Prog Urol
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A first serum total PSA assay is recommended during the first three months after treatment. When PSA is detectable, PSA assay should be repeated three months later to confirm this elevation and to estimate the PSA doubling time (PSADT). In the absence of residual cancer, PSA becomes undetectable by the first month after total prostatectomy: less than 0.1 ng/ml (or less than 0.07 ng/ml) for the ultrasensitive assay method and less than 0.2 ng/ml for the other methods. ⋯ No consensus has been reached concerning the indication for complementary investigations by bone scan and abdominopelvic CT in patients with biochemical recurrence after treatment of localized cancer without endocrine therapy. However, when PSADT greater than six months, the risk of metastasis is less than 3% even for PSA greater than 30 ng/ml. When PSADT less than six months and PSA greater than 10 ng/ml, the risk of metastasis is close to 50%.
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Review Practice Guideline
[Recommendations for the urodynamic examination in the investigation of non-neurological female urinary incontinence].
INDICATIONS FOR URODYNAMIC ASSESSMENT IN WOMEN: Urodynamic assessment is not useful for the diagnosis of female urinary incontinence which remains a clinical diagnosis. Before any form of surgery for pure stress urinary incontinence, evaluation of bladder emptying by determination of maximum flow rate and residual urine is recommended. In the presence of pure stress urinary incontinence with no other associated clinical symptoms, a complete urodynamic assessment is not mandatory, but can be helpful to define the prognosis and inform the patient about her vesicosphincteric function. ⋯ The urethral pressure profile cannot be considered to be a useful test for the diagnosis of female urinary incontinence. However, in combination with clinical criteria, it is predictive of the results of female stress urinary incontinence surgical repair techniques. The pressure transmission ratio is neither a diagnostic criterion nor a prognostic criterion of urinary incontinence.
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Botulinum toxin was first used in urology in the field of neuro-urology as treatment for detrusor-sphincter dyssynergia and incontinence due to neurogenic overactive bladder. Its action has now been clearly demonstrated and it is now widely used for the treatment of neurogenic overactive bladder. ⋯ Well conducted, prospective, controlled studies on larger sample sizes must now be performed to confirm these preliminary results. This review of the literature presents the preliminary results of intraprostatic botulinum toxin injection supporting its use in the treatment of symptomatic benign prostatic hyperplasia.
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Rupture of the tunica albuginea of the corpus cavernosum of the penis is a rare disease, usually occurring in young adults during sexual intercourse. In Western countries, the most frequent causes is coital injuries. ⋯ An associated rupture of the urethra must be excluded. Complications of these fractures of the tunica albuginea especially comprise erectile dysfunction, deviation of the erect penis, development of plaques resembling those of La Peyronie disease, urethro-cavernous or urethro-cutaneous fistula or dysuria secondary to urethral stricture.
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Blunt trauma to the scrotum is increasingly frequent and is mainly due to motor vehicle accidents, especially with direct trauma from a motorbike petrol tank or falling astride a bicycle frame. The surgical exploration of these cases of trauma remains a controversial issue. However, according to the authors, the presence of haematocele on clinical examination justifies systematic early surgical exploration, which shortens the patient's length of hospital stay allowing more rapid return to work. Ultrasound is only really indicated in the case of scrotal trauma without haematocele, looking for rupture of the tunica albuginea or intratesticular haematoma.