The Journal of urology
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The Journal of urology · Dec 2004
ReviewA systematic review and critique of the literature relating hospital or surgeon volume to health outcomes for 3 urological cancer procedures.
We performed a systematic review and critique of the literature of the relationship between hospital or surgeon volume and health outcomes in patients undergoing radical surgery for cancer of the bladder, kidney or prostate. ⋯ Outcomes after radical prostatectomy and cystectomy are on average likely to be better if these procedures are performed by and at high volume providers. For radical nephrectomy the evidence is unclear. The impact of volume based policies (increasing volume to improve outcomes) depends on the extent to which "practice makes perfect" explains the observed results. Further studies should explicitly address selective referral and confounding as alternative explanations. Longitudinal studies should be performed to evaluate the impact of volume based policies.
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We reviewed the current literature on mechanisms involved in the pathogenesis of prostatitis/chronic pelvic pain syndrome (CPPS). ⋯ The symptoms of CP/CPPS appear to result from an interplay between psychological factors and dysfunction in the immune, neurological and endocrine systems.
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The Journal of urology · Apr 2004
ReviewBallistics for physicians: myths about wound ballistics and gunshot injuries.
Wound ballistics is a difficult subject. The behavior of all bullets is unpredictable but the specific effect of high velocity projectiles has been a particular source of confusion in the literature. This confusion has resulted in the likely incorrect conclusion that all high velocity wounds require massive débridement. We reviewed the entirety of the literature on this subject and concluded that high velocity weapons do not reliably create massive wounds, and judicious débridement and staged explorations may be the best treatment method for these patients. ⋯ For the majority of high velocity gunshot wounds, especially military rifles that generally fire a projectile that is meant to stay intact after impact, wound severity can be limited, even much less than that from a civilian rifle, shotgun or handgun. Judicious use of débridement during surgical exploration limits the extent of iatrogenic injury in the surgical care of these patients.
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The Journal of urology · Nov 2003
ReviewThe nonsteroidal effects of diethylstilbestrol: the rationale for androgen deprivation therapy without estrogen deprivation in the treatment of prostate cancer.
During the last 2 decades there has been an increase in the number of men with prostate cancer placed on luteinizing hormone releasing hormone (LH-RH) agonist therapy. In addition, the duration of individual therapy has extended from what was once only a few months to, in many cases, several years. As a result there has been an increase in the incidence of side effects, including osteoporosis, decreased cognitive abilities, vascular stiffness and fatigue. We explored the use of estrogen in the form of diethylstilbestrol (DES) as an alternative treatment for men with prostate cancer, and introduce the concept of androgen deprivation without estrogen deprivation. In doing so we hope to elucidate some of the nonhormonal nonsteroidal effects of DES. Furthermore, we hope to define the mechanisms by which DES can be useful when LH-RH agonist therapy or orchiectomy has failed. ⋯ The efficacy of 1 mg DES extends well beyond its androgen suppressive effects. Androgen deprivation without estrogen deprivation is a concept that deserves further attention in the urological community.
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The Journal of urology · Apr 2003
ReviewDoxazosin and terazosin suppress prostate growth by inducing apoptosis: clinical significance.
Doxazosin and terazosin are known to relax prostate smooth muscle through blockade of alpha 1-adrenergic innervation to the prostate. This action alone however does not fully account for the long-term clinical responses exerted by these drugs in the treatment of patients with benign prostatic hyperplasia (BPH). ⋯ The correlation of induced prostate smooth muscle cell apoptosis with improvement of urinary symptoms in patients with BPH treated with doxazosin and terazosin, identifies apoptosis as an additional molecular mechanism for the long term therapeutic impact of these drugs in BPH. Moreover, the apoptotic effect elicited by quinazolines may have high clinical significance in the prevention and treatment of prostate cancer.