The Urologic clinics of North America
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Urol. Clin. North Am. · May 1998
Laparoscopic pyeloplasty. Indications, technique, and long-term outcome.
Laparoscopic pyeloplasty is one of several minimally invasive treatment options for UPJ obstruction. In fact, several endoscopically and fluoroscopically controlled methods of incising the obstructed UPJ are now available that are significantly less invasive and less morbid in comparison with open pyeloplasty. However, the long-term success rates of these incisional techniques are less than the rates reported for open pyeloplasty. ⋯ They now prefer the Fenger-plasty technique, even in the setting of ventrally crossing vessels, because the technique can be performed quickly with one to three sutures, and the anastomosis can be sealed with fibrin glue and a flap of Gerota's fascia. Their experience with this technique, however, remains relatively limited. Technologic advances such as the Endostitch device have facilitated reconstructive laparoscopic procedures such as pyeloplasty. (ABSTRACT TRUNCATED)
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Multiple sclerosis is an enigmatic and devastating neurologic disease. Voiding dysfunction is common and the irritative and obstructive symptoms can be disabling to the patient. ⋯ Detrusor hyperreflexia is the most common urodynamic finding. However, a variety of urodynamic patterns can be seen and voiding function may change over time with this chronic neurologic disorder.
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This article summarizes the preoperative evaluation and postoperative care recommended for elderly patients undergoing urologic procedures. Most of the common issues faced during the perioperative period are discussed, but many other topics require reference to other sources or consultation with specialists. ⋯ Surgical risk in elderly patients is increased, but most of this excess risk is because of associated comorbid conditions. Effective pre- and postoperative assessment and care can minimize this risk and maximize the chances of a successful outcome.
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Urol. Clin. North Am. · Nov 1995
ReviewDiagnosis and management of endocrine disorders of erectile dysfunction.
Organic causes of erectile dysfunction with androgen deficiency may be associated with aging, systemic illness, and a number of specific endocrine disorders stemming from pituitary, thyroid, and adrenal dysfunction. Central hypogonadism is the main mechanism in the majority. Erectile dysfunction in diabetes mellitus is caused by chronic complications due to poor metabolic control. Diagnosis and management of these disorders are discussed, as is the need for tight glycemic control in men with diabetes.
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Urol. Clin. North Am. · Feb 1995
ReviewPostoperative pain management for pediatric urologic surgery.
The issues relating to postoperative pain management for pediatric urologic surgery have been discussed. Child development and the behavioral responses to pain have been reviewed, with emphasis on their relation to pain assessment in the pediatric patient. The benefits and limitations of various modalities for the treatment of postoperative pain have been reviewed, and their appropriate use for different urologic surgical procedures has been presented.