AIM: To assess the outcomes of men treated for urolithiasis at the time of radical prostatectomy.METHODS: From 1991 to 2010, 22 patients were retrospectively identified who were treated simultaneously(n = 10) at radic...AIM: To assess the outcomes of men treated for urolithiasis at the time of radical prostatectomy.METHODS: From 1991 to 2010, 22 patients were retrospectively identified who were treated simultaneously(n = 10) at radical prostatectomy, or(n = 12) within 120 d prior to prostatectomy, for urolithiasis. Clinical characteristics were reviewed including: type of prostatectomy and stone surgery, location and amount of stone burden, perioperative change in hemoglobin and creatinine, stent frequency, total hospital d, stone-free rates, additional stone procedures and complications. Long-term functional outcomes including stress urinary incontinence and bladder neck contracture were reported. Differences between cohorts(simultaneous vs staged treatment) were assessed. RESULTS: Among men undergoing radical prostatectomy, primary stone procedures included 12 ureteroscopy, 6 shock wave lithotripsy, 2 open nephrolithotomyand 2 percutaneous nephrolithotomy. In staged shock wave lithotripsy there were 4 complications and 3 additional procedures vs 1(P = 0.5) and 0(P = 0.2) in the simultaneous cohort. Meanwhile in staged ureteroscopy there were 5 complications and 1 additional procedure vs 1(P = 0.2) and 1(P = 0.9) in the simultaneous cohort. Additional procedures for residual stones was greater among patients with asymptomatic upper tract calculi 3(60%) relative to patients with symptomatic stones 2(13%; P = 0.02). Likewise, patients with proximal or multiple calculi had a greater total hospital days 5.5 vs 4.1(P = 0.04), additional procedures 6 vs 0(P = 0.04) and lower stone-free rates 39% vs 89%(P = 0.02) relative to men with distal stones. Finally, there was no difference in the incidence of bladder neck contracture(P = 0.4) or stress urinary incontinence(P = 0.7) between cohorts.CONCLUSION: Ureteroscopic treatment of symptomatic distal urolithiasis at radical prostatectomy appears to be safe and efficacious with a low rate of adverse postoperative outcomes.展开更多
Since their popularization,genitourinary prosthetics have remained a gold-standard therapy for the treatment of erectile dysfunction and stress urinary incontinence and in cases of testicular loss or dysfunction.They ...Since their popularization,genitourinary prosthetics have remained a gold-standard therapy for the treatment of erectile dysfunction and stress urinary incontinence and in cases of testicular loss or dysfunction.They have also represented an area of significant innovation,which has contributed to excellent long-term outcomes.Given this history,the objective of the current review was to provide a 5-10-year outlook on anticipated trends and developments in the field of genitourinary prosthetics.To accomplish this objective,a PubMed and patent search was performed of topics relating to penile and testicular prostheses and urinary sphincters.In regard to penile prostheses,findings demonstrated several new concepts including temperature-sensitive alloys,automated pumps,devices designed specifically for neophalluses,and improved malleable designs.With artificial urinary sphincters,new concepts include the ability to add or remove fluid from an existing system,two-piece systems,and new mechanisms to occlude the urethra.For testicular prosthetics,future implementations may not only better replicate the feel of a biological testicle but also add endocrinological functions.Beyond device innovation,the future of prosthetics is also one of expanding geographic boundaries,which necessitates variable cost modeling and regulatory considerations.Surgical trends are also changing,with a greater emphasis on nonnarcotic,postoperative pain control,outpatient surgeries,and adjunctive techniques to lengthen the penis and address concomitant stress incontinence,among others.Concomitant with device and surgical changes,future considerations also include a greater need for education and training,particularly given the rapid expansion of sexual medicine into developing nations.展开更多
文摘AIM: To assess the outcomes of men treated for urolithiasis at the time of radical prostatectomy.METHODS: From 1991 to 2010, 22 patients were retrospectively identified who were treated simultaneously(n = 10) at radical prostatectomy, or(n = 12) within 120 d prior to prostatectomy, for urolithiasis. Clinical characteristics were reviewed including: type of prostatectomy and stone surgery, location and amount of stone burden, perioperative change in hemoglobin and creatinine, stent frequency, total hospital d, stone-free rates, additional stone procedures and complications. Long-term functional outcomes including stress urinary incontinence and bladder neck contracture were reported. Differences between cohorts(simultaneous vs staged treatment) were assessed. RESULTS: Among men undergoing radical prostatectomy, primary stone procedures included 12 ureteroscopy, 6 shock wave lithotripsy, 2 open nephrolithotomyand 2 percutaneous nephrolithotomy. In staged shock wave lithotripsy there were 4 complications and 3 additional procedures vs 1(P = 0.5) and 0(P = 0.2) in the simultaneous cohort. Meanwhile in staged ureteroscopy there were 5 complications and 1 additional procedure vs 1(P = 0.2) and 1(P = 0.9) in the simultaneous cohort. Additional procedures for residual stones was greater among patients with asymptomatic upper tract calculi 3(60%) relative to patients with symptomatic stones 2(13%; P = 0.02). Likewise, patients with proximal or multiple calculi had a greater total hospital days 5.5 vs 4.1(P = 0.04), additional procedures 6 vs 0(P = 0.04) and lower stone-free rates 39% vs 89%(P = 0.02) relative to men with distal stones. Finally, there was no difference in the incidence of bladder neck contracture(P = 0.4) or stress urinary incontinence(P = 0.7) between cohorts.CONCLUSION: Ureteroscopic treatment of symptomatic distal urolithiasis at radical prostatectomy appears to be safe and efficacious with a low rate of adverse postoperative outcomes.
文摘Since their popularization,genitourinary prosthetics have remained a gold-standard therapy for the treatment of erectile dysfunction and stress urinary incontinence and in cases of testicular loss or dysfunction.They have also represented an area of significant innovation,which has contributed to excellent long-term outcomes.Given this history,the objective of the current review was to provide a 5-10-year outlook on anticipated trends and developments in the field of genitourinary prosthetics.To accomplish this objective,a PubMed and patent search was performed of topics relating to penile and testicular prostheses and urinary sphincters.In regard to penile prostheses,findings demonstrated several new concepts including temperature-sensitive alloys,automated pumps,devices designed specifically for neophalluses,and improved malleable designs.With artificial urinary sphincters,new concepts include the ability to add or remove fluid from an existing system,two-piece systems,and new mechanisms to occlude the urethra.For testicular prosthetics,future implementations may not only better replicate the feel of a biological testicle but also add endocrinological functions.Beyond device innovation,the future of prosthetics is also one of expanding geographic boundaries,which necessitates variable cost modeling and regulatory considerations.Surgical trends are also changing,with a greater emphasis on nonnarcotic,postoperative pain control,outpatient surgeries,and adjunctive techniques to lengthen the penis and address concomitant stress incontinence,among others.Concomitant with device and surgical changes,future considerations also include a greater need for education and training,particularly given the rapid expansion of sexual medicine into developing nations.
