BJU international
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Comparative Study
The long-term efficacy of sacral neuromodulation in the management of intractable cases of bladder pain syndrome: 14 years of experience in one centre.
Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Bladder pain syndrome (BPS) is a chronic debilitating disease. A recently done survey estimates the prevalence of the BPS symptoms among adult females in the U.S. to be 7%. Conservative management is the first line of therapy but at least 10% of the patients show poor response. Sacral neuromodulation is a minimal invasive technique with good long-term outcomes in these patients. It should be considered before any invasive surgical intervention is planned. However, the revision rate is high and patients need lifelong follow-up. ⋯ • SNM is an effective treatment to control the symptoms of BPS. It should be considered before any major invasive surgical intervention if conservative measures have failed. It is a minimally invasive, safe procedure with good long-term outcome. However, the revision rate is high and patients require lifelong follow-up.
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• To review the literature and the generally accepted unsatisfactory management of chronic genital pain in men. • To refer such patients for Journey psychotherapy and record the outcomes of such treatment. ⋯ • Chronic genital pain syndromes are common and often debilitating. Patients are subject to an array of investigations that usually identify non-specific abnormalities at best. Treatment is usually aimed at symptomatic control as underlying organic pathology is rarely identified. Patients have been given multiple courses of antibiotics even in the absence of identifiable organisms, anti-inflammatory drugs in the absence of proven inflammation, and narcotic analgesics in an attempt to control chronic pain. Occasionally surgery, such as orchidectomy, has been performed to remove the painful organ, without satisfactory results. We therefore looked for an alternative approach that had the promise of a more satisfactory outcome. • Given the usual psychotherapeutic requirement of lengthy periods of therapy, and given that each patient only had one session, we find the above results remarkable and very encouraging. • With this experience, we now offer this approach early to avoid wasting time and money, and would persist with further therapy sessions especially in those with partial relief of their pain.
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Comparative Study
Comparison of lymph node yield in robot-assisted laparoscopic prostatectomy with that in open radical retropubic prostatectomy.
• To investigate both the feasibility and the adequacy of pelvic lymph node dissection (PLND) during robot-assisted laparoscopic prostatectomy (RALP) by comparing lymph node yields obtained during RALP with those obtained during traditional open retropubic radical prostatectomy (RRP). ⋯ • In patients undergoing RALP, PLND is feasible and provides lymph node yields comparable with those of the standard open approach. • PLND should be strongly considered in all radical prostatectomy patients when clinically indicated, regardless of surgical technique.
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• To assess the content validity of an early prototype robotic simulator. Minimally invasive surgery poses challenges for training future surgeons. The Robotic Surgical Simulator (RoSS) is a novel virtual reality simulator for the da Vinci Surgical System. ⋯ • Results based on expert evaluation of RoSS as a teaching modality illustrate that RoSS has appropriate content validity.