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We report our experience with successful treatment of 2 cases of severe recurrent vesicourethral anastomotic stricture after radical prostatectomy with endourethroplasty. Both patients had multiple failures of conventional treatments but have been free of stricture recurrence after endourethroplasty with 11 and 25 months follow-up, respectively. Follow-up urethroscopy showed open anastomotic segments with epithelialization after endourethroplasty in both patients. The patient who was continent prior to endourethroplasty remained continent afterward.
A case of metastatic seminoma to the ureter is presented. The metastasis formed a polypoid intraluminal mass that led to complete obstruction of the ureter, leading to advanced hydronephrosis of the kidney. This is the second case in the world literature of a primary testicular tumor metastasizing to the ureter.
Closure of renal parenchymal defects created by partial nephrectomy can be difficult. We describe a method of using exogenous material to bolster the strength of the parenchymal closure. The horizontal mattress sutures closing the renal parenchyma are less likely to tear through the parenchyma as the result of the application of a more uniform tension across a broad front. This technique is particularly helpful for large and irregular defects. Tying the closure sutures over an exogenous bolster material aids in a rapid, hemostatic, and watertight closure.
The best treatment of patients with clinical Stage I nonseminomatous germ cell testicular tumors (NSGCTT) remains controversial. Archival formalin-fixed paraffin-embedded testicular tumor specimens from 23 patients diagnosed between 1977 and 1988 were available for analysis. All patients had clinical Stage I NSGCTT, and the specimens were prepared using Hedley's technique and propidium iodide staining prior to flow cytometric ploidy analysis. Tumors from 3 patients (13%) were classified as DNA diploid; the remaining 20 tumors had DNA aneuploid patterns. Eleven patients had retroperitoneal lymph node dissection (RPLND); 2 (18%) were upstaged to pathologic NSGCTT Stage IIA, and 1 had a subsequent relapse in the contralateral testicle. Among 12 patients in the surveillance protocols, 3 (25%) had tumor recurrence. All patients who were either upstaged to pathologic NSGCTT Stage IIA or had tumor recurrence while under surveillance had DNA aneuploid patterns. The 3 patients with DNA diploid tumor patterns had been in the surveillance protocols. To date, with fifteen months minimum follow-up, none has had tumor recurrence. Such data suggest that flow cytometric DNA ploidy analysis, when used as an adjuvant to more traditional prognostic parameters, may help to identify a group of patients with clinical Stage I NSGCTT at very low risk for recurrence and perhaps well-suited for surveillance management.
Review and analyze various approaches to performance measurement in health care, demonstrating the value of provider-initiated performance measurement in which ongoing monitoring of both processes and outcomes of care coupled with the use of clinical guidelines enhances performance improvement efforts. Describe some of the issues and findings associated with the use of such a methodology in prostate cancer care.
To examine by race how frequently the data after radical prostatectomy translates into a substantial change in prognosis. Many nomograms exist to predict the survival outcomes using the pretreatment clinical parameters and post-treatment pathologic parameters. Race might be an important factor affecting their predictive ability.
Myelolipoma of the adrenal gland is a rare, benign tumor of which only 17 clinical cases have been reported previously in the literature. We document 1 additional case and review the pathogenesis of the tumor, with emphasis on the theory of the tissue necrosis as the major stimulus of the myelolipomatous changes in the adrenals.
To report the long-term clinical outcomes and durability of response after treatment with induction intravesical docetaxel. Most novel agents used to treat bacillus Calmette-Guerin refractory high-grade non-muscle-invasive (NMI) bladder cancer are evaluated only after short follow-up periods. Our previously published phase I trial demonstrated that docetaxel is a safe agent for intravesical therapy with minimal toxicity and no detectable systemic absorption. We sought to determine long-term clinical outcomes after treatment with intravesical docetaxel.
To assess the impact of the COVID-19 pandemic on the rate of same-day discharge (SDD) after robotic surgery METHODS: We reviewed our robotic surgeries during COVID-19 restrictions on surgery in Ohio between March 17 and June 5, 2020 and compared them with robotic procedures before COVID-19 and after restrictions were lifted. We followed our formerly described protocol in use since 2016 offering the option of SDD to all robotic urologic surgery patients, regardless of procedure type or patient-specific factors.
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