Urological Survey 786would likely decrease the risk of unnecessary anesthesia. For patients who cannot reliably strain their urine, reimaging with a low-dose CT pelvis should be seriously considered for those patients with distal ureteral calculi ≤ 5mm in size. Objective: To describe the first clinical experience, pathologic, and perioperative outcomes of natural orifice transluminal endoscopic surgery (NOTES) radical prostatectomy. NOTES represents the evolution of minimally invasive surgery. The conceptual feasibility has been shown in careful laboratory and animal studies, but a scarcity of information regarding clinical applications exists. Methods: After institutional review board approval, 2 patients agreed to undergo NOTES radical prostatectomy for localized prostate cancer. The prostate was radically resected using a 26F resectoscope, 550-µm laser fiber, and holmium laser. The prostate was delivered into the bladder and removed at the conclusion of the procedure through a suprapubic cystotomy for histopathologic analysis. The vesicourethral anastomosis was completed using a cannula scope, urethral-vesical suturing device, and titanium knot applier. Cystograms were taken immediately postoperatively and at catheter removal. Results: Both patients tolerated the procedure without operative complications. All intraoperative cystograms showed watertight anastomoses. The pathologic examination revealed Gleason score 3 + 3 and Stage pT2aNx-Mx for 1 patient and Gleason score 3 + 4 and Stage pT2cNxMx for 1 patient, with negative margins for both. No blood transfusions were required. Patient 2 experienced some left-sided gluteal and suprapubic pain postoperatively. Conclusion: NOTES radical prostatectomy appears to be a safe and feasible option for the management of carefully selected, organ-confined prostate cancer. The perioperative and pathologic outcomes show promise with this new technique; however, the high standards of oncologic and functional outcomes demand close and longer follow-up before adoption into the surgical armamentarium can be recommended. Dr. Manoj Monga Editorial CommentThe authors must be congratulated for their pioneer work. The advancement of minimally invasive urological surgery has pushed the technology and surgical instruments industry to collaborate with surgeons allowing better care of our patients.
" CASE PRESENTATIONA 25-yr-old female presented to a pulmonary clinic carrying a plastic sandwich bag containing 50 mL of bloody sputum. She had experienced approximately eight episodes of haemoptysis similar to this throughout the previous year. Her primary care physician had treated her with antibiotics empirically; however, haemoptysis had recurred.During a typical episode of haemoptysis, the patient described having a sensation of fullness in her chest. This was followed by an urge to cough, which was productive of f50mL of bloody sputum. These episodes would last for up to 3-4 days and would resolve spontaneously. The patient did not have any chest pain associated with the haemoptysis.The patient could not name any exacerbating factors and denied weight loss, fevers, dyspnoea, palpitations, gastrointestinal complaints or a history of easy bruising or bleeding. She had recently developed a rash on the anterior aspect of her chest after having taken a combination of herbal supplements, including oregano oil and extracts from grape seeds, black walnut, wormwood and cloves. Her rash had resolved after discontinuation of the herbal supplements.The patient's medical history was unremarkable and she specifically denied a history of cardiopulmonary and rheumatological disease. She also denied a history of thromboembolism. Her surgical history was significant for dilation and curettage 2 yrs previously. No allergies were reported. Curent medications included an herbal cough suppressant.The patient was married without children. She denied smoking, use of alcohol and illicit drugs. She worked at a natural foods store and enjoyed yoga in her free time. The patient had spent 6 months in India and had also travelled to China. She denied having been ill during her travels and reported a negative tuberculin skin test. Her mother and one of her cousins had rheumatoid arthritis.Her physical examination was within normal limits, as was pulmonary function testing. Chest computed tomography (CT) scans were performed 2 days after the onset of menstruation and these demonstrated multiple lesions ( fig. 1). However, CT angiography was negative and revealed no evidence of pulmonary embolism or other abnormality (not shown). Bronchoscopy revealed mild pitting of the airways along the trachea and in the right upper lobe. Scant amounts of bloody secretions were seen in the lingual. No masses were seen. Lavage fluid cytology was negative. No abnormalities were noted on transbronchial biopsies taken from the right upper lobe. Routine laboratory tests, as well as tests for antinuclear antibody, rheumatoid factor, antineutrophil cytoplasmic antibody, glomerular basement membrane, protein C, S and antiphospholipid antibodies were within normal limits.The patient was referred for video-assisted thoracic surgery (VATS) lung biopsy. During VATS, subpleural haemorrhagic discoloration was seen within the bounds of lobules or groups of lobules ( fig. 2). The parietal pleura appeared free of haemorrhage or other lesions, as did the pleural aspect...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.