The Journal of urology
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The Journal of urology · Feb 2009
Comparative StudyNomogram predicting the probability of early recurrence after radical prostatectomy for prostate cancer.
We developed a nomogram predicting the probability of early biochemical recurrence after radical prostatectomy because early recurrence predisposes to distant metastasis and prostate cancer related mortality. Identifying patients at risk for early recurrence may improve prognosis as early institution of adjuvant therapy may reduce the risk of progression. ⋯ Two-thirds of all instances of relapse occur during the first 2 years after radical prostatectomy. Those patients can be highly accurately identified with our nomogram. They might benefit the most from adjuvant treatment and could be the ideal candidates for adjuvant treatment trials.
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Leading organizations increasingly recognize clinical practice guidelines as an important approach in promoting an evidence-based clinical practice of urology. In light of their considerable clinical, economic and medicolegal impact, guideline users should be confident that the guidelines were rigorously developed and address relevant patient questions. In this article we outline a practical approach for critically appraising a clinical practice guideline. ⋯ The systematic approach presented in this article will allow urologists to critically appraise clinical practice guidelines. Determining the validity of the recommendations, understanding the recommendations and assessing their applicability to patients are 3 fundamental steps toward an evidence-based approach to using clinical practice guidelines.
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The Journal of urology · Feb 2009
Randomized Controlled TrialCombination of perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block for pain control during transrectal ultrasound guided prostate biopsy: a randomized, controlled trial.
To our knowledge the optimal analgesia during prostate biopsy remains undetermined. We tested the efficacy and safety of combined perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block during transrectal ultrasound guided prostate biopsy. ⋯ Our findings suggest that the combination of perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block provides better pain control than the 2 modalities alone during the sampling part of transrectal ultrasound guided prostate biopsy with no increase in the complication rate. The magnitude of this effect is higher in younger men, men with a larger prostate and men with lower anorectal compliance.
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The Journal of urology · Feb 2009
Comparative StudyRadical cystectomy for bladder cancer: morbidity of laparoscopic versus open surgery.
We compared the morbidity and mortality of laparoscopic vs open surgery in radical cystectomy for bladder cancer. ⋯ Laparoscopic radical cystectomy for bladder cancer has a lower morbidity rate than cystectomy by open surgery. It allows more rapid resumption of oral fluid and solid intake as well as return to normal bowel function and shorter hospital stay.
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The Journal of urology · Feb 2009
Staged reconstruction of long segment urethral strictures in men with previous pediatric hypospadias repair.
Reconstruction of long segment urethral stricture disease in adults with a history of pediatric hypospadias repair remains complex secondary to poor urethral blood supply, extensive penile scarring and the need for significant amounts of graft or flap tissue. We describe our experience with staged urethroplasty in this cohort of men. ⋯ We describe outcomes after staged reconstruction for extensive urethral stricture disease in men after previous pediatric hypospadias repair in childhood. At intermediate followup staged urethroplasty provided acceptable outcomes.