The Urologic clinics of North America
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Urol. Clin. North Am. · Feb 1995
ReviewThe management of urinary tract infections in children without urinary tract abnormalities.
Although most urinary tract infections in children with normal urinary tract anatomy pose little threat to renal function, pyelonephritis, particularly in infants, may cause renal scarring when not diagnosed and treated promptly. For most children, however, the problems of urinary tract infection may be related to a biologic predisposition to recurrent infections and the bothersome clinical symptoms associated with them. In these children, infections should be diagnosed carefully and then treated for 3 days with appropriate antimicrobial agents. ⋯ There may also be a decrease in the rate of urinary tract infections with this treatment. When covert bacteriuria is found and bothersome symptoms are associated with it, symptoms should be treated. If recurrent covert bacteriuria is truly asymptomatic, however, not treating the infection may be the best option.
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Urol. Clin. North Am. · Nov 1993
PSA velocity for the diagnosis of early prostate cancer. A new concept.
An evaluation of longitudinal changes in PSA in men with and without prostate disease revealed that with age, the development of prostate disease is the most important factor influencing changes in PSA. Furthermore, the PSA changes with age are significantly different in men with and without prostate disease. The PSA velocity is greater in men with prostate cancer than in men with BPH and greater in men with prostate cancer and BPH than in men without any prostate disease. ⋯ This idea will need to be confirmed prospectively. Finally, estimation of PSA doubling time from changes in PSA suggests that changes reflect prostatic growth. Therefore, PSA velocity could be of benefit in identifying men with prostate cancer that is destined to progress.
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Urol. Clin. North Am. · Aug 1993
ReviewElectrical stimulation of sacral roots for micturition after spinal cord injury.
In patients with suprasacral spinal cord injury, electrical stimulation of the sacral anterior nerve roots can produce micturition with low residual volumes of urine and reduced urinary tract infection. Voiding pressures can be maintained at acceptable levels by selective peripheral neurotomy and myotomy or, more commonly, by an intermittent pattern of stimulation. Occasionally, external sphincterotomy is required. ⋯ Penile erection is produced in a substantial proportion of male patients. The procedure has now been applied in about 700 patients with spinal cord injury, some of whom have been followed for nearly 15 years. The nerves do not appear to be damaged by long-term stimulation, and technical faults with the equipment are now uncommon.
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Urol. Clin. North Am. · Aug 1991
Management of renal cell carcinoma with vena caval thrombi via cardiopulmonary bypass and deep hypothermic circulatory arrest.
Cardiopulmonary bypass with deep hypothermic circulatory arrest allows safe and effective removal of renal tumors with extensive thrombi involving the vena cava under controlled circumstances without permanent side effects. The technique averts extensive dissection of the inferior vena cava and occlusion of major vessels while providing up to 60 minutes of safe operating time in a bloodless field and complete visibility of the interior of the vena cava. Adjunctive procedures for tumor excision or cardiac revascularization can be performed at the same time without increased operative risk.
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Extraperitoneal bladder ruptures secondary to blunt trauma are caused by fractures of the bony pelvis 95 per cent of the time. A static cystogram is the only way to diagnose the lesion definitely. We have treated our 41 patients successfully with catheter drainage alone despite extensive urinary extravasation. Eighty-seven per cent of the ruptures will be healed in 10 days, and virtually all will be healed in 3 weeks.