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Partial nephrectomy: novel closure technique using bovine pericardium
Uhlman A. Matthew , Brown A. James, MD Department of Urology, University of Iowa, Iowa City, Iowa, USA
Partial nephrectomy (PN) has gained popularity over the past two decades as an alternative to radical nephrectomy (RN) in patients with small renal masses. Morbidity and mortality from PN have been shown to be lower than from RN, while oncologic outcomes have been shown to be equivalent for tumors < 7 cm. PN has become increasingly popular in academic centers, but the general urologic community continues to lag behind. The reason for this is not known, but may be related to the relatively high complication rate, including delayed complications associated with inadequate closure. Here we describe a novel PN closure technique that provides additional strength and hemostasis by incorporating bovine pericardium.
Keywords: surgical techniques, novel closure, penile carcinoma, laparoscopy, robotics,
Oct 2012 (Vol. 19, Issue 5 , Page 6485) -
Sacral nerve stimulation for neuromodulation of the lower urinary tract
Hubsher P. Chad , Jansen Robert , Riggs R. Dale , Jackson J. Barbara , Zaslau Stanley, MD Division of Urology, Department of Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
Sacral neuromodulation (SNM) has become a standard treatment option for patients suffering from urinary urge incontinence, urgency-frequency, and/or nonobstructive urinary retention refractory to conservative and pharmacologic treatment. Since its initial development, the manufacturer of InterStim therapy (Medtronic, Inc., Minneapolis, MN, USA), has introduced technical modifications, while surgeons and researchers have adapted and published various innovations and alterations of the implantation technique. In this article, we feature our SNM technique including patient selection, comprehensive dialogue/evaluation, procedure details, and appropriate follow up. Although there is often great variability in patients with lower urinary tract dysfunction, we maintain that great success can be achieved with a systematic and methodical approach to SNM.
Keywords: bovine pericardium, renal cancer, partial nephrectomy,
Oct 2012 (Vol. 19, Issue 5 , Page 6480) -
Novel knot tying technique for robot-assisted surgery
Guru A. Khurshid, Sheikh Raashid Mohd, Raza J. Syed, Stegemann P. Andrew, Nyquist John, MD Department of Urology, Roswell Park Cancer Institute, Buffalo, New York, USA
Robot-assisted surgery has seen significant advancements in recent years, with dedicated training opportunities to acquire adequate skills. With improved degree of rotation and movement offered by the robot arm, newer techniques of knot tying need to be developed. Here we present a novel method of knot tying to help place a secure knot, especially with short suture length.
Keywords: testosterone, hypogonadism, diagnosis,
Aug 2012 (Vol. 19, Issue 4 , Page 6401) -
Functional oncologic and technical outcomes after endoscopic groin dissection for penile carcinoma
Canter J. Daniel, Dobbs W. Ryan, Jafri Mohammed A. S., Herrel A. Lindsey, Ogan Kenneth, Delman A. Keith, Master A. Viraj, MD Department of Urology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
Penile cancer is a rare cutaneous malignancy that frequently spreads to the regional inguinal lymph nodes with a prolonged locoregional phase. An inguinal lymph node dissection may be both diagnostic and therapeutic, even in the setting of advanced disease. Despite its proven oncologic importance and efficacy, an inguinal lymphadenectomy remains underutilized, even with the publication of guidelines advocating its use. Failure to apply this modality is most likely due to the significant morbidity associated with a traditional open approach, including flap necrosis, wound infection and debilitating lymphedema. The risks and complications associated with an open inguinal lymph node dissection have driven several investigators to develop techniques for performing a minimally invasive endoscopic inguinal lymph node dissection that is oncologically equivalent to the ?gold standard? open approach, while potentially minimizing the complications traditionally seen with the open technique. In this report, we detail our technique for performing a minimally invasive endoscopic groin dissection with inguinal lymphadenectomy for penile carcinoma. We also present preliminary complication and short term oncologic data employing this surgical technique in an initial cohort of patients.
Keywords: penile carcinoma, laparoscopy,
Aug 2012 (Vol. 19, Issue 4 , Page 6395) -
A critical appraisal of accuracy and cost of laboratory methodologies for the diagnosis of hypogonadism: the role of free testosterone assays
Morales Alvaro, Collier P. Christine, Clark F. Albert, MD Queen's University, Kingston, Ontario, Canada
The biochemical diagnosis of male hypogonadism remains a controversial issue. The problem is compounded by the variety of laboratory assays available to measure serum testosterone (T) and the limited understanding, among clinicians, of their relative diagnostic validity. It is widely accepted that only the testosterone not bound to sex hormone-bounding globulin is metabolically active. Therefore, for diagnostic purposes it is frequent practice to order the measurement of free T (FT) or bioavailable T (BAT). Our objective is to describe the methods available for measuring FT and to review the literature to determine the relevance of ordering FT as a diagnostic laboratory tool in cases of suspected hypogonadism. We also provide our biochemical approach in evaluating men with T deficiency. The limited information available in this regard is frequently confined to the biochemistry literature. The few reliable studies indicate that analog-based measurement of FT offers no diagnostic or financial advantage over automated assay for total T. The manuscript also describes 'How we do it.' For optimal diagnostic accuracy and financial responsibility, total T and calculated FT (cFT) should be the tests employed for initial and confirmatory diagnosis respectively. Measurement of bioavailable T is an alternative option but not germane to the points to which we are calling attention in this paper. While clinicians should be discouraged from ordering FT assays, laboratories performing it should indicate what method was used and warned about possible reliability concerns. FT assays should no longer be a reimbursable test
Keywords: free testosterone, superficial bladder cancer, non-muscle invasive bladder cancer, fluorescence cystoscopy,
Jun 2012 (Vol. 19, Issue 3 , Page 6314)
