The Journal of urology
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The Journal of urology · Jun 2011
Review Biography Historical ArticleThe portrayal of J. Marion Sims' controversial surgical legacy.
In the mid 1800s Dr. J. Marion Sims reported the successful repair of vesicovaginal fistulas with a technique he developed by performing multiple operations on female slaves. A venerated physician in his time, the legacy of Dr. Sims is controversial and represents a significant chapter in the mistreatment of African-Americans by the medical establishment. This review compares the modern debate surrounding his legacy with the presentation of his operation in widely consulted urological texts and journals. ⋯ While historians, ethicists and the popular press have debated Dr. Sims' legacy, medical sources have continued to portray him unquestionably as a great figure in medical history. This division keeps the medical profession uninformed and detached from the public debate on his legacy and, thus, the larger issues of ethical treatment of surgical patients.
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The Journal of urology · Aug 2010
ReviewAssessment of the methodological quality of systematic reviews published in the urological literature from 1998 to 2008.
Well done systematic reviews provide the highest quality evidence for clinical questions of therapeutic effectiveness. We assessed the methodological quality of systematic reviews in the urological literature. ⋯ Results suggest that an increasing number of systematic reviews are published in the urological literature. However, many systematic reviews fail to meet established methodological standards, raising concerns about validity. Increased efforts are indicated to promote quality standards for performing systematic reviews among the authors and readership of the urological literature.
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The Journal of urology · Jun 2010
ReviewUrological surgery and antiplatelet drugs after cardiac and cerebrovascular accidents.
The perioperative treatment of patients on dual antiplatelet therapy after myocardial infarction, cerebrovascular event or coronary stent implantation represents an increasingly frequent issue for urologists and anesthesiologists. We assess the current scientific evidence and propose strategies concerning treatment of these patients. ⋯ The risk of coronary thrombosis when antiplatelet agents are withdrawn before surgery is generally higher than the risk of surgical hemorrhage when antiplatelet agents are maintained. However, this issue has not yet been sufficiently evaluated in urological patients and in many instances during urological surgery the risk of bleeding can be dangerous. A thorough dialogue among surgeon, cardiologist and anesthesiologist is essential to determine all risk factors and define the best possible strategy for each patient.
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The Journal of urology · May 2010
ReviewReporting of harm in randomized controlled trials published in the urological literature.
Evidence-based decision making seeks to balance potential benefits and harms (adverse effects) of health care interventions for an individual patient. We determined the prevalence and completeness of harm reporting in randomized controlled trials in the urological literature. ⋯ Randomized controlled trials published in the urological literature contain significant deficiencies in adverse event reporting. These findings suggest the need for reporting standards for harm in urological journals. Improvements in adverse event reporting would permit a more balanced assessment of interventions and would enhance evidence-based urological practice.
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The Journal of urology · Jan 2010
ReviewContemporary applications and limitations of magnetic resonance imaging contrast materials.
Improvements in imaging technologies have dramatically increased the ability to accurately diagnose and treat many urological disease processes. As urological patients often have chronic kidney disease, the well characterized nephrotoxicity of contrast induced nephropathy when using iodine based contrast materials has long been a concern. With the development of gadolinium based contrast agents it seemed that the concern regarding nephrotoxicity had been resolved. In 1997 a new disorder, nephrogenic systemic fibrosis, appeared in patients with severe renal failure. Nephrogenic systemic fibrosis is a serious and potentially devastating disorder characterized by progressive thickening and hardening of the skin and other body tissues, and complicated by flexion contractures of the joints. ⋯ This review provides clarification of the gadolinium based contrast agent characteristics, tissue interactions that lead to the development of nephrogenic systemic fibrosis, prevention possibilities and available treatment options.