Can J Urol
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Multicenter Study Comparative Study
Multi-institutional outcomes and cost effectiveness of using alvimopan to lower gastrointestinal morbidity after cystectomy and urinary diversion.
Radical cystectomy is associated with significant morbidity and cost, 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 and cost benefit associated. ⋯ 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 post-operative ileus in patients following radical cystectomy and urinary diversion.
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Multicenter Study
Experience with robotic assisted laparoscopic surgery in upper tract urolithiasis.
Early results indicate that robot assisted laparoscopic surgery (RALS) may be useful in managing upper tract (UT) urolithiasis. We reviewed our experience of managing 50 cases of UT urolithiasis with or without reconstruction using RALS. ⋯ RALS for UT urolithiasis is safe and efficacious. It is particularly useful when stone removal is combined with reconstruction. It is a reasonable alternative for treating a solitary partial staghorn or a large pelvic stone including those in pelvic/anomalous kidneys. RALS did not seem substantially better than pure laparoscopy for isolated ureterolithotomy and for nephrectomy for a nonfunctioning kidney. Its role in the treatment of large, multiple or complete staghorn calculi needs further investigation.
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Randomized Controlled Trial Multicenter Study Comparative Study
Dutasteride and bicalutamide in patients with hormone-refractory prostate cancer: the Therapy Assessed by Rising PSA (TARP) study rationale and design.
Bicalutamide blocks androgen action in men with prostate cancer but has low affinity for the androgen receptor compared to dihydrotestosterone (DHT). Dutasteride, a dual 5-reductase inhibitor (5ARI), blocks the conversion of testosterone to DHT, reduces tumor volume and improves PSA in prostate cancer. Bicalutamide should be a more effective antiandrogen if it competes against intraprostatic testosterone, rather than DHT, for the androgen receptor. The Therapy Assessed by Rising PSA (TARP) study investigates dutasteride in combination with bicalutamide to prevent or delay disease progression in patients with castrate-refractory prostate cancer (CRPC) after initial androgen deprivation therapy. ⋯ TARP will be the first study to evaluate the effects of dutasteride and an antiandrogen in patients failing GnRH analogue and help elucidate the potential role of a dual 5ARI in reducing the rate of progression in non-metastatic CRPC.