The Journal of urology
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The Journal of urology · Jun 2001
ReviewUpdate on pain management for advanced genitourinary cancer.
Pain is a significant problem in many patients with genitourinary malignancy at all stages of disease. Optimal pain control becomes a primary concern as disease progresses and other therapies are exhausted. The selection of the most appropriate therapy becomes difficult without an understanding of the underlying mechanisms of pain and the available therapies. ⋯ Opioid medication is the mainstay of therapy in the majority of patients but with the appropriate addition of other adjuvant drugs patients may achieve optimal pain control without unwanted side effects. A few patients benefit from more invasive techniques, including plexus blocks and neuraxial infusion therapy, and the indications for these treatments are discussed. These therapies have largely superseded neuroablative procedures that are more destructive and associated with higher morbidity.
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The Journal of urology · Nov 2000
ReviewNeoadjuvant hormonal ablative therapy before radical prostatectomy: a review. Is it indicated?
Neoadjuvant hormonal ablation therapy has been used to decrease the rate of positive surgical margins in patients treated with radical prostatectomy. We reviewed the available literature to determine whether this therapy is indicated and beneficial. ⋯ Analysis of the available literature revealed no significant improvement in outcome to support the routine administration of neoadjuvant hormonal therapy before prostatectomy.
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The Journal of urology · Sep 1999
ReviewPediatric management of ambiguous and traumatized genitalia.
The present standard of practice in the management of ambiguous and traumatized genitalia was evaluated. ⋯ A moratorium on sex reassignment cosmetic surgery is recommended. Also recommended are that followup studies should be instituted on past cases, and honesty and counseling should be the core of initial and subsequent treatment.
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The Journal of urology · Jul 1999
ReviewHave complication rates decreased after treatment for localized prostate cancer?
The American Urological Association Prostate Cancer Clinical Guidelines Panel reviewed 12,501 publications on prostate cancer from 1955 to 1992 to determine whether the complication rates of external beam radiation therapy, interstitial radiotherapy and radical prostatectomy have decreased. ⋯ Complication rates in the treatment of localized prostate cancer have decreased during the last 20 to 40 years. This decrease occurred despite evidence that the average age of treated patients had increased during the same period.
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The Journal of urology · Feb 1999
Review Comparative StudyComparison of digital rectal examination and biopsy results with the radical prostatectomy specimen.
Digital rectal examination is integral to staging prostate cancer. Ultrasound guided biopsy establishes the diagnosis, and it may provide useful information regarding disease grade and extent. Treatment decisions are largely based on information gained from digital rectal examination and biopsy but this information is only useful if it correlates with the radical prostatectomy specimen and prognosis. We correlated digital rectal examination and transrectal ultrasound guided biopsy results with a detailed analysis of the radical prostatectomy specimen. ⋯ Digital rectal examination and the interpretation of prostate biopsy are not accurate clinical tools for defining the location and extent of prostatic carcinoma. Bilateral positive biopsy may be useful as an adjunct to the current clinical staging system.