The Urologic clinics of North America
-
Urol. Clin. North Am. · May 2012
ReviewIntegration of surgery and systemic therapy for renal cell carcinoma.
Proper integration of surgery and systemic therapy is essential for improving outcomes in renal cell carcinoma (RCC). There is no current role for adjuvant therapy after nephrectomy for clinically localized disease. ⋯ Presurgical targeted therapy is feasible and may be beneficial. Pending the results of randomized controlled trials, upfront cytoreductive nephrectomy in appropriate patients will likely continue as the paradigm of choice in metastatic RCC.
-
The metabolic syndrome (MetS) has become one of the major public health challenges worldwide. Emerging data have now clearly demonstrated its impact on male sexual function. ⋯ Few randomized studies exist to guide treatment of sexual dysfunction related to MetS; rather, most studies have been observational in nature. Medical therapy has formed the mainstay of treatment, with the advent of surgical intervention as a more recent phenomenon.
-
Urol. Clin. North Am. · Feb 2012
ReviewMen's health in primary care: an emerging paradigm of sexual function and cardiometabolic risk.
An office evaluation of men's health in primary care requires a thorough understanding of the implications of male sexual dysfunctions, hypogonadism, and cardiometabolic risk stratification and aggressive risk management. The paradigm of the men's health office visit in primary care is the recognition and assessment of male sexual dysfunction, specifically erectile dysfunction, and its value as a signal of overall cardiometabolic health, including the emerging evidence linking low testosterone and the metabolic syndrome. Indeed, erectile dysfunction may now be thought of as a harbinger of cardiovascular clinical events and other systemic vascular diseases in some men.
-
Neurogenic bladder resulting from spinal cord injury and spina bifida has a profound impact on voiding function. This article reviews the current literature with regards to electrical stimulation for neurogenic bladder and the clinical outcomes associated with sacral neuromodulation, pudendal neuromodulation, posterior tibial nerve stimulation, and the Finetech-Brindley posterior/anterior stimulator. ⋯ The article also examines the safety of magnetic resonance imaging in patients with implanted neurostimulators and discusses common complications. Neuromodulation, both electrical and physical, play an important role in the management of neurogenic bladder.
-
Urol. Clin. North Am. · May 2009
ReviewTechnological advances in robotic-assisted laparoscopic surgery.
In this article, the authors describe the evolution of urologic robotic systems and the current state-of-the-art features and existing limitations of the da Vinci S HD System (Intuitive Surgical, Inc.). They then review promising innovations in scaling down the footprint of robotic platforms, the early experience with mobile miniaturized in vivo robots, advances in endoscopic navigation systems using augmented reality technologies and tracking devices, the emergence of technologies for robotic natural orifice transluminal endoscopic surgery and single-port surgery, advances in flexible robotics and haptics, the development of new virtual reality simulator training platforms compatible with the existing da Vinci system, and recent experiences with remote robotic surgery and telestration.