The Journal of urology
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The Journal of urology · Dec 2007
Comparative StudyA comparison of the incidence and location of positive surgical margins in robotic assisted laparoscopic radical prostatectomy and open retropubic radical prostatectomy.
Surgical technique, patient characteristics and method of pathological review may influence surgical margin status. We evaluated the incidence and location of positive surgical margins in 200 sequential robotic assisted laparoscopic radical prostatectomy and 200 sequential open radical retropubic prostatectomy cases. ⋯ In the hands of surgeons experienced in robotic assisted laparoscopic radical prostatectomy and radical retropubic prostatectomy, there was a statistically significant lower positive margin rate for patients undergoing robotic assisted laparoscopic radical prostatectomy. The most common location of a positive surgical margin in robotic assisted laparoscopic radical prostatectomy and radical retropubic prostatectomy cases was at the apex. Patients treated with radical retropubic prostatectomy had higher risk features which may have independently influenced these results. The method of pathological specimen analysis and reporting may account for the higher positive margin rates in both groups compared to some reports.
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The Journal of urology · Dec 2007
Randomized Controlled TrialDorsal onlay buccal mucosa versus penile skin flap urethroplasty for anterior urethral strictures: results from a randomized prospective trial.
Reconstructive techniques for anterior urethral strictures have not been subjected to a randomized comparison. In a randomized controlled study we compared outcomes of buccal mucosa dorsal onlay vs skin flap dorsal onlay urethroplasty in patients with complex anterior urethral strictures. ⋯ On intermediate followup dorsal onlay penile skin flap and buccal mucosa urethroplasty provide similar success rates. Compared to buccal mucosa, penile flap procedures are technically complex, associated with higher morbidity and less preferred by patients.
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The Journal of urology · Dec 2007
Autonomic nervous system activity during bladder filling assessed by heart rate variability analysis in women with idiopathic overactive bladder syndrome or stress urinary incontinence.
Idiopathic overactive bladder syndrome is a common disorder, especially in women. Of various pathophysiological factors several studies suggest a specific dysfunction of the autonomic nervous system. To verify this hypothesis we compared heart rate variability parameters, which provide an analysis of autonomic function, in women with idiopathic overactive bladder syndrome to those in a reference population of women with stress urinary incontinence. ⋯ This preliminary study demonstrates the predominance of parasympathetic activity with the bladder emptied and a preponderance of sympathetic activity at the end of bladder filling in women with overactive bladder syndrome. These results suggest dysfunction in the autonomic balance, as implied in idiopathic overactive bladder syndrome. Further studies in a larger population of patients with overactive bladder syndrome with reference to normal subjects free of urinary symptoms are necessary to confirm this hypothesis.
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Missed diagnoses are a patient safety concern and they can result in malpractice allegation. The specialist physician may be liable for missed or delayed diagnoses even if an abnormality in the physician area of expertise is ruled out. We approached this largely unstudied area of medical malpractice in an effort to increase physician awareness and identify opportunities for prevention. ⋯ Indemnity payments resulting from missed diagnosis claims represent a disproportionately high percent of total indemnity payments (27%) due to a high average payment for such claims. Liability for the urologist resulted from missed diagnoses not only of urological conditions, but also of nonurological conditions.
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The Journal of urology · Dec 2007
Comparative StudyGender differences in nighttime plasma arginine vasopressin and delayed compensatory urine output in the elderly population after desmopressin.
Monosymptomatic polyuric nocturia is a consequence of aging. We investigated physiological differences between nonpolyuric and polyuric nocturia in the elderly population in relation to urine production regulation in young volunteers with special reference to gender. ⋯ Age and gender related decreased arginine vasopressin secretion at night underscores the fact that other factors modulate urine production. The pharmacodynamics of desmopressin as an antidiuretic in the elderly population are different from those in young individuals.