The Urologic clinics of North America
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Early detection of testicular tumors has been touted as beneficial for more than 100 years. In earlier eras, early detection was virtually the only way to improve outcomes. ⋯ In the modern era of effective chemotherapy, the effects of a delayed diagnosis on survival can be overcome but at the cost of a more morbid treatment regimen. Although screening on a population basis is not currently recommended by the National Cancer Institute, teaching testicular self examination to young men, particularly those who have risk factors, is reasonable.
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Urol. Clin. North Am. · Feb 2007
ReviewAsymptomatic bacteriuria and symptomatic urinary tract infections during pregnancy.
Urinary tract infections are common complications of pregnancy; upper tract infections in particular may lead to significant morbidity for both the mother and fetus. Bacteriuria is a significant risk factor for developing pyelonephritis in pregnant women. ⋯ All women should be screened for bacteriuria in the first trimester, and women with a history of recurrent urinary tract infections or anomalies should have repeat bacteriuria screening throughout pregnancy. Treatment of bacteriuria should include 3-day therapy with appropriate antimicrobials, and women should be followed closely after treatment because recurrence may occur in up to one third of patients.
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Urol. Clin. North Am. · May 2005
ReviewThe current and future application of adjuvant systemic chemotherapy in patients with bladder cancer following cystectomy.
Urothelial transitional cell cancer has a high rate of response to combination cytotoxic therapy. Approximately 50% of patients with high-grade bladder cancer and deep muscle invasion ultimately die of disseminated disease. ⋯ This article reviews the use of adjuvant chemotherapy in localized or locally advanced transitional cell cancer. The chemotherapy of urological malignancies, including bladder cancer, has recently been reviewed in detail; this article does not contain an extensive review of the drugs used.
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The authors believe that the principles underlying the multiple possible SNS mechanisms of action can be summarized as somatic afferent inhibition of sensory processing in the spinal cord. Regardless of whether the lower urinary tract dysfunction involves storage versus emptying abnormalities, the pudendal afferent signaling serves as a common crossroads in the neurologic wiring of the system. ⋯ For these reasons, SNS can take advantage of the complex neurologic pathways described and offer successful treatment for a seemingly disparate group of lower urinary tract pathologies. SNS is a urologic technique that has proved safe and minimally invasive, and it holds great promise for many patients who have lower urinary tract dysfunction.
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Neuromodulation in one form or another has been studied for decades for various disease states. Although its mechanism of action remains un-explained, numerous clinical success stories suggest it is a therapy with efficacy and durability. Controlled studies have led to the approval of sacral neuromodulation for urinary urgency and frequency, urinary retention, and urinary urge incontinence. ⋯ Neuromodulation is changing the future of urology. Treatment of voiding dysfunction and likely other disorders, such as pelvic pain, sexual dysfunction, and bowel disorders, will no longer rely only on medications that are "OK" or destructive-reconstructive procedures that suffer from significant complications. Rather, by modulating the nerves, the urologists will treat these disorders in a minimally invasive fashion and neuromodulation will become the first-line therapy before any major surgery is undertaken.