Urology
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The impact of patient positioning can be profound. Urological surgeons must often exercise strategic positioning in order to access retroperitoneal and pelvic organs. ⋯ The purpose of the following review is to summarize the current literature on positioning-related concerns as they pertain to the practicing urologist. To our knowledge, this is the first such review of its kind in the urological literature.
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To present outcomes of a contemporary series of patients undergoing radical cystectomy (RC) for bladder cancer after previous treatment for localized cancer of the prostate (CaP). ⋯ Patients undergoing RC after previous treatment for localized CaP are at increased risk for perioperative morbidity. Patients should be counseled that orthotopic diversion after RP may be associated with significant incontinence. Extravesical disease is more prevalent in patients treated with previous radiation. We observed a high rate of positive margins associated with pathologic T4 disease in this cohort.
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To describe a technique to facilitate the urethral stump exposure and aid the suture placement of vesicourethral anastomosis during laparoscopic radical prostatectomy. ⋯ Use of a Foley catheter for laparoscopic vesicourethral anastomosis is simple and easy and provided good surgical results in our experience.
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Comparative Study
Preemptive multimodal pain regimen reduces opioid analgesia for patients undergoing robotic-assisted laparoscopic radical prostatectomy.
Minimally invasive surgical techniques have many benefits, including reduced postoperative pain. Despite this, most patients require opioid analgesia, which can have significant side effects and toxicity. We report the first urologic study using multimodal analgesia with pregabalin, a gabapentinoid. ⋯ The present retrospective review has indicated that a multimodal analgesic approach with pregabalin and celecoxib administered preoperatively decreases intraoperative and postoperative opioid use in patients undergoing robotic-assisted laparoscopic radical prostatectomy.
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To critically evaluate the perioperative management of rectal injury during radical prostatectomy. ⋯ Rectal injury is an infrequent complication of radical prostatectomy. When recognized intraoperatively and primarily repaired, rectourethral fistula was prevented in 87.5% of men. Primary repair performed with vascularized tissue interposition prevented rectourethral fistula development. In men with unrecognized rectal injury, the rectourethral fistula tended to persist and eventually required delayed surgical repair.