International journal of urology : official journal of the Japanese Urological Association
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Review Comparative Study
Current status of robot-assisted laparoscopic radical prostatectomy: how does it compare with other surgical approaches?
The aim was to review the current status and evaluate the outcomes of robot-assisted laparoscopic radical prostatectomy in comparison with open radical prostatectomy and laparoscopic radical prostatectomy. Between January 2008 and June 2012, published English language comparative studies comparing robot-assisted laparoscopic radical prostatectomy with either open radical prostatectomy and/or laparoscopic radical prostatectomy were reviewed. End-points for this review include oncological, functional and perioperative outcomes, and complications. ⋯ Risks of perioperative complications were also low after robot-assisted laparoscopic radical prostatectomy. Robot-assisted laparoscopic radical prostatectomy offers at least equivalent oncological and functional outcomes with low risks of complications when compared with open radical prostatectomy and laparoscopic radical prostatectomy. However, there is a paucity of high-level evidence available in current literature.
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Botulinum toxin has been recently accepted as a novel treatment for lower urinary tract dysfunctions refractory to conventional treatment. Review of the clinical trials in recent years, botulinum toxin type A has been widely used in the urethra or urinary bladder to treat voiding dysfunction due to detrusor sphincter dyssynergia, incontinence due to neurogenic or idiopathic detrusor overactivity, sensory disorders such as bladder hypersensitivity, overactive bladder, and interstitial cystitis/painful bladder syndrome. ⋯ Currently botulinum toxin type A has also been applied to treat lower urinary tract symptoms due to benign prostatic hyperplasia in patients not suitable for surgery. This article reviewed the recent advances of botulinum toxin type A on lower urinary tract dysfunction.
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Nephrogenic systemic fibrosis is a progressive, potentially fatal, multiorgan-system fibrosing disease related to exposure of patients with renal failure to gadolinium-based contrast agents used in magnetic resonance imaging. Between 1997 and 2007, more than 500 cases of nephrogenic systemic fibrosis in patients with severe renal insufficiency (glomerular filtration rate less than 30 mL/min/1.73 m(2)) were reported, and no known cases of nephrogenic systemic fibrosis have occurred in patients with a glomerular filtration rate of more than 30 mL/min/1.73 m(2) without acute kidney injury. ⋯ Although the mechanism of nephrogenic systemic fibrosis is unclear and there is no consistently-effective therapy, nephrogenic systemic fibrosis is an entity that can be eliminated by observing recent recommended guidelines for gadolinium-based contrast agents and nephrogenic systemic fibrosis. This article reviews current knowledge about nephrogenic systemic fibrosis and focuses mainly on how to prevent it.
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Sensory dysfunction could be involved in various pathogeneses in the lower urinary tract including neurogenic bladder, overactive bladder, painful bladder syndrome and neuropathy as a result of endocrine disorders. The ability to diagnose sensory function more objectively is of increasing interest to clinicians. Afferent innervations of the lower urinary tract involve myelinated (A-delta) and unmyelinated (C) fibers. ⋯ Recently, increased evidence has suggested that measurement of CPT values of A-delta and C-fibers in the lower urinary tracts is feasible and shows significant correlation with clinical symptoms and conventional urodynamic variables, as well as the efficacy of various treatments. However, there are still controversial issues in the wider use of this technology in diagnosis and assessment of the therapeutic effectiveness of sensory dysfunction in the lower urinary tracts. In order to resolve the remaining challenges in the CPT test of the lower urinary tract, recent efforts include development of a new balloon-type electro-catheter with dual electrodes as an alternative sensory test for the bladder or urethra, which allows simultaneous performance of conventional urodynamic tests and urine collection, and future standardized techniques available for comparison with validated control values.
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The most recent epidemiological survey revealed that the mortality rate for prostate cancer in Japan has increased and has been getting very close to that in the USA, where it has decreased since 1992. The low exposure rate of prostate-specific antigen (PSA) screening in Japan and the high exposure rate of PSA screening in the USA may result in completely deferent trends in the mortality rate of prostate cancer between the two countries. ⋯ The fact sheet on screening for prostate cancer should indicate the most recent reliable clinical research on screening for prostate cancer and its demerits including false-negative and false-positive PSA test results and prostate biopsy, overdetection and overtreatment. However, it should be explained to the public that the demerits for PSA screening will be clarified step by step during screening, and in general, men having more information on screening results (PSA level, pathological findings of biopsy specimens, clinical stage, etc.) can understand their current situation better than those having no information on screening results, including PSA levels.