Can J Urol
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The emergency department (ED) is a common setting for evaluation of patients with urolithiasis based on acute symptoms and a propensity for recurrent disease. We sought to characterize practice patterns in the emergency treatment of stone disease, and to identify potential disparities in care based on non-medical factors. ⋯ Kidney stones are associated with a high rate of repeated presentations to the ED. Certain non-medical factors did impact details of management. Future efforts should focus on optimizing clinical pathways to improve the efficiency of acute care for kidney stone patients.
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Radical cystectomy is associated with significant morbidity, with rates of gastrointestinal complications as high as 30%. Alvimopan is a mu opioid receptor antagonist that has been shown in randomized control trials to accelerate gastrointestinal recovery in patients undergoing bowel resection with primary anastamosis. We report our experience with gastrointestinal recovery for patients undergoing cystectomy with urinary diversion treated with alvimopan. ⋯ In our experience, the use of alvimopan perioperatively significantly accelerates the rate of gastrointestinal recovery and hospital discharge, eliminates the need for nasogastric tube decompression, and reduces the incidence of postoperative ileus in patients following radical cystectomy and urinary diversion.
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This pilot study determined the efficacy of rifaximin, a gut-directed antibiotic, in reducing chronic prostatitis (CP) and gastrointestinal (GI) symptoms in patients with CP type III. The prevalence of small intestinal bacterial overgrowth (SIBO) and irritable bowel syndrome (IBS) in patients with CP was also evaluated. ⋯ Data from this pilot study suggest that SIBO and IBS are common in CP and that patients with CP and SIBO may benefit from rifaximin therapy. Further studies are warranted.
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Spinal anesthesia for ambulatory transurethral resection of the prostate (TURP) is a well established technique. The following study examines data over a 5 year period at a major Canadian tertiary academic center. The purpose of the study is to review our experience and complications associated with spinal anesthesia using combined low dose local anesthetic + narcotic for ambulatory TURP procedures. ⋯ Low dose spinal anesthesia with bupivacaine and lidocaine were well tolerated for short duration TURP. Low dose bupivacaine and conventional dose lidocaine were associated with significantly longer block duration, longer PACU stay and higher frequency of prolonged blocks compared with low dose lidocaine for spinal anesthesia.
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Prostate cancer is the second most common cause of cancer death in American men. For patients with adverse pathologic features, postoperative radiotherapy to prostate bed after radical prostatectomy has been shown in randomized studies to improve many important clinical endpoints including overall survival. In this review article, we distinguish adjuvant radiation treatment (ART) from salvage radiation treatment (SRT), discuss the evidences for ART and its potential side effects focusing on the debate concerning the optimal timing of post prostatectomy radiation treatment (RT). ⋯ for patients with adverse pathologic factors, adjuvant radiation treatment after prostatectomy reduces the rate of PSA failure with the potential for significantly improving metastases-free and overall survival. Whether an equivalent survival benefit can be attained with early salvage radiation treatment after biochemical recurrence, is still an area of debate.