Current urology reports
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Current urology reports · Mar 2010
ReviewEvaluation and follow-up of patients with urinary lithiasis: minimizing radiation exposure.
As unenhanced computed tomography (CT) has supplanted other modalities (eg, intravenous urography, ultrasonography) as the "test of choice" for evaluation of stone disease, patients have been exposed to higher doses of ionizing radiation in both primary evaluation and follow-up. There has been progressive recognition that low doses of radiation in the range of conventional CT may increase the long-term risk of cancer in exposed patients; these data have been extrapolated from longitudinal and ongoing study of atomic bomb survivors. There have been mounting efforts to develop alternative approaches to conventional CT (eg, low-dose protocols, substitution of ultrasound/plain X-ray) to provide comparable data while reducing total radiation exposure. It is essential that urologists collaborate with radiologists, emergency room physicians, and other providers to appropriately balance the theoretical risks and practical benefits of ionizing radiation in the diagnosis of stone disease.
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The nonsurgical management of patients with spina bifida is predicated on maintaining a compliant bladder of adequate size or correcting detrusor sphincter dyssynergy that can lead to progressive bladder damage and ultimately upper tract changes. Pharmacologic management, targeted at the detrusor and/or external sphincter, can be done. Neuromodulation using transcutaneous approaches with interferential electrostimulation, sacral (S2-S3) via digital transcutaneous electrical nerve stimulation, and percutaneous tibial nerve stimulation all have shown varied successes.
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Current urology reports · Nov 2007
ReviewCurrent and future techniques of neuromodulation for bladder dysfunction.
Recent increase in the use of neuromodulation for the treatment of urinary urgency and frequency, urge incontinence, and nonobstructive urinary retention has coincided with improved knowledge of micturition physiology and concurrent technologic advances in nerve stimulation. Currently, the most common technology for bladder neuromodulation involves stimulation through the S3 foramen, or sacral neuromodulation, although other techniques of neuromodulation continue to be explored. ⋯ As we continue to improve patient selection criteria and better understand the mechanism of action, the efficacy and patient satisfaction should continue to increase. Currently, most patients considered for implantation with a neuromodulator are those unresponsive to other conservative treatments for bladder dysfunction.
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Over the past several years, the morbidity associated with radical prostatectomy has improved due to advances in surgical technique, better understanding of male pelvic anatomy, and improved perioperative care. Despite these advances, patients are still at risk for several complications both intraoperatively and in the postoperative course. These risks include significant blood loss, rectal injury, ureteral injury, thromboembolic events, urinary incontinence, impotence, and a perioperative death rate of less than 1%. These risks should be reviewed and discussed before treating the patient with prostate cancer.
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Current urology reports · Nov 2005
ReviewHypogonadism in the man with erectile dysfunction: what to look for and when to treat.
Hypogonadism (low serum testosterone) is commonly associated with erectile dysfunction (ED). However, many urologists may lack appreciation of the relative merits of treating hypogonadism compared with oral phosphodiesterase inhibitors for sexual dysfunction. Testosterone-replacement therapy (TRT) may be the best treatment for men with ED when the presentation includes diminished libido or other sexual symptoms or when non-sexual symptoms such as depressed mood, decreased sense of vitality, and increased fatigue also exist. ⋯ Nevertheless, men receiving TRT must be monitored at regular intervals with digital rectal examination and blood testing for prostate-specific antigen. Hematocrit or hemoglobin also should be obtained regularly due to the risk of erythrocytosis. Awareness of the benefits of TRT in the man with ED may improve clinical outcomes.