The Journal of urology
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The Journal of urology · Oct 2005
The regionalization of radical cystectomy to specific medical centers.
Regionalization of high risk surgical procedures to larger teaching hospitals has been suggested as a means to improve the quality of care. We established a novel framework for characterizing regionalization, implemented it to determine the extent to which regionalization of radical cystectomy has occurred and delineated whether specific patient characteristics are associated with this phenomenon. ⋯ Without broad legislation from health care payers radical cystectomy has increasingly regionalized to specific medical centers. Despite this regionalization disparities in its use exist among specific, vulnerable patients. Addressing this may facilitate further concentration of this procedure.
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The Journal of urology · Oct 2005
Randomized Controlled Trial Comparative Study Clinical TrialSedation during voiding cystourethrography: comparison of the efficacy and safety of using oral midazolam and continuous flow nitrous oxide.
We compare the efficacy and safety profile of oral midazolam and continuous flow 50% nitrous oxide (N(2)O) for alleviating anxiety and pain during voiding cystourethrography (VCU) in children. ⋯ Continuous flow 50% nitrous oxide and oral midazolam are comparably safe and effective in reducing anxiety and distress during VCU in children older than 3 years. However, N(2)O provides a more rapid onset of sedating effect and has a shorter recovery time.
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The Journal of urology · Oct 2005
ReviewUrological laparoscopy: basic physiological considerations and immunological consequences.
The applications of laparoscopy to urological surgery continue to grow at a steady pace. A complete understanding of the physiological and immunological changes associated with pneumoperitoneum is required. We reviewed the physiology of laparoscopy with regard to the major organ systems and summarize the effects of pneumoperitoneum on immune function. ⋯ Physiological changes incurred as a result of pneumoperitoneum have minimal adverse effects in healthy individuals undergoing laparoscopic surgery. Interest has grown in the impaired peritoneal immune response to CO2 pneumoperitoneum. Altered intraperitoneal immunity may represent a new avenue for the development of adjuvant therapies for minimally invasive treatments of urological malignancies and for the prevention of port site metastasis. Further elucidation and investigation into the immunological responses to pneumoperitoneum during urological laparoscopic procedures is called for.
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The Journal of urology · Oct 2005
ReviewMedical and surgical palliative care of patients with urological malignancies.
Urological malignancies are relatively common and patients often live many years with disease. There are many effective medical and surgical palliative treatments, although few comprehensive guidelines have been published. We reviewed the various palliative treatments available for the 3 most common urological malignancies, namely prostate cancer, bladder cancer and renal cancer. ⋯ Palliative care includes disease directed treatment as well as functional, psychosocial and spiritual support. Disease directed therapy and palliative care should be provided simultaneously throughout illness. Improved quality of care and quality of life as well as physician satisfaction are frequent outcomes of this approach. Supportive care begins at initial diagnosis and it should be flexible to meet the changing needs of patients with cancer and their families.
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The Journal of urology · Oct 2005
Salvage radiation therapy for prostate specific antigen progression following radical prostatectomy: 10-year outcome estimates.
We evaluated men treated with salvage radiation therapy for increasing serum prostate specific antigen (PSA) following radical retropubic prostatectomy (RRP). ⋯ An undetectable PSA level following salvage radiation therapy is more frequently achieved in men with lower pre-radiation serum PSA and those without seminal vesicle or lymph node involvement. Overall approximately a fourth of men with PSA evidence of cancer progression following RRP had a durable response 10 years after the initiation of salvage radiation therapy in the protocols used in this patient cohort.