Introduction: As the number of geriatric patients continues to increase, urologists will encounter more elderly patients who require counseling about medical or surgical management of their conditions. In this review we provide a practical pathway for the elderly patient being considered for urological surgery.
Methods: Our review includes preoperative evaluation and assessment for cognition, frailty, functional status, falls, cardiovascular and pulmonary status, and nutritional state.
Elderly urologic patients require the same cautions as used in development of treatment programs for them in other disciplines. Because of potential interference with poor renal function or crossover effects with central or peripheral nervous system, however, many urologic drugs must be titrated appropriately. In treating cancer, erectile dysfunction, incontinence or urinary infection, patient quality of life and life span become dominant factors in making therapeutic decisions, by behavioral change, medication, or surgical intervention.
View Article and Find Full Text PDFIn 1994, under the leadership of the late Dennis Jahnigen, the American Geriatrics Society, with support of the John A. Hartford Foundation, began a project to improve the amount and quality of geriatrics education that surgical and related medical specialty residents receive. The targeted disciplines initially were general surgery, emergency medicine, gynecology, orthopedic surgery, and urology and, later, anesthesiology, ophthalmology, otolaryngology, physical medicine and rehabilitation, and thoracic surgery.
View Article and Find Full Text PDFUrology is one of the surgical specialties that has been most affected by the growing demographic of older adults in the United States. Urological problems are common in elderly people, and care of patients aged 65 and older represents a large proportion of many urologists' practices. However, this has also presented unique challenges to the development of the field of geriatric urology as an identified subspecialty.
View Article and Find Full Text PDFPurpose: To determine tumor response, patterns of relapse, and prognostic indicators in patients followed long-term after combined hormonal radiation therapy of adenocarcinoma of the prostate in men with tumor metastatic to pelvic lymph nodes.
Methods And Materials: Seventy-nine patients with adenocarcinoma of the prostate with pathologically confirmed pelvic lymph node metastases were treated with combined radiation therapy and hormonal therapy. Of these, 55 patients (70%) had T3 disease, with the remainder having earlier-stage disease; 45 (57%) patients had N2 disease (Whitmore-Jewett staging).
Background: The current study was conducted to evaluate the combination of external beam radiation therapy and hyperthermia in the treatment of patients with locally advanced prostate carcinoma.
Methods: Twenty-six patients were treated on a Phase I/II protocol between June 1990 and April 1993. The median age of the patients was 69 years.
Urol Clin North Am
May 2000
Secondary stones, those with no "classic" cause, provide unusual diagnostic and treatment challenges to the urologist. Stones related to medications, to urinary diversions or augmentation, or to presence of foreign bodies within the urinary tract occur rarely. Nevertheless, they represent situations that may be corrected fully by appropriate conservative or procedural therapy, and therefore they must be included in the differential diagnosis of many patients who present with symptoms of urolithiasis.
View Article and Find Full Text PDFThis past year produced some remarkable reports on renal (and other urinary) calculi. Randall's plaques have returned, phosphate relates to insulin and lipid metabolism, and sialic acid is out. Risk factors for astronauts, cystinuric individuals, older and indinavir patients achieve importance.
View Article and Find Full Text PDFObjectives: To assess the safety and efficacy of the Alexandrite laser for intracorporeal lithotripsy of renal and ureteral stones in conjunction with ureterorenoscopy or percutaneous nephrostolithotomy.
Methods: We retrospectively analyzed the records of 137 patients with 169 calculi in 143 renoureteral units who were treated with the Alexandrite laser via a retrograde (91.5%) or antegrade (8.
Purpose: The aim of this investigation was to differentiate between aggregation and crystal growth by studying the structure of oxalate stones at high spatial resolution using recently developed microscopy techniques.
Materials And Methods: Sections from 6 complete human oxalate stones and 4 stone fragments were prepared by ultramicrotomy and examined by both low voltage scanning electron microscopy and atomic force microscopy.
Results: The scanning electron microscopy showed lamellar structures up to 10 microns.
Metabolic evaluation of children with urinary stones begins with analysis of calculi or gravel if at all possible. If no stone is available, radiographic appearances may predict types. Once stone composition is known or suspected, a targeted testing program is performed.
View Article and Find Full Text PDFFour patients with severe ureteral strictures recovered adequate renal and ureteral function after application of an ileal patch graft to the area of stenosis. No metabolic abnormalities resulted from use of the ileal patch graft. Candidates for this type of repair have severe ureteral strictures after prior attempts at repair.
View Article and Find Full Text PDFSix institutions throughout the United States participated in this study. Each center used a multifunctional flat table lithotriptor (Dornier MFL-5000) to treat 658 patients with kidney and upper ureteral stones (766 treatments) and 323 with middle and lower ureteral stones (391 treatments), for a total of 925 patients (1,157 treatments). Some patients received more than 1 treatment (that is the kidney and ureter), for a total of 981 patient events.
View Article and Find Full Text PDFWe report a case of leukemoid reaction associated with tumor recurrence and rapid progression in a patient following resection of a high-grade transitional cell carcinoma of the bladder. The clinical, pathologic, and etiologic features of tumor-associated leukemoid reactions are emphasized. In the setting of recurrent carcinoma, a leukemoid reaction suggests highly aggressive or metastatic disease.
View Article and Find Full Text PDFTo date few studies have described the effects of high-energy shock waves (HESW) on benign, rapidly proliferating cells. In the African clawed toad (Xenopus laevis) model, previously described in vitro fertilization methods were used to study the effects of HESW on zygote cleavage and blastocytosis. Groups of 50 freshly fertilized ova were placed at the bottom of clear ultracentrifuge tubes filled with 5% DeBoers solution, positioned at the f2 focus utilizing the biprismatically split halogen red laser of a Dornier XL-1 experimental lithotripter, and treated using an 80-nF capacitor at various kilovoltages and shock wave (SW) numbers.
View Article and Find Full Text PDFExtracorporeally-perfused rabbit kidneys were exposed to five shock waves at 14 kV on the XL1 Dornier experimental lithotripter (Dornier Medical Systems, Inc., Germering, Germany). While the perfusion flow rate was kept constant, the arterial perfusion pressure was recorded to assess changes in vascular resistance.
View Article and Find Full Text PDFPurpose: This Phase I trial tests the ability of a new hyperthermia device, the transrectal ultrasound probe, to heat the prostate gland, and evaluates the toxicity of transrectal ultrasound hyperthermia (TRUSH) given with concurrent standard external beam irradiation in the treatment of locally-advanced adenocarcinoma of the prostate.
Methods And Materials: Between June, 1990 and August, 1991, 14 patients with American Urological Society Stage C2 or D1 adenocarcinoma of the prostate were treated with TRUSH concurrently with standard external beam radiotherapy to the prostate. Twenty-two heat treatments were delivered in 14 patients; 8 patients received two TRUSH procedures, each separated by 1 week.
We report 4 cases of anastomotic stricture after radical retropubic prostatectomy caused by erosion of suture material used to ligate the dorsal vein complex. In 2 patients there was overlying stone formation. The clinical features of this complication, management options, and means of prevention are reviewed.
View Article and Find Full Text PDFA rupture of a large, tense hydrocele is presented. The patient was chronically treated with steroids for asthma control. Scrotal ultrasound was used to document hydrocele presence, rupture and recurrence.
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