems, along with the sensory and psychological peculiarities of voiding without gravity and in the unusual setting of a spacecraft. Urolithiasis due to the above-normal calcium excretion increases the risk of UO in long duration space missions. Finally, the individual risk of UO is higher against the background of preexisting conditions such as benign prostatic hyperplasia (BPH) or urethral stricture. Both acute retention and ureteral obstruction are associated with substantial patient distress, and carry a risk of urosepsis and/or acute renal failure. If UO in orbital flight is unresolved or complicated, it would likely result in crew emergency return from orbit. Exploration missions, however, may require means for definitive treatment of urinary tract obstruction. This study documents successful ultrasound-guided percutaneous catheterization of the urinary bladder in microgravity. A porcine model of urethral occlusion was used. The results demonstrate an additional capability from our previous investigations describing endoscopic catheterization and stenting of the ureters in microgravity conditions. ⋯ Percutaneous bladder catheterization and drainage can be successfully performed in weightless conditions under ultrasound guidance. Ultrasound provides a low-power, portable means to safely conduct minimally invasive procedures in pertinent organs and tissues. Percutaneous bladder catheterization is a standard procedure when luminal bladder catheterization is not possible; this technique can be successfully modified for use in space medicine applications.
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Review Case Reports
High-flow priapism: An overview of diagnostic and therapeutic concepts.
We describe the case of a 23 year-old man with high-flow priapism following blunt perineal trauma. He was treated successfully with super-selective embolization with a resorbable material (gel foam). We will review the pathophysiology, etiology, and diagnosis and treatment approaches of high-flow priapism based on a review of the medical literature.
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Bacillus Calmette-Guerin (BCG) has shown promise in large scale studies. We assessed recurrence-free survival in patients treated with intravesical BCG/Interferon (IFN) for non-muscle invasive, BCG refractory, transitional cell carcinoma (TCC) of the urinary bladder at our local institution. ⋯ Our results corroborate previous BCG/IFN reports. In selected patients, intravesical BCG/IFN offers a valid alternative to definitive therapy.
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Peri-operative bladder management after major arthroplasty procedures remains controversial. The purpose of this study was to assess the risk of urological complications in those patients undergoing hip or knee joint replacement. As well, we identified those factors that may affect the likelihood of developing complications. ⋯ Bladder management is a significant problem for patients after hip and knee arthroplasty as urinary retention was identified in almost half of the patients. Parameters that may identify those with higher risks include patients with hypertension and those who receive intrathecal narcotics. In high-risk patients, the practice of utilizing a catheter peri-operatively may decrease the risk of multiple post-operative catheterizations without increasing the rate of infections.
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The Royal College of Physicians and Surgeons of Canada (RCPSC) and The American Accreditation Council for Graduate Medical Education (ACGME) general objectives mandate that all residents be competent to independently perform select surgical procedures. Unfortunately, no objective standardized measures presently exist for surgical training assessment. Operative logs have been implemented to quantify the number of cases the resident has been exposed to, however, these do not assess their degree of involvement or aptitude. An analysis of what exactly a resident performs, and how well, per case may assist in measuring their training progress. Herein, we evaluate a questionnaire to quantify the level of resident participation in radical retropubic prostatectomy (RRP) and assess whether resident perception of how much involvement in a case correlates with staff surgeons. ⋯ Our results suggest that there exists good agreement between resident perception of their level of involvement in RRP and staff validation. As such, a residents' assessment of their participation is likely to be accurate. Designation of performance of key operative steps into logs may be more relevant than recording simple exposure to index cases. Attempts at measuring quality of key operative steps in the future may be beneficial.