Complications of Minimally Invasive Treatments for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia
Kevin R. Loughlin in Complications of Urologic Surgery and Practice, 2007
The bladder neck usually constitutes the primary source of arterial bleeds, as it houses the prostatic division of the inferior vesical arteries. When exposed, these pulsatile bleeding vessels must be immediately fulgurated. It would also be prudent to re-examine this site at the termination of the procedure to prevent delayed identification of a postoperative hemorrhage site. Caution should be taken during fulguration as to prevent damage to surrounding structures or perforation of bladder or urethral mucosa. Intra-operative venous bleeding can generally be managed with cauterization. Additionally, contraction of the prostatic capsule itself during the course of resection will aid in tamponading this bleeding. In the setting of venous sinus bleeding, a different course of action must be undertaken. In this setting, further cauterization may only serve to intensify the degree of bleeding, as the vessel defect will be exacerbated.
Sexually Transmitted Diseases
Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Treatment of condyloma is influenced by size/number/location of lesions, cost, side effects, patient preference and provider experience. Excision, cryotherapy and fulguration of small lesions can be done in the outpatient setting. Larger or multiple lesions may necessitate a deeper level of sedation. Overall clearance rates for surgical techniques range from 60%–90% with recurrence rates of 20%–30%.19,68 Eradiation of visible condyloma may reduce but probably does not eliminate HPV infectivity. A variety of topical agents are currently used to treat condyloma including podophyllin, fluorouracil, imiquimod and sinecatechins. Imiquimod modifies the local immune response by increasing the local production of interferon and sequestration of activated T lymphocytes into the infected area. It is applied three nights per week to the perianal area. Treatment is typically for 16 weeks. The main side effect is local skin irritation that may result in patient non-compliance. Use of imiquimod following destruction of lesions has been shown to decrease recurrence.69,70 Podofilox is an antimitotic drug that destroys the lesions with clearance rates from 28% to 74%.71 Although used, no agents have been approved for intra-anal canal use as results so far have not been as favourable as for perianal use.72
Electrosurgical Principles In Gastrointestinal Endoscopy
John P. Papp in Endoscopie Control of Gastrointestinal Hemorrhage, 2019
There are three basic electrosurgical modes; cut, fulgurate, and desiccate. The word “coagulation” or “coag” can mean either fulguration or desiccation. Electrosurgical cutting is defined as sparking to tissue with a cutting effect. Fulguration is defined as sparking to tissue to produce necrosis without a cutting effect. Electrosurgical desiccation is defined as necrosing tissue by directly applying the electrosurgical electrode to the tissue so that there is no sparking and no cutting effect.
The diagnostic challenge of suspicious or positive malignant urine cytology findings when cystoscopy findings are normal: an outpatient blue-light flexible cystoscopy may solve the problem
Published in Scandinavian Journal of Urology, 2021
Marie Andersson, Marthe Berger, Karsten Zieger, Per-Uno Malmström, Mats Bläckberg
Fifty millilitres of HAL was instilled in the urinary bladder 1 hour before cystoscopy. At two of the centres, 10 ml 2% lidocaine (w/v) was included in the instillation as an anaesthetic. At one centre, a local anaesthetic was injected submucosally in the case of fulguration. Otherwise, only gel-anaesthesia including lidocaine was instilled into the urethra. Cystoscopy was performed by a urologist specialising in bladder cancer and with long experience of PDD. Flexible high-definition videoscopes were used with a blue and white light source from Richard Wolf or Karl Storz, Germany. The urethra and the bladder were first examined in white light, and tumours and any suspicious areas were recorded. The examination was then carried out in blue light, and fluorescing lesions were documented. Biopsies were obtained through the flexible cystoscope with oval cup biopsy forceps (EndoJaw, Olympus) with a working diameter of 1.9 mm. The biopsies were histologically examined by the local pathologist. Small tumours or localised CIS were fulgurated by electrocautery or diode laser in the same session. In the case of negative BLFC, it was possible to obtain selective cytology from the upper urinary tract using ureteral catheters 5 Charrier, length 100 cm (Boston Scientific). Any adverse events were recorded. After cystoscopy, the patients were asked to describe their individual experience as either ‘Painful’ or ‘Not painful’. They were also asked whether they would have preferred to do the BLFC procedure at the outpatient clinic or the TURB procedure in the operating theatre under general anaesthesia.
An evaluation of the pharmacotherapy for interstitial cystitis
Published in Expert Opinion on Pharmacotherapy, 2018
Laura L. Giusto, Patricia M. Zahner, Daniel A. Shoskes
Even though the AUA guidelines do not suggest that cystoscopy is a necessary component of the evaluation of patients with IC/BPS, it may offer a diagnostic and therapeutic opportunity for those patients who have these lesions and should be considered when the phenotype suggests a bladder-specific subtype. For example, we strongly believe that the subset of IC/BPS patients who have Hunner’s lesions benefit from initial cystoscopy and fulguration and that this should be the first step of their care path [70]. Fulguration has been shown to be provide relief when patients are symptomatic and may save the patient from needing further interventions, such as mediations or installation therapies of the subtype most likely to respond to low-dose cyclosporine therapy. Of new therapies in development, the SHIP1 agonists have the most interesting combination of efficacy and safety profile so far. Phase II studies were successful with low side effect profile and phase III studies are currently underway.
Post vasectomy chronic pain: are we under diagnosing vasitis? A case report and review of the literature
Published in The Aging Male, 2020
Adam Jones, Mahmood Vazirian-Zadeh, Yih Chyn Phan, Wasim Mahmalji
What is unique to this case is that the patient had a reversal of vasectomy and subsequent re-do vasectomy. To our best knowledge, no previous case reports of acute vasitis have had a vasectomy. Vasectomy is one of the most common urological procedures performed, there are around 500,000 performed in the United States each year [5], Trinick et al. [6] reported rates of vasectomy at 34% in patients in their 60s. It is the most effective male contraceptive method and has a success rate of 98% [7]. The procedure is typically performed under local anaesthesia and involves excision of at least 1 cm of the vas deferens. Electrocautery fulguration to the remaining ends of the vas deferens, or placement of sutures, is a technique used to prevent recanalization [5]. Complications associated with vasectomy include infection, symptomatic hematoma, vasectomy failure and post-vasectomy pain syndrome (PVPS) [8].
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