The Urologic clinics of North America
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Both urinary tract infection (UTI) and asymptomatic bacteriuria (ASB) are common problems among elderly adults and represent a significant health care burden. Despite their frequency, differentiating between ASB and true UTI remains controversial among health care providers. ⋯ Symptoms of UTI are variable; problems are encountered in the collection, testing, and interpretation of urine specimens; and results of urinalysis are often misinterpreted and mishandled. Multiple studies have shown no morbidity or mortality benefit to antibiotic therapy in either community or long-term care facility residents with ASB.
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Bacteriuria during pregnancy may be classified as asymptomatic bacteriuria, infections of the lower urinary tract (cystitis), or infections of the upper urinary tract (pyelonephritis). Lower tract bacteriuria is associated with an increased risk of developing pyelonephritis in pregnancy, which is itself associated with adverse maternal and fetal outcomes. ⋯ All bacteriuria in pregnancy should be treated, and antimicrobial choice in pregnancy should reflect safety for both the mother and the fetus. After treatment of bacteriuria, patients should be followed closely due to risk of recurrent bacteriuria.
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Urol. Clin. North Am. · Feb 2015
ReviewMIS-behavior: practical heuristics for precise pediatric minimally invasive surgery.
Minimally invasive surgery (MIS) has changed pediatric urology and general surgery, offering less morbidity and new surgical options for many procedures. This promise goes unrealized when technical methods lag. ⋯ Principles of versatile and proficient technique may remain unstated and implicit in surgical training, often leaving surgical training an exercise in inference and imitation. This article describes some essential practical principles of precision MIS applied to patients of any size.
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Urol. Clin. North Am. · Nov 2014
ReviewEconomics of robotic surgery: does it make sense and for whom?
The authors performed a literature review to identify cost-effectiveness research as it pertains to robotic surgery. There is increased utilization of robotic surgery in urology with limited comparative effectiveness research demonstrating superiority over conventional, less costly treatment options. Further research into identifying determinants for optimal utilization of robotics and newer technology is needed.