Rapid excision of massive localized lymphedema of the male genitalia with vessel sealing device.

Introduction: To present a series of patients who underwent surgical treatment for massive localized lymphedema (MLL) of the male genitalia and explore the utility of the LigaSure hemostatic vessel sealing device (VSD) for resection of advanced cases.

Materials And Methods: Although conservative and microsurgical treatments have been reported, MLL of the male genitalia requires open surgical resection with primary reconstruction. We reviewed our prospectively maintained database of all lymphedema excisions performed between January 2007 and December 2014 comparing resection with Bovie electrocautery to resection with the LigaSure VSD.

A randomized trial of urodynamic testing before stress-incontinence surgery.

Background: Urodynamic studies are commonly performed in women before surgery for stress urinary incontinence, but there is no good evidence that they improve outcomes.

Methods: We performed a multicenter, randomized, noninferiority trial involving women with uncomplicated, demonstrable stress urinary incontinence to compare outcomes after preoperative office evaluation and urodynamic tests or evaluation only. The primary outcome was treatment success at 12 months, defined as a reduction in the score on the Urogenital Distress Inventory of 70% or more and a response of "much better" or "very much better" on the Patient Global Impression of Improvement.

Retropubic versus transobturator midurethral slings for stress incontinence.

Background: Midurethral slings are increasingly used for the treatment of stress incontinence, but there are limited data comparing types of slings and associated complications.

Methods: We performed a multicenter, randomized equivalence trial comparing outcomes with retropubic and transobturator midurethral slings in women with stress incontinence. The primary outcome was treatment success at 12 months according to both objective criteria (a negative stress test, a negative pad test, and no retreatment) and subjective criteria (self-reported absence of symptoms, no leakage episodes recorded, and no retreatment).

Behavioral therapy to enable women with urge incontinence to discontinue drug treatment: a randomized trial.

Background: Women with urge urinary incontinence are commonly treated with antimuscarinic medications, but many discontinue therapy.

Objective: To determine whether combining antimuscarinic drug therapy with supervised behavioral training, compared with drug therapy alone, improves the ability of women with urge incontinence to achieve clinically important reductions in incontinence episodes and to sustain these improvements after discontinuing drug therapy.

Design: 2-stage, multicenter, randomized clinical trial conducted from July 2004 to January 2006.

Treatment of urinary calculi in the combat zone.

Renal colic is a common condition among deployed soldiers in the Middle East. Eight percent of all admissions to the jump package of the 21st Combat Support Hospital in Mosul, Iraq, during Operation Iraqi Freedom involved patients with renal colic and urinary stones. The majority of patients were treated successfully with primary care measures.

Ultrasonography in a forward-deployed military hospital.

Military medical units must be flexible and mobile to keep up with maneuver units on the modern battlefield. The requirements for unit mobility and maneuverability preclude bulky advanced radiologic imaging support, such as computed tomography or magnetic resonance imaging systems. Portable sonography is rapid, reliable, efficient, and user-friendly; it markedly expanded the diagnostic capability of our forward-deployed combat support hospital during Operation Iraqi Freedom.

The association of body mass index and prostate-specific antigen in a population-based study.

Background: Recent studies of men with prostate carcinoma suggest that obesity may be associated with more advanced-stage disease and lower overall survival rates. One possible link between body mass index (BMI) and prostate carcinoma prognosis may be disease ascertainment. Prostate-specific antigen (PSA) is widely used to screen for prostate carcinoma.

Central renal stab wounds: treatment with augmented fibrin sealant in a porcine model.

Purpose: We determined whether fibrin sealant augmented by an absorbable bolster could salvage kidneys with major, centrally located stab wounds.

Materials And Methods: A grade 4 renal injury was created in 16 commercial swine via a 1.5 cm sagittal, centrally located, through-and-through right renal laceration.

Fibrin sealant for the management of genitourinary injuries, fistulas and surgical complications.

Purpose: We report our preliminary experience with the use of fibrin sealant to manage iatrogenic urinary tract injuries, complex urinary fistulas, and urological surgical complications.

Materials And Methods: Topical fibrin sealant was used in 19 patients for iatrogenic urinary tract injury during gynecological or general surgical procedures (7), complex urinary fistulas (5) or urological surgical complications (7).

Results: Successful resolution of the injury, fistula or complication was attained after a single application of fibrin sealant in the 18 patients (94.

Single dose levofloxacin prophylaxis for prostate biopsy in patients at low risk.

Purpose: We determine if a single 500 mg. oral tablet of levofloxacin represents adequate prophylaxis for patients at low risk who undergo transrectal prostate biopsy.

Materials And Methods: From April 2000 to May 2001 we prospectively evaluated 400 consecutive men who underwent transrectal needle biopsy of the prostate after a single 500 mg.