摘要:

As a result of the recent resurgence of interest in interstitial brachytherapy, extended follow-up studies of early experience in this field are now being reported. However, such outcomes must be evaluated within the context of recent comprehensive assessments of the age-specific natural history of conservatively managed prostate cancer (‘watchful waiting’, i.e. no curative intervention). This raises issue with the contention that treating patients with low-grade cancer using brachytherapy alone results in a treatment-derived, extended, clinical-progression-free survival. The necessity for proposed randomized trials of brachytherapy (compared with conservative management in low-grade disease, and brachytherapy plus external beam radiotherapy) is discussed in this context. There is no consensus regarding the best modality for the treatment of localized prostate cancer, since no well-accepted, adequately powered randomized trial of competing modalities for this disease has ever been completed. Consequently, it has become common while counseling patients with the disease to place substantial emphasis on ‘quality of life’ considerations and the ‘outcomes uncertainty management’ issues associated with each option of therapy. There is even a question of whether every patient who is diagnosed with prostate cancer should be treated. However, while the importance of the variable biologic risk is generally widely accepted by experienced physicians caring for such patients, it is extremely difficult for the individual patient to weigh the evidence of the relative risks of progression dispassionately at the time of diagnosis. In this review, I wish to highlight several papers that have been published within the past year that are important in addressing this ongoing clinical problem. Any physician counseling patients about localized prostate cancer treatment should read and become familiar with the data herein: papers addressing the issues of interstitial brachytherapy outcomes, and the natural history of prostate cancer itself

ISSN:0963-0643    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

There continue to be several controversies surrounding the role for retroperitoneal lymphadenectomy (RPL) in the management of patients with germ cell cancer of the testis. The initial treatment options for those with clinical stage I disease are surveillance (orchiectomy only), RPL or chemotherapy. Survival rates are similar with RPL and surveillance. Surgical morbidity has been reduced as techniques for RPL continue to improve. The likelihood of early or late (>2 years) recurrence in the retroperitoneum is almost eliminated by RPL. Fewer follow-up computerized tomography scans of the abdomen are required and there are opportunities to reduce the duration and methods of follow-up, compared with surveillance.For patients with stage II disease, chemotherapy and RPL are equally effective initial treatment options but many patients require a combined approach. Initial RPL should be reserved for patients with smaller volume disease and possibly with lower preoperative marker levels. With RPL, patients are accurately staged and cured most of the time without double treatment. Approximately 30% of those with larger masses will have residual disease after initial chemotherapy and will require RPL as a second treatment.The third indication for RPL is to excise residual retroperitoneal masses following primary chemotherapy. Models to predict the presence of residual viable tumor, rather than necrosis only, at the time of surgery have been developed. If the orchiectomy specimen contained no teratoma, the tumor markers normalize after three or four courses of chemotherapy, and if the residual mass on computerized tomography scan is less than 2 cm in diameter, the rate of viable tumor may be low enough to omit RPL. In this way, the greater morbidity often associated with post-chemotherapy RPL may be avoided.

ISSN:0963-0643    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Promising early results have been reported with periurethral collagen injections in the treatment of incontinence after radical prostatectomy. However, a significant proportion of patients does not benefit from this minimally invasive option. Recently, the results of longer follow-up studies have become available in some series. Investigators have also attempted to identify the prognostic factors of success. This review reports the latest advances on periurethral collagen injections in the treatment of incontinence after radical prostatectomy.

ISSN:0963-0643    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Small hormone-active benign tumors are considered as clear indication for laparoscopic adrenalectomy. Laparoscopy resection of pheochromocytomas is still a controversial issue, but recent data have shown that the specific risks of pheochromocytoma surgery are not increased by the laparascopic approach. The majority of endoscopic adrenalectomies are performed via the transperitoneal route, but there is growing interest in the retroperitoneoscopic approach. The advantages and disadvantages of each endoscopic approach have to be weighed carefully, but the final decision will also depend on the experience of the surgeon. Several retrospective studies have compared laparoscopy with open surgery. There is general agreement that laparoscopy is superior to open surgery since it is associated with less pain, a shorter hospital stay, and more rapid return to normal activities, and also yields the best cosmetic and long-term results. Partial adrenalectomy may be indicated for bilateral pheochromocytoma, and also has advantages for patients with aldosterone-producing adenomas. The feasibility of laparoscopic partial adrenalectomy has been demonstrated. Laparoscopic intraoperative ultrasonography is valuable in selected cases. The already low morbidity of laparoscopic adrenalectomy can be reduced further by using needlescopic techniques.

ISSN:0963-0643    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Laparoscopic donor nephrectomy was developed to remove disincentives to live donation. It has been demonstrated to decrease the length of hospitalization, postoperative pain, time to convalescence and activity, while providing an optimal cosmetic result. Initial reports suggest that laparoscopic donor nephrectomy is feasible and equivalent to open donor nephrectomy.

ISSN:0963-0643    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0963-0643    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Because trauma is an unplanned event, guidelines for managing patients sustaining upper urinary tract injury must already exist in the surgeon's mind before laying eyes on the injured patient. In order to simplify and standardize the evaluation and treatment of such patients, urologists have applied a system of staging paradigms and treatment algorithms, analogous to systems successfully used in the less chaotic arena of, for example, urologic oncology. Advancements in imaging modalities, improvements and renovations of surgical technique, and critical review of outcomes data have impacted on the management of genitourinary trauma and will be likely to influence the way we treat trauma patients in the future.

ISSN:0963-0643    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Urological prostheses have been available and widely used for the past two decades. The use of penile prostheses, artificial urinary sphincters, and testicular implants for genitourinary reconstruction for erectile dysfunction, incontinence, and orchiectomy have been successful, widely used and of low morbidity. More recently designed devices, innovations in implantation techniques, and improved intraoperative and postoperative care have resulted in the successful worldwide use of these prosthetic devices.

ISSN:0963-0643    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Preliminary data have shown that composite reservoirs consisting of gastric segments in combination with ileum or colon may reduce metabolic problems. Orthotopic neobladders are the most natural way to reconstruct the urinary bladder and are a safe option in selected male and female patients. Experimental and preliminary clinical data about new methods using autologous muscle transfer and tissue engineering are promising.

ISSN:0963-0643    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

There have been some suggestions for changes in technique and investigations of the quality of life. As experience has grown, there have been increasing numbers of reports of complications. Careful attention to technique, especially in nerve-sparing cystectomy and orthotopic cystoplasty may reduce the rate of incontinence. Increasing awareness of quality of life issues should improve preoperative counselling of patients, especially those whose underlying condition is not life-threatening.

ISSN:0963-0643    

出版商:OVID    

年代:1999

数据来源: OVID