The Urology Program at Maine Medical Center
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University of California, Irvine School of Medicine Spring 2006 UCI Medical Center Department of Urology 101 THE CITY DRIVE SOUTH ORANGE, CA 92868-5395 N E W S L E T T E R Re-United: The facts about vasectomy reversal "When a man consents to undergo a vasectomy, he is usually instructed that the procedure should be considered Aaron Spitz, MD to be permanent and irreversible.... Nonetheless, even the Assistant Clinical Professor Male Reproductive Medicine most insightful, thoughtful decision can ultimately prove and Surgery wrong. When that decision is a vasectomy, a man may still change his mind." re you considering a vasec- tomy. Therefore, before undergoing a tomy reversal? Thousands vasectomy, a man should be as sure as A of men undergo vasectomy possible that he is finished having chil- each year as a permanent means of dren. Nonetheless, even the most birth control, yet for some of these men insightful, thoughtful decision can ulti- life brings unexpected turns, which mately prove wrong. When that deci- leads them to change their mind. For sion is a vasectomy, a man may still Epididymo-vasostomy some, there is a strong desire to have change his mind. sperm travel from the testicle to the another child a few years later. For urethra. It feels like a piece of under- others, there may be a tragic loss of a What is a vasectomy? cooked spaghetti in each side of the child. For many men, a new marriage To understand the vasectomy reversal, scrotum. The sperm are produced in brings a new opportunity for creating a it is important to understand the vasec- the testicle, and then they exit out the family. -
Guidelines on Paediatric Urology S
Guidelines on Paediatric Urology S. Tekgül (Chair), H.S. Dogan, E. Erdem (Guidelines Associate), P. Hoebeke, R. Ko˘cvara, J.M. Nijman (Vice-chair), C. Radmayr, M.S. Silay (Guidelines Associate), R. Stein, S. Undre (Guidelines Associate) European Society for Paediatric Urology © European Association of Urology 2015 TABLE OF CONTENTS PAGE 1. INTRODUCTION 7 1.1 Aim 7 1.2 Publication history 7 2. METHODS 8 3. THE GUIDELINE 8 3A PHIMOSIS 8 3A.1 Epidemiology, aetiology and pathophysiology 8 3A.2 Classification systems 8 3A.3 Diagnostic evaluation 8 3A.4 Disease management 8 3A.5 Follow-up 9 3A.6 Conclusions and recommendations on phimosis 9 3B CRYPTORCHIDISM 9 3B.1 Epidemiology, aetiology and pathophysiology 9 3B.2 Classification systems 9 3B.3 Diagnostic evaluation 10 3B.4 Disease management 10 3B.4.1 Medical therapy 10 3B.4.2 Surgery 10 3B.5 Follow-up 11 3B.6 Recommendations for cryptorchidism 11 3C HYDROCELE 12 3C.1 Epidemiology, aetiology and pathophysiology 12 3C.2 Diagnostic evaluation 12 3C.3 Disease management 12 3C.4 Recommendations for the management of hydrocele 12 3D ACUTE SCROTUM IN CHILDREN 13 3D.1 Epidemiology, aetiology and pathophysiology 13 3D.2 Diagnostic evaluation 13 3D.3 Disease management 14 3D.3.1 Epididymitis 14 3D.3.2 Testicular torsion 14 3D.3.3 Surgical treatment 14 3D.4 Follow-up 14 3D.4.1 Fertility 14 3D.4.2 Subfertility 14 3D.4.3 Androgen levels 15 3D.4.4 Testicular cancer 15 3D.5 Recommendations for the treatment of acute scrotum in children 15 3E HYPOSPADIAS 15 3E.1 Epidemiology, aetiology and pathophysiology -
Thromboprophylaxis in Urological Surgery
EAU Guidelines on Thromboprophylaxis in Urological Surgery K.A.O. Tikkinen (Chair), R. Cartwright, M.K. Gould, R. Naspro, G. Novara, P.M. Sandset, P. D . Violette, G.H. Guyatt © European Association of Urology 2018 TABLE OF CONTENTS PAGE 1. INTRODUCTION 3 1.1 Aims and objectives 3 1.2 Panel composition 3 1.3 Available publications 3 1.4 Publication history 3 2. METHODS 3 2.1 Guideline methodology 3 3. GUIDELINE 4 3.1 Thromboprophylaxis post-surgery 4 3.1.1 Introduction 4 3.1.2 Outcomes and definitions 4 3.1.3 Timing and duration of thromboprophylaxis 4 3.1.4 Basic principles for recommending (or not recommending) post-surgery thromboprophylaxis 5 3.1.4.1 Effect of prophylaxis on key outcomes 5 3.1.4.2 Baseline risk of key outcomes 5 3.1.4.3 Patient-related risk (and protective) factors 5 3.1.4.4 From evidence to recommendations 6 3.1.5 General statements for all procedure-specific recommendations 7 3.1.6 Recommendations 7 3.2 Peri-operative management of antithrombotic agents in urology 14 3.2.1 Introduction 14 3.2.2 Evidence summary 14 3.2.3 Recommendations 14 4. RESEARCH RECOMMENDATIONS 16 5. REFERENCES 16 6. CONFLICT OF INTEREST 18 7. ACKNOWLEDGEMENTS 18 8. CITATION INFORMATION 18 2 THROMBOPROPHYLAXIS - MARCH 2017 1. INTRODUCTION 1.1 Aims and objectives Due to the hypercoagulable state induced by surgery, serious complications of urological surgery include deep vein thrombosis (DVT) and pulmonary embolism (PE) - together referred to as venous thromboembolism (VTE) - and major bleeding [1-4]. -
Effective Endoscopic Holmium Laser Lithotripsy in the Treatment of a Large
Cases and Techniques Library (CTL) E485 The patient was discharged after 15 days with complete resolution of the occlusive Effective endoscopic holmium laser lithotripsy symptoms, and her scheduled chole- in the treatment of a large impacted gallstone cystectomy was canceled. in the duodenum Endoscopy_UCTN_Code_CCL_1AZ_2AD Competing interests: None Fig. 1 Computed tomographic scan shows a large calcified Vincenzo Mirante, Helga Bertani, ring (stone) in the Giuseppe Grande, Mauro Manno, duodenum of an Angelo Caruso, Santi Mangiafico, 87-year-old woman Rita Conigliaro presenting with ab- U.O.C. Gastroenterology and Digestive dominal pain and vomiting of 3 days’ Endoscopy Unit, Nuovo Ospedale Civile duration. Sant'Agostino Estense, Modena, Italy References 1 Reisner RM, Cohen JR. Gallstone ileus: a re- view of 1001 reported cases. Am Surg 1994; 60: 441–446 2 Rodriguez H, Codina C, Girones V et al. Gall- stone ileus: results of analysis of a series of Gallstone ileus is caused by the passage To fragment the stone, we performed an- 40 patients. Gastroenterol Hepatol 2001; – of one or more large gallstones (at least other endoscopic procedure. A holmium 24: 489 494 3 Rigler LG, Borman CN, Noble JF. Gallstone ob- 2.5 cm in size) in the gastrointestinal tract laser (HLS30W Holmium:YAG 30W Laser; struction: pathogenesis and roentgen mani- through a bilioenteric fistula. It accounts Olympus America, Center Valley, Penn- festations. JAMA 1941; 117: 1753 –1759 for 1 % to 4% of all cases of mechanical sylvania, USA) was applied for a total of 4 Goldstein EB, Savel RH, Pachter HL et al. Suc- small-bowel obstruction [1,2]. -
Cystectomy and Neo Bladder Surgery
Form: D-5379 Cystectomy and Neo Bladder Surgery A guide for patients and families Reading this booklet can help you prepare for your surgery, hospital stay and recovery after surgery. We encourage you to take an active role in your care. If you have any questions, please ask a member of your health care team. Inside this booklet page Learning about your surgery ...................................................3 Preparing for surgery ...............................................................5 Your hospital stay ......................................................................9 Getting ready to leave the hospital .........................................17 Your recovery after surgery .....................................................19 Who to call if you have questions ............................................29 When to get medical help ........................................................30 2 Learning about your surgery What is a Cystectomy? Cystectomy is surgery to remove your bladder. This is usually done to control bladder cancer. Depending on the extent of the cancer, the bladder and some surrounding organs may need to be removed. • The prostate gland, seminal vesicles and nerve bundles may also be removed. • The ovaries, fallopian tubes, uterus, cervix and part of the vagina may also be removed. What is a Neo Bladder? Words to know A neo bladder is a pouch made from a Neo means new. piece of your bowel that is placed where A neo bladder is a new bladder. your bladder was removed. A neo bladder is commonly called a pouch, because a piece The pouch acts like a bladder, collecting of your bowel is made into a urine that comes down the ureters from pouch that can store urine. the kidneys. When you pass urine, it The medical name for this is a leaves the pouch through your urethra. -
Comparison of Postoperative Renal Function Between Non-Steroidal
Journal of Clinical Medicine Article Comparison of Postoperative Renal Function between Non-Steroidal Anti-Inflammatory Drug and Opioids for Patient-Controlled Analgesia after Laparoscopic Nephrectomy: A Retrospective Cohort Study Jiwon Han 1 , Young-Tae Jeon 1,2, Ah-Young Oh 1,2 , Chang-Hoon Koo 1, Yu Kyung Bae 1 and Jung-Hee Ryu 1,2,* 1 Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; [email protected] (J.H.); [email protected] (Y.-T.J.); [email protected] (A.-Y.O.); [email protected] (C.-H.K.); [email protected] (Y.K.B.) 2 Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul 03080, Korea * Correspondence: [email protected]; Tel.: +82-31-787-7497 Received: 7 August 2020; Accepted: 9 September 2020; Published: 13 September 2020 Abstract: Non-steroidal anti-inflammatory drugs (NSAIDs) can be used as opioid alternatives for patient-controlled analgesia (PCA). However, their use after nephrectomy has raised concerns regarding possible nephrotoxicity. This study compared postoperative renal function and postoperative outcomes between patients using NSAID and patients using opioids for PCA in nephrectomy. In this retrospective observational study, records were reviewed for 913 patients who underwent laparoscopic or robot-assisted laparoscopic nephrectomy from 2015 to 2017. After propensity score matching, 247 patients per group were analyzed. Glomerular filtration rate (GFR) percentages (postoperative value divided by preoperative value), blood urea nitrogen (BUN)/creatinine ratios, and serum creatinine percentages were compared at 2 weeks, 6 months, and 1 year after surgery between users of NSAID and users of opioids for PCA. -
Vasectomy Reversal (VR)
Vasectomy Reversal (VR) ! Need to know Please read this before your Vasectomy Reversal Preparing for the VR • Do not eat or drink after midnight if your operation is in the morning and not after 7.00am if it is in the afternoon. • Please shave the hair at the front and sides of the scrotum from the base of the penis down. You do not need to shave the pubic hair • Take supportive underpants (not your best) or a jockstrap into the hospital with you and to theatre to wear after the operation. • Arrange a week off work. • Avoid intercourse for two weeks after the operation and heavy lifting for four weeks. REF 0000.0 – 12/15 What to expect during the VR • An infection of the scrotum rarely occurs but if it does, • An incision is placed on each side of the scrotum that will present a few days after the surgery and is apparent are a little larger than those used for the vasectomy. because the pain becomes worse rather than better and the scrotum becomes red. • The vas is a very small muscular tube with a 2mm outer diameter and an inner diameter through which If you experience any of the above complications or sperm flow (the lumen), of less than 1/2mm. Since the have any other problem occur after your VR, please structure is so small, the stitches must be placed very call the Clinic or your Surgeon if outside clinic exactly so that there is minimal scarring. Too much hours. scarring can cause the lumen of the vas to close and the procedure to fail. -
Single Scrotal Incision Orchiopexy - a Systematic Review ______Hugo Fabiano Fernandes Novaes, José Abraão Carneiro Neto, Antonio Macedo Jr, Ubirajara Barroso Júnior
REVIEW Article Vol. 39 (3): 305-311, May - June, 2013 doi: 10.1590/S1677-5538.IBJU.2013.03.02 Single scrotal incision orchiopexy - a systematic review _______________________________________________ Hugo Fabiano Fernandes Novaes, José Abraão Carneiro Neto, Antonio Macedo Jr, Ubirajara Barroso Júnior Section of Pediatric Urology, Division of Urology Bahiana School of Medicine and Federal University of Bahia and Federal University of São Paulo ABSTRACT ARTICLE INFO _________________________________________________________ ___________________ Objective: To conduct a systematic review on single scrotal incision orchiopexy. Key words: Materials and Methods: A search was performed using Pubmed, through which 16 ar- Cryptorchidism; Orchiopexy; ticles were selected out of a total of 133. The following conditions were considered ex- Scrotum; Surgical Procedures, clusion criteria: other surgical methods such as an inguinal procedure or a laparoscopic Operative approach, retractile testes, or patients with previous testicular or inguinal surgery. Results: A total of 1558 orchiopexy surgeries initiated with a transcrotal incision were Int Braz J Urol. 2013; 39: 305-11 analyzed. Patients’ ages ranged between 5 months and 21 years. Thirteen studies used __________________ high scrotal incisions, and low scrotal incisions were performed in the remainder of the studies. In 55 cases (3.53%), there was a need for inguinal incision. Recurrence was ob- Submitted for publication: served in 9 cases, testicular atrophy in 3, testicular hypotrophy in 2, and surgical site in- December 18, 2012 fections in 13 cases. High efficacy rates were observed, varying between 88% and 100%. __________________ Conclusions: Single scrotal incision orchiopexy proved to be an effective technique and is associated with low rates of complications. -
Surgical Management of Male Infertility
6 Surgical Management of Male Infertility Sandro C Esteves, Alaa Hamada, Ashok Agarwal (Sandro C Esteves) tertiary center for male reproduction, CHAPTER CONTENTS potentially surgical correctable conditions were identi- fied in 34.4% of the male partners. Azoospermia is iden- ♦ Surgical Treatment to Improve Sperm Production tified in about one-third of the individuals. Despite the ♦ Reconstructive Surgeries of Ductal System feasibility of reconstructive surgery in only about 30% of ♦ Ejaculatory Duct the azoospermic subgroup, most of the remaining would ♦ Sperm Retrieval Techniques be candidates for sperm retrieval techniques, if enrolled ♦ Preoperative Planning in assisted reproduction programs. These figures are ♦ Operative Procedure clearly shown in Table 1. ♦ Postoperative Care and Results Two major advances have recently occurred in the surgical management of male infertility. The first was the implementation of microsurgery which increased success rates for reconstruction of the reproductive tract. The second was the development of intracytoplasmic INTRODUCTION sperm injection (ICSI) and the demonstration that sper- matozoa retrieved from either the epididymis or the testis nfertility is a common problem in the urologic prac- were capable of fertilization and pregnancy.2,3 Thereafter, Itice. Approximately, 8% of men in reproductive age several sperm retrieval methods have been developed may ask for medical consultation for fertility problems. to collect epididymal and testicular sperm for ICSI in Of these, 1–10% carries conditions that compromise the azoospermic men. Microsurgery was incorporated to this reproductive potential.1 The essential roles of the urolo- armamentarium, either for collection of sperm from the gist in this context are to diagnose, to counsel, to provide epididymis in men with obstructive azoospermia or from medical or surgical treatment whenever possible or to the testicle in those with nonobstructive azoospermia correctly refer the male patient for assisted conception. -
The History of Microsurgery in Urological Practice
Chen-1 The History of Microsurgery in Urological Practice Mang L. Chen1, Gregory M. Buncke2 and Paul J. Turek3 1G.U. Recon, San Francisco, CA, 94114 2The Buncke Clinic, San Francisco, CA 94114 3The Turek Clinic, Beverly Hills, CA 90210 Correspondence to: Mang Chen, MD G.U. Recon 45 Castro St, Suite 111 San Francisco, CA 94114 Tel: 415-481-3980 Email: [email protected] Chen-2 Abstract Operative microscopy spans all surgical disciplines, allowing human dexterity to perform beyond direct visual limitations. Microsurgery started in otolaryngology, became popular in reconstructive microsurgery, and was then adopted in urology. Starting with reproductive tract reconstruction of the vas and epididymis, microsurgery in urology now extends to varicocele repair, sperm retrieval, penile transplantation and free flap phalloplasty. By examining the peer reviewed and lay literature this review discusses the history of microsurgery and its subsequent development as a subspecialty in urology. Keywords: urology, microsurgery, phalloplasty, vasovasostomy, varicocelectomy Chen-3 I. Introduction Microsurgery has been instrumental to surgical advances in many medical fields. Otolaryngology, ophthalmology, gynecology, hand and plastic surgery have all embraced the operating microscope to minimize surgical trauma and scar and to increase patency rates of vessels, nerves and tubes. Urologic adoption of microsurgery began with vasectomy reversals, testis transplants, varicocelectomies and sperm retrieval and has now progressed to free flap phalloplasties and penile transplantation. In this review, we describe the origins of microsurgery, highlight the careers of prominent microsurgeons, and discuss current use applications in urology. II. Birth of Microsurgery 1) Technology The birth of microsurgery followed from an interesting marriage of technology and clinical need. -
Parviz K. Kavoussi, M.D., F.A.C.S. Reproductive Urologist
PARVIZ K. KAVOUSSI, M.D., F.A.C.S. REPRODUCTIVE UROLOGIST www.AustinFertility.com www.AustinVasecomyCenter.com www.WestlakeIVF.com www.AustinMensHealth.com WESTLAKE LOCATION: 300 BEARDSLEY LANE Building B, SUITE 200 AUSTIN, TX 78746 SOUTH AUSTIN LOCATION: 4303 JAMES CASEY, SUITE B AUSTIN, TEXAS 78745 ROUND ROCK LOCATION: 7700 CAT HOLLOW DRIVE, SUITE 106 ROUND ROCK, TEXAS 78681 Phone: (512) 444-1414 EXT 2 Fax: (512) 441-1202 POSTDOCTORAL TRAINING THE UNIVERSITY OF VIRGINIA HEALTH SCIENCES CENTER. Charlottesville, Virginia. Fellowship- Reproductive Urology/Andrology – Male Infertility, Sexual Medicine, and Microsurgery (Vasectomy Reversals/Sperm Retrievals). National Institute of Health funded fellow. July 2008-June 2010. BAYLOR SCOTT & WHITE MEMORIAL HOSPITAL AND HEALTH SCIENCES CENTER. Temple, Texas. Residency- Urology- July 2004-June 2008. General Surgery July 2002-June 2004 EDUCATION THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON. Galveston, Texas. Doctor of Medicine. August 1998-May 2002. BAYLOR UNIVERSITY. Waco, Texas. Bachelor of Arts, degree in Biology. August 1994-May 1998. BOARD CERTIFICATION The American Board of Urology ACADEMIC APPOINTMENTS • Adjunct Assistant Professor. Department of Urology. University of Texas Health Sciences Center at San Antonio. September 2015-present. • Adjunct Assistant Professor. Department of Psychology, Division of Neuroendocrinology and Motivation. University of Texas at Austin. March 2013- present. SPECIALTY CREDENTIALS RAMSES. Credentialed in Robot Assisted Microsurgery in Urology/Robot Assisted Vasectomy Reversals by RAMSES (Robot Assisted Microsurgical and Endoscopic Society). Winter Haven Hospital & University of Florida. April 2011. LABORATORY EXPERIENCE • Basic science laboratory research in the Department of Urology at University of Virginia funded via NIH training grant. July 2008-June 2010. • Non-human primate surgery at the Michael E. -
(Part 1): Management of Male Urethral Stricture Disease
EURURO-9412; No. of Pages 11 E U R O P E A N U R O L O G Y X X X ( 2 0 2 1 ) X X X – X X X ava ilable at www.sciencedirect.com journa l homepage: www.europeanurology.com Review – Reconstructive Urology European Association of Urology Guidelines on Urethral Stricture Disease (Part 1): Management of Male Urethral Stricture Disease a, b c d Nicolaas Lumen *, Felix Campos-Juanatey , Tamsin Greenwell , Francisco E. Martins , e f a c g Nadir I. Osman , Silke Riechardt , Marjan Waterloos , Rachel Barratt , Garson Chan , h i a j Francesco Esperto , Achilles Ploumidis , Wesley Verla , Konstantinos Dimitropoulos a b Division of Urology, Gent University Hospital, Gent, Belgium; Urology Department, Marques de Valdecilla University Hospital, Santander, Spain; c d Department of Urology, University College London Hospital, London, UK; Department of Urology, Santa Maria University Hospital, University of Lisbon, e f Lisbon, Portugal; Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK; Department of Urology, University Medical Center Hamburg- g h Eppendorf, Hamburg, Germany; Division of Urology, University of Saskatchewan, Saskatoon, Canada; Department of Urology, Campus Biomedico i j University of Rome, Rome, Italy; Department of Urology, Athens Medical Centre, Athens, Greece; Aberdeen Royal Infirmary, Aberdeen, UK Article info Abstract Article history: Objective: To present a summary of the 2021 version of the European Association of Urology (EAU) guidelines on management of male urethral stricture disease. Accepted May 15, 2021 Evidence acquisition: The panel performed a literature review on these topics covering a time frame between 2008 and 2018, and used predefined inclusion and exclusion criteria Associate Editor: for the literature to be selected.