The impact of prostate biopsy on patient well-being begins while waiting for the scheduled procedure. Shortening the anticipation period before results are disclosed and administering pre-biopsy anxiety decreasing measures may benefit patients. Analgesic therapy is recommended in younger patients, those reporting moderate to severe intraoperative pain and those with known prostatic inflammatory infiltrate. The risk of acute erectile dysfunction should be discussed cautiously with patients who are potent before biopsy.
The results of extracorporeal shock wave lithotripsy (ESWL*) and percutaneous nephrostolithotomy for the treatment of lower pole nephrolithiasis were examined in 32 consecutive patients undergoing percutaneous nephrostolithotomy at the Methodist Hospital of Indiana and through meta-analysis of publications providing adequate stratification of treatment results. Of 101 cases managed with percutaneous nephrostolithotomy 91 (90%) were stone-free, a result significantly better than that achieved with ESWL (1,733 of 2,927 stone-free, 59%). Stone-free rates with percutaneous nephrostolithotomy were independent of stone burden, whereas stone-free rates with ESWL were inversely correlated to the stone burden treated. The morbidity of patients undergoing percutaneous nephrostolithotomy at our hospital was minimal, with a mean hospital stay of 4.7 +/- 2.8 days. No blood transfusions were required. All patients became stone-free. The percentage of urolithiasis patients with lower pole calculi is increasing. Because of the significantly greater efficacy of percutaneous nephrostolithotomy for lower pole calculi, particularly stones larger than 10 mm. in diameter, further consideration should be given to an initial approach with percutaneous nephrostolithotomy.
We evaluated the variability and circadian changes in consecutive measurements of home uroflowmetry in 32 patients with symptomatic benign prostatic hyperplasia (BPH) and 16 healthy men. In the BPH group 476 uroflow measurements were recorded during 24 to 72 hours (mean 14.9 measurements per patient), and the controls produced 100 flow recordings (mean 6.25 measurements per participant). Great variability between consecutive peak flow rates was observed in the BPH group, ranging from at least 1 standard deviation in 28 of 32 patients (87.5%) to at least 2 standard deviations in 15 of 32 (47%). In 21 of 32 patients (65.6%) the highest recorded peak flow rate was greater than, while the lowest peak flow rate was less than the -2 standard deviations plot in voiding nomograms. In the control group variability between consecutive voiding episodes also was marked, namely at least 1 standard deviation in 8 of 16 men (50.0%) and at least 2 standard deviations in 2 of 16 (12.5%). However, in none of the control men was any peak flow rate measurement less than the -2 standard deviations line. Circadian changes in diurnal and nocturnal measurements of voided volume, interval to maximal flow, flow time, peak flow rate and adjusted peak flow rate were recorded in the BPH group, providing a urodynamic support to a well known clinical observation.
Transient voiding impairment may be precipitated by ultrasound guided prostate biopsy. To decrease this morbidity appropriate evaluation and possible treatment for bladder outlet obstruction are justified in patients with a larger transition zone and in those with preoperative baseline I-PSS greater than 20 points.
A series of spontaneous multiple fragmentations of 3 ureteral stents presenting with a variety of clinical features is reported. Physical analysis measuring the tensile mechanical properties was done of the retrieved fragments together with 2 new stents, as well as electron microscopy scanning of the retrieved fragments. This methodology in evaluating fractured stents is unique in its capability to determine the accelerated aging process of stent material and to our knowledge has not been reported previously in this context. The retrieved catheters were moderately incrusted. The tensile elongation (maximal elongation at break point), known to be a sensitive indicator of the aging process of plastic materials, was dramatically decreased in the retrieved stents. The fractures in all catheters retrieved as well as in the new stents were found to pass exclusively through the side holes. Fragmented catheters had a distinctive electron microscopic appearance and physical properties, which may be defined in a systematic manner and may contribute to further refinement of stent quality.
Local hyperthermia of the prostate was used to treat 72 patients who had an indwelling catheter because of urinary retention caused by benign prostatic hypertrophy. One month after completion of treatment 50% of patients were able to dispense with the catheter and 1 year later 40% remained catheter-free. The best results were achieved in patients who underwent 6 to 10 treatment sessions in conjunction with cyproterone acetate 50 mg tid administered during the treatment period only.
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.