Sixty new patients with advanced local or metastatic prostatic cancer were randomised to receive either bilateral orchiectomy, orchiectomy plus dexamethasone 0.5 mg in the morning and 0.3 mg at night, or orchiectomy plus cyproterone acetate 100 mg 3 times per day. All surviving patients have been followed up for a minimum of 2 years. An improvement in both objective and subjective responses in patients receiving dexamethasone compared with those receiving cyproterone acetate suggests a possible additional role for the pituitary in the control of prostatic tumour growth. A larger study with longer follow-up may be indicated.
A series of 20 unselected patients with impotence of various aetiologies were given a custom fitted external erection assistance device, the Correctaid. They have been followed up for 14 months. Only 4 patients are still using the device regularly to attain satisfactory intercourse and a further 4 use it occasionally. This device is a useful, non-invasive alternative for the treatment of impotence in well selected, motivated patients and their partners.
Objectives: We have been performing laparoscopic nephrectomies since 2002 and have used the hand assisted technique on a regular basis. We aim to report our results and to comment on the use of the hand port.
Patients and Methods: A combination of retrospective and prospective data collection was used to obtain patient demographics, operative details, pathology information and outcome data for all patients who underwent laparoscopic nephrectomy between April 2002 and June 2005 at St. Vincent's Hospital and the Melbourne Urology Group in Melbourne.
Results: We performed 78 laparoscopic nephrectomies, 47 of which were hand assisted in the specified time period on patients with a mean age of 63.4 years. 38% of the public patients were operated on by a non‐consultant as the primary surgeon and the median operating time was 180 min. No differences were observed between pure and hand assisted laparoscopy (HAL) in terms of patient recovery, morbidity, in patient stay and analgesic use.
Conclusions: We have found the hand port to be a safe and effective tool for nephrectomy without the inherent risks of pure laparoscopy. As an incision is required to remove the kidney from the abdomen it seems illogical not to utilise that incision from the beginning of the case. The benefits are safer port placement, tactile feedback and early control of heavy bleeding. We would therefore advocate its use in all extirpative renal surgery.
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