Urology
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To evaluate the effectiveness and safety of retroperitoneal laparoscopic adrenalectomy for pheochromocytoma and report our experience in adrenalectomy without previous control of the adrenal vein. ⋯ Retroperitoneal laparoscopic adrenalectomy without previous control of the adrenal vein is effective and safe for ablation of pheochromocytoma. For experienced surgeons, the tumors larger than 6 cm in diameter can also be removed using the retroperitoneal endoscopic approach.
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Comparative Study
Is nasogastric tube drainage required after reconstructive surgery for neurogenic bladder dysfunction?
To determine whether the routine use of nasogastric tubes (NGTs) after bowel surgery for neurogenic bladder dysfunction improves outcomes. ⋯ Routine use of NGTs in patients undergoing bladder reconstruction or replacement for neurogenic bladder dysfunction seems to confer no benefit. The omission of NGTs in this population is possible without increasing overall morbidity. These findings parallel those previously reported in neurologically intact patients undergoing urinary diversion.
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To test the validity of preoperative prostate-specific antigen velocity (PSAV) (the rate of PSA rise before diagnosis) as a predictor for relapse after radical prostatectomy, in the context of patient obesity as measured by body mass index (BMI). ⋯ Preoperative PSAV greater than 2 ng/mL/yr was associated with a higher risk of relapse after radical prostatectomy, but its clinical usefulness might be limited to nonobese patients. Obesity conferred higher relapse rates, regardless of other prognostic factors including preoperative PSAV.
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Randomized Controlled Trial
Treatment of postoperative ileus after bowel surgery with low-dose intravenous erythromycin.
Treatment of postoperative ileus remains unsatisfactory. Erythromycin (EM), a macrolide antibiotic, has prokinetic effects on the gut. We investigated whether intravenous erythromycin decreases the time to the return of normal bowel function after bowel surgery in patients with bladder cancer and interstitial cystitis who have undergone cystectomy and urinary diversion. ⋯ No significant difference was found between EM and placebo with regard to the onset of bowel sounds, passage of flatus, passage of the first bowel movement, and the time to tolerate a general diet. These data indicate that erythromycin is not useful in improving postoperative bowel function.
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Randomized Controlled Trial Comparative Study
Comparing two local anesthesia techniques for extracorporeal shock wave lithotripsy.
To evaluate the efficacy of a eutectic mixture of local anesthetics (EMLA) cream compared with dimethyl sulfoxide (DMSO) with lidocaine during extracorporeal shock wave lithotripsy (ESWL) in a prospective randomized study. ⋯ Our findings have indicated that the pain scores were significantly lower for the DMSO group than for the EMLA group. In addition to the local anesthetic effect of DMSO, diuretic, anti-inflammatory, muscle relaxant, and hydroxyl radical scavenger effects can be important for patients undergoing ESWL. These effects should be evaluated with new studies of patients undergoing ESWL.