Hand-assisted laparoscopic suturing: reconstruction.

Reconstructive techniques performed using open, laparoscopic, or hand-assisted techniques depend on the surgeon's ability to approximate tissues and secure bleeding vessels safely and efficiently. The indications for hand-assisted suturing include hemostasis, diaphragmatic and visceral repair, and reconstruction. The equipment required includes a standard laparoscopic needle driver, sutures with noncutting needles, and the handaccess device.

Populations at high risk for prostate cancer.

Although prostate cancer tends to be a slow-growing neoplasm affecting older men, there is clearly a subset of patients at high risk for developing early and possibly more aggressive disease. This group of high-risk patients includes men with a family history of prostate cancer and various histologic features such as PIN and ASAP identified on an initial biopsy. Black American men have a much higher risk of developing prostate cancer when compared with white men and especially Asian men.

Lower urinary tract symptoms in the older male.

Lower urinary tract symptoms (LUTS) are common in older men and include urinary frequency, urgency, nocturia and slow stream. Traditionally, this symptom complex has been called benign prostatic hypertrophy or prostatism, yet such symptoms may also result from detrusor over-activity and/or excessive urine output. Clinical assessment of older men with LUTS is based on a careful history, a clinical examination and a check of the postvoid residual, with urodynamic studies reserved for select individuals.