The Urologic clinics of North America
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Urol. Clin. North Am. · Aug 2014
ReviewUrodynamics in pelvic organ prolapse: when are they helpful and how do we use them?
The routine use of preoperative urodynamics in the woman considering surgery for pelvic organ prolapse is a topic of much debate. This article addresses the use of urodynamics in patients with pelvic organ prolapse. It specifically discusses the utility of urodynamics in the evaluation stress incontinence on prolapse reduction (occult stress urinary incontinence) as well as concomitant storage and voiding symptoms in these patients.
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The American Urological Association/Society of Urodynamics Female Pelvic Medicine and Urogenital Reconstruction Adult Urodynamics Guideline was published with the intent of guiding the clinician in the role of urodynamics in the evaluation and management of complex lower urinary tract conditions. This article examines each guideline statement and attempts to provide clinical context for each statement. Key points are emphasized in the form of clinical case scenarios, which demonstrate application of the principles stressed in this guideline. It is hoped the reader will have a better clinical frame of reference relative to each statement in these guidelines.
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Urol. Clin. North Am. · Aug 2014
ReviewNeurogenic lower urinary tract dysfunction: how, when, and with which patients do we use urodynamics?
Neurogenic lower urinary tract dysfunction (NLUTD) affects many patients and requires close monitoring. Initial studies establishing patients at risk for upper tract disease revealed that high detrusor leak point pressures were predictive of upper tract disease. ⋯ In children with spinal dysraphism, studies should be done early to established potential risk. The goals are maintaining low bladder pressures, decreasing risk of infection, and maintaining continence.
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This article describes office-based surgery and office-based anesthesia (OBA), including the safe setup of OBA and safety concerns regarding OBA. Also discussed are the preoperative selection and workup of a patient undergoing OBA, anesthetic options, the prevention and treatment of postoperative nausea, vomiting, and pain, and planning for safe discharge.