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Complications of open aortofemoral bypass
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Erectile dysfunction (ED) has been reported in up to 80% of patients with occlusive aortoiliac disease; however, there are many nonvascular causes in this patient population for ED including age, hormonal, neuropathic, diabetes, medication, urologic, or alcohol/hepatic causes. Five to fifteen percent of patients with ED are primarily from inadequate pelvic perfusion.10,13 While up to 60% of patients report some deterioration of penile function (including those who reported some decreased function preoperative), 25–37% of patients develop new erectile dysfunction after ABF, which is thought to be iatrogenic.32,66,67
General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
The MRI shows multiple metastases causing spinal cord compression at T12 to L3 levels. Meanwhile, his PSA returns as 3000 ng/mL. What is the immediate management?If there is an isolated metastasis, a decompression laminectomy can be performed. However, depending on the local infrastructure or availability of emergency spinal surgery, surgery may not be recommended.In such cases and for patients with multiple metastases, Dexamethasone (8 mg bd) and radiotherapy are an alternative treatment.Urgent referral to the urology MDT should be made to plan treatment of the prostate cancer.
Multiple Sclerosis, Transverse Myelitis, Tropical Spastic Paraparesis, Progressive Multifocal Leukoencephalopathy, Lyme Disease
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Michele Fascelli, Howard B. Goldman
Initial assessment should characterize urologic symptoms and voiding dysfunction. Insight into temporal and spatial details, protective absorbent pad use, fluid intake, and quality of life (QOL) should be solicited.9 One should identify the presence or absence of urologic complications: upper or lower urinary tract infection, hematuria, and stones. Past medical and surgical history are mandatory; urologic pathologies like BPH or stress incontinence are common in older populations and may confound the neuro-urologic profile. Note current medications, as many drugs may affect bladder function. It is critical to recognize the presentation of a young patient with unexplained urologic symptoms. Every effort should be made to elicit neurologic symptoms suggestive of MS, and prompt referral is mandatory.20,21
Association between body mass index, metabolic syndrome and common urologic conditions: a cross-sectional study using a large multi-institutional database from the United States
Published in Annals of Medicine, 2023
Maria Camila Suarez Arbelaez, Sirpi Nackeeran, Khushi Shah, Ruben Blachman-Braun, Isaac Bronson, Maxwell Towe, Abhishek Bhat, Robert Marcovich, Ranjith Ramasamy, Hemendra N. Shah
We assessed the potential associations between BMI thresholds and MS with urologic conditions, using the following diagnoses and ICD-10 codes: type 2 DM (E11), overweight and obesity (E66), essential (primary) hypertension (I10) and disorders of lipoprotein metabolism and other lipidaemia (E78). We additionally determined the percentage of each cohort that had potentially complicated comorbid conditions, including ischaemic heart diseases (I20-25), alcohol related disorders (F10) and nicotine dependence (F17). We determined associations with urologic conditions if they had a diagnosis code for any of the following diseases: stones (N20-23), ureteral cancer (C66), kidney cancer (C64), bladder cancer (C67), OAB (N32.81), prostate cancer (C61), male hypogonadism (E29.1), male ED (N52) and BPH (N40).
The Effectiveness of Jet (Needle-Free) Injector to Provide Anesthesia in Child Circumcision under Local Anesthesia
Published in Journal of Investigative Surgery, 2022
Needle phobia is an important problem not only for children but also for adult patients. Peng et al. used needle-free jet injectors in their study for adult circumcision and reported that no-needle technique was safe, effective and well tolerated [4]. They stated that the jet injector can be used for patients with needle phobia. In urology practice, jet injectors have been also used in vasectomy. It has been reported that the local anesthesia application with the jet injector has high acceptance rates by the patient [5]. However, there are publications in the literature that state that injection with a jet injector is more painful than conventional needle injection [11]. Harding et al. used jet injectors for intracavernosal injection of alprostadil in patients with erectile dysfunction. They found that the procedure was more painful with lower effectiveness than the conventional needle method. They reported that patients preferred the conventional needle injection method [7]. In this study we aimed to evaluate the effectiveness of anesthesia provided by the use of jet injectors for children who rejected needle injection in the circumcisions performed under local anesthesia. However, it was observed that local anesthetic injection with a jet injector could not provide sufficient analgesia required for a comfortable circumcision.
Villous adenoma of the urethra
Published in Baylor University Medical Center Proceedings, 2021
Katherine E. Dowd, Derek Yang, Harry Papaconstantinou, Erin T. Bird
An 89-year-old white man presented to the urology clinic with increasing difficulty voiding, with a slowed stream, dysuria, and gross hematuria. He had a past urologic history significant for brachytherapy in 2004 and postbrachytherapy transurethral resection of the prostate in 2006, with an undetectable prostate-specific antigen level since treatment and minimal voiding complaints. He had no prior smoking history, had right nephrectomy previously for a nonfunctioning kidney, and had coronary artery disease. His physical exam revealed bilateral descended testes, no meatal stenosis, and no suprapubic fullness or tenderness. Urine culture was obtained in the clinic, and the patient was treated for urinary tract infection with culture-specific antibiotics for 7 days. His creatinine was at baseline.