The Urologic clinics of North America
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Urol. Clin. North Am. · May 2009
ReviewMiniature in vivo robotics and novel robotic surgical platforms.
Robotic surgical systems, such as the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California), have revolutionized laparoscopic surgery but are limited by large size, increased costs, and limitations in imaging. Miniature in vivo robots are being developed that are inserted entirely into the peritoneal cavity for laparoscopic and natural orifice transluminal endoscopic surgical (NOTES) procedures. In the future, miniature camera robots and microrobots should be able to provide a mobile viewing platform. This article discusses the current state of miniature robotics and novel robotic surgical platforms and the development of future robotic technology for general surgery and urology.
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The United States is in desperate need of health care reform. What has been brought to the table so far, however, has been insufficient. This article outlines a comprehensive change to health care delivery in the United States. If implemented, the author proposes that Americans will be healthier; more Americans will have health care; and costs can be greatly reduced.
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Although surgical treatment is curative for localized renal cell carcinoma (RCC), 25% of patients present with locally advanced or disseminated disease, and disease will recur systemically in another 20% to 30% of those who have localized disease at presentation. Many clinical, histologic, and molecular factors have been identified that place patients who have localized RCC at greater risk for recurrence and those who have metastatic disease at risk for progression or death. This article reviews the major prognostic factors for RCC and the most commonly used algorithms developed for use before or after nephrectomy and before initiation of systemic therapy. These RCC nomograms allow more accurate counseling of patients regarding their likely clinical course and facilitate treatment planning.
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Urol. Clin. North Am. · Feb 2008
ReviewUncomplicated urinary tract infection in adults including uncomplicated pyelonephritis.
Acute uncomplicated urinary tract infection and acute pyelonephritis are very common infections affecting many women throughout their lives. The determinants of infection have been well described and current strategies to prevent recurrent infections are highly effective. While antimicrobial management is straightforward for most episodes, the evolution of antimicrobial susceptibility of E. coli in community-acquired infection requires continuing re-evaluation of appropriate empiric therapy.
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Priapism, a pathologic condition of persistent penile erection in the absence of sexual excitation, is a true erectile disorder. Although it may seem to affect only a small population of male individuals, it carries major significance. Possible complications of the disorder include penile fibrosis and permanent erectile dysfunction. All health care professionals should appreciate the importance of the disorder and be prepared to follow current principles of diagnosis and treatment to reduce or avert its complications.