The Journal of urology
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The Journal of urology · Nov 2001
Sacral nerve stimulation in patients with chronic intractable pelvic pain.
Transforamenal sacral nerve stimulation with an implantable neuroprosthetic device has been shown to benefit patients with chronic voiding dysfunction. In this study we measured the effectiveness of sacral nerve stimulation in 10 patients with chronic intractable pelvic pain. ⋯ These data imply that transforamenal sacral nerve stimulation can have beneficial effects on the severity and frequency of chronic intractable pelvic pain. Future clinical studies are necessary to determine the long-term effectiveness of this therapy.
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The Journal of urology · Nov 2001
Conservative management of prostate cancer in the prostate specific antigen era: the incidence and time course of subsequent therapy.
The long natural history of early stage prostate cancer is well recognized and a conservative approach to the treatment of elderly men is often encouraged. We assessed the ability of patients and physicians to adhere to a policy of watchful waiting in the prostate specific antigen (PSA) era. ⋯ When patients do not die of co-morbid illness, they are likely to proceed to therapy well within the first decade after diagnosis (57% by 5 years and 74% by 7). Therapy was usually definitive (radical) and triggered by slight, inevitable PSA increases. The patient perception was that the physicians initiated therapy in response to increasing PSA. However, the physicians more often perceived that treatment was initiated by patients. Therefore, watchful waiting in the PSA era often represents radical therapy delayed by a few years.
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The Journal of urology · Oct 2001
Randomized Controlled Trial Comparative Study Clinical TrialLocal anesthesia for ultrasound guided prostate biopsy: a prospective randomized trial comparing 2 methods.
Since the introduction of prostate specific antigen (PSA) screening, asymptomatic men often undergo transrectal ultrasound guided prostate biopsy. This procedure may cause significant discomfort, which may limit the number of biopsies. We performed a randomized prospective study to compare periprostatic infiltration with 1% lidocaine with intrarectal instillation of 2% lidocaine gel before prostate biopsy. ⋯ Men should have the opportunity to receive local anesthesia before ultrasound guided prostate biopsy with the goal of decreasing the discomfort associated with this procedure. Our prospective randomized study indicates that ultrasound guided periprostatic nerve block with 1% lidocaine provides anesthesia superior to the intrarectal placement of lidocaine gel.
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The Journal of urology · Oct 2001
Salvage intravesical therapy with interferon-alpha 2b plus low dose bacillus Calmette-Guerin is effective in patients with superficial bladder cancer in whom bacillus Calmette-Guerin alone previously failed.
We determined whether combining low dose bacillus Calmette-Guerin (BCG) interferon-alpha 2B would be effective for patients in whom previous BCG failed. ⋯ While longer followup and larger multicenter studies are required to validate these encouraging findings, intravesical low dose BCG plus interferon-alpha 2B appears to be effective in many cases of high risk disease previously deemed BCG refractory. However, early failure while on this regimen should be aggressively pursued with more radical treatment options.
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The Journal of urology · Oct 2001
Review Case ReportsKlippel-Trénaunay syndrome: 2 case reports and a review of genitourinary manifestations.
We summarize the literature and present our experience with genitourinary manifestations of the Klippel-Trénaunay syndrome, which can lead to challenging management problems. ⋯ Intra-abdominal and intrapelvic extension of the vascular malformations of the Klippel-Trénaunay syndrome frequently occurs concurrently with the lower abdominal, pelvic cutaneous involvement of the external genitalia, as in our 2 cases and in our review of the literature. These data provide a better understanding of the spectrum of genitourinary manifestations in the Klippel-Trénaunay syndrome and provide insight for the clinician to formulate individual therapies for these patients.