Marc Goldstein, MD, D.Sc
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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. -
Examining Male Infertility
C O Examining Male Infertility N T I N U Susanne Quallich I N G n increasing number of Problems of male infertility can seem like minor issues within the couples seek evaluation larger realm of urology. But many male infertility diagnoses can be and treatment for infer- successfully treated, allowing the couple to conceive naturally or E tility, especially as more with minimal medical assistance. Some patients presenting with male D Acouples delay childbearing in infertility can have more significant disease. Treatments for male U order to establish their careers. A infertility will continue to progress, and as an increasing number of male factor alone is the cause of couples seek infertility services, the need to provide basic informa- C infertility in up to 20% of infer- tion grows as well. A tile couples and a contributing factor in another 30% to 40% of T all couples presenting for infertil- reproductive technologies. influence on overall male develop- I ity evaluations (American It is common to recommend ment and growth. Spermatogenesis O Urological Association [AUA] & an infertility evaluation in couples is driven by testosterone production N American Society for Reproduc- with a history of unprotected in the Leydig cells of the testes. tive Medicine (ASRM), 2001a; intercourse for at least 12 months Under the influence of luteinizing ASRM, 2004). Problems with without a pregnancy and with hormone (LH) and follicle-stimulat- infertility affect approximately 6.1 attempts to time intercourse with ing hormone (FSH), which are million people in the United ovulation, although this length of released from the anterior pituitary, States, or roughly 10% of the time can be shortened as the the testes begin to produce sperm in reproductive-age population. -
Robotic Surgery for Male Infertility
Robotic Surgery for Male Infertility Annie Darves-Bornoz, MD, Evan Panken, BS, Robert E. Brannigan, MD, Joshua A. Halpern, MD, MS* KEYWORDS Robotic surgical procedures Infertility Male Vasovasostomy Varicocele KEY POINTS Robotic-assisted approaches to male infertility microsurgery have potential practical benefits including reduction of tremor, 3-dimensional visualization, and decreased need for skilled surgical assistance. Several small, retrospective studies have described robotic-assisted vasectomy reversal with com- parable clinical outcomes to the traditional microsurgical approach. Few studies have described application of the robot to varicocelectomy, testicular sperm extrac- tion, and spermatic cord denervation. The use of robotic-assistance for male infertility procedures is evolving, and adoption has been limited. Rigorous studies are needed to evaluate outcomes and cost-effectiveness. INTRODUCTION with intraperitoneal and pelvic surgery. On the other hand, many of the theoretic and practical ad- Up to 15% of couples have infertility, with approx- 1,2 vantages offered by the robotic approach are imately 50% of cases involving a male factor. A highly transferrable to surgery for male infertility: substantial proportion of men with subfertility have surgically treatable and even reversible etiologies, High quality, 3-dimensional visualization is such as a varicocele or vasal obstruction. The essential for any microsurgical procedure. introduction of the operating microscope revolu- Improved surgeon ergonomics are always desir- tionized the field of male infertility, dramatically able, particularly given the surgeon morbidity improving visualization of small, complex associated with microsurgery.3 anatomic structures. The technical precision Filtering of physiologic tremor can improve pre- afforded has improved operative outcomes across cision during technically demanding micro- the board. -
Urology Supplemental Guide
Supplemental Guide for Urology Supplemental Guide: Urology April 2020 1 Supplemental Guide for Urology TABLE OF CONTENTS Introduction .................................................................................................................................... 3 Patient Care .................................................................................................................................... 4 Patient Evaluation ........................................................................................................................ 4 Peri-Procedural Care .................................................................................................................... 6 Endoscopic Procedures ............................................................................................................... 8 Open Procedures ......................................................................................................................... 9 Minimally Invasive Procedures (Laparoscopic and Robotic) ..................................................... 10 Office-Based Procedures ........................................................................................................... 12 Medical Knowledge ...................................................................................................................... 14 Clinical Medical Knowledge........................................................................................................ 14 Clinical Reasoning ..................................................................................................................... -
The Acute Scrotum 12 Module 2
Department of Urology Medical Student Handbook INDEX Introduction 1 Contact Information 3 Chairman’s Welcome 4 What is Urology? 5 Urology Rotation Overview 8 Online Teaching Videos 10 Required Readings 11 Module 1. The Acute Scrotum 12 Module 2. Adult Urinary Tract Infections (UTI) 22 Module 3. Benign Prostatic Hyperplasia (BPH) 38 Module 4. Erectile Dysfunction (ED) 47 Module 5. Hematuria 56 Module 6. Kidney Stones 64 Module 7. Pediatric Urinary Tract Infections (UTI) 77 Module 8. Prostate Cancer: Screening and Management 88 Module 9. Urinary Incontinence 95 Module 10. Male Infertility 110 Urologic Abbreviations 118 Suggested Readings 119 Evaluation Process 121 Mistreatment/Harassment Policy 122 Research Opportunities 123 INTRODUCTION Hello, and welcome to Urology! You have chosen a great selective during your Surgical and Procedural Care rotation. Most of the students who take this subspecialty course enjoy themselves and learn more than they thought they would when they signed up for it. During your rotation you will meet a group of urologists who are excited about their medical specialty and feel privileged to work in it. Urology is a rapidly evolving technological specialty that requires surgical and diagnostic skills. Watch the video “Why Urology?” for a brief introduction to the field from the American Urological Association (AUA). https://youtu.be/kyvDMz9MEFA Urology at UW Urology is a specialty that treats patients with many different kinds of problems. At the UW you will see: patients with kidney problems including kidney cancer -
PROGRAM BOOK EXECUTIVE COMMI EE Urological Society, Inc
2013 Annual Meeting March 8 – 10, 2013 Urological Society, Inc. Great Wolf Lodge Wisconsin Dells, Wisconsin HOWARD B. GOLDMAN, MD, FACS Center for Quality and Patient Safety | Glickman Urologic and Kidney Institute The Cleveland Clinic | Cleveland, OH GLENN M. PREMINGER, MD Chief, Division of Urologic Surgery Duke University Medical Center | Durham, NC GRANVILLE LLOYD, MD University of Wisconsin | Madison, WI STEPHEN Y. NAKADA, MD Chairman, Dept. of Urology University of Wisconsin | Madison, WI FEATURED SPEAKERS FEATURED MICHAEL GURALNICK, MD Medical College of Wisconsin | Milwaukee, WI PROGRAM BOOK EXECUTIVE COMMIEE Urological Society, Inc. Wisconsin Urological Society Executive Committee President David R. Paolone, MD Madison, WI President-Elect Jay I. Sandlow, MD Milwaukee, WI Secretary/Treasurer John V. Kryger, MD Milwaukee, WI Immediate Past President James A. Wright, MD Fond du Lac, WI Wisconsin Representative to NCS Board of Directors John V. Kryger, MD Milwaukee, WI 2013 Program Planning Committee David R. Paolone, MD John V. Kryger, MD Executive Director Wendy J. Weiser Managing Director Sue O’Sullivan Associate Director Mary Tully Message from the President Dear WUS Members, As president of the Wisconsin Urological Society, it is my privilege to welcome you to the annual meeting in the Wisconsin Dells, March 8 – 10, 2013. The two-day academic format has worked well the past two years, and we are continuing it for the 2013 meeting to maximize the amount of educational content provided by the meeting. Our guest speakers for the meeting are Dr. Howard Goldman from the Cleveland Clinic Foundation and Dr. Glenn Preminger of Duke University. Dr. Goldman is a specialist in female urology and will be lecturing on management of overactive bladder and surgical treatment of stress urinary incontinence. -
Efficacy of Vasectomy Reversal According to Patency for The
International Journal of Impotence Research (2012) 24, 202 -- 205 & 2012 Macmillan Publishers Limited All rights reserved 0955-9930/12 www.nature.com/ijir ORIGINAL ARTICLE Efficacy of vasectomy reversal according to patency for the surgical treatment of postvasectomy pain syndrome JY Lee1, JS Chang1, SH Lee1, WS Ham1, HJ Cho2,TKYoo2, KS Lee3, TH Kim3, HS Moon4, HY Choi4 and SW Lee4 This study was conducted to assess outcomes (according to patency) of vasectomy reversal (VR) in qualified patients with postvasectomy pain syndrome (PVPS). A total of 32 patients with PVPS undergoing VR between January 2000 and May 2010 were examined retrospectively. Of these, 68.8% (22/32) completed a study questionnaire, either onsite at the outpatient clinic or via telephone interview. Preoperative clinical findings, preoperative and postoperative visual analogue scale (VAS) pain scores, patency and pregnancy rate and overall patient satisfaction were analyzed. For the latter, a four-point rating of (1) cure, (2) improvement, (3) no change or (4) recurrence was used. The mean age was 45.09±4.42 years and the mean period of follow-up was 3.22 years (0.74--7.41). Patency rates were 68.2% (15/22) and pregnancy rates were 36.4% (8/22). The mean VAS was 6.64±1.00 preoperatively and 1.14±0.71 postoperatively (Po0.001). The difference in the mean preoperative and postoperative VAS was 6.00±1.25 (4--8) in the patency group and 4.43±0.98 (3--6) in the no patency group (P ¼ 0.011). A significant difference in procedural satisfaction with surgical outcome was observed between patency and no patency groups (P ¼ 0.014). -
Robotic Surgery: Disruptive Innovation Or Unfulfilled Promise? a Systematic
Surg Endosc and Other Interventional Techniques DOI 10.1007/s00464-016-4752-x Robotic surgery: disruptive innovation or unfulfilled promise? A systematic review and meta-analysis of the first 30 years 1 1 1 1 Alan Tan • Hutan Ashrafian • Alasdair J. Scott • Sam E. Mason • 1 1 1,2 Leanne Harling • Thanos Athanasiou • Ara Darzi Received: 25 August 2015 / Accepted: 11 January 2016 Ó The Author(s) 2016. This article is published with open access at Springerlink.com Abstract (RoM 0.982, 0.936–1.027) and 30-day overall complication Background Robotic surgery has been in existence for rate (RR 0.988, 0.822–1.188). In both comparisons, robotic 30 years. This study aimed to evaluate the overall periop- surgery prolonged operative time (OS: RoM 1.073, erative outcomes of robotic surgery compared with open 1.022–1.124; MIS: RoM 1.135, 1.096–1.173). The benefits of surgery (OS) and conventional minimally invasive surgery robotic surgery lacked robustness on RCT-sensitivity analy- (MIS) across various surgical procedures. ses. However, many studies, including the relatively few Methods MEDLINE, EMBASE, PsycINFO, and Clini- available RCTs, suffered from high risk of bias and inadequate calTrials.gov were searched from 1990 up to October 2013 statistical power. with no language restriction. Relevant review articles were Conclusions Our results showed that robotic surgery hand-searched for remaining studies. Randomised con- contributed positively to some perioperative outcomes but trolled trials (RCTs) and prospective comparative studies longer operative times remained a shortcoming. Better (PROs) on perioperative outcomes, regardless of patient quality evidence is needed to guide surgical decision age and sex, were included. -
Male Genital Surgical Procedures
MALE GENITAL SURGICAL PROCEDURES Male Genital Surgical ProceduresApril 1, 2015 PENIS Asst Surg Anae INCISION Slit of prepuce (complete care) # S567 - newborn ............................................................................................................. 14.35 # S568 - infant .................................................................................................................. 21.50 6 # S569 - adult or child....................................................................................................... 30.256 EXCISION Circumcision - for physical symptomatology only # S573 - for patients aged one year or older .................................................................... 6 179.40 6 # S577 - for infants less than one year of age.................................................................. 6 90.05 6 Note: 1. Circumcision is an insured service only when medically necessary. As such, circumcision performed for ritual, cultural, religious or cosmetic reasons at any age is not an insured service. 2. Circumcision for neonatal phimosis is not an insured service. Z702 Biopsy ...................................................................................................................... 23.55 6 E542 - when performed outside of hospital..........................................................add 11.15 Amputation # S574 - partial ................................................................................................................. 6 170.65 7 # S575 - partial with inguinal glands 1 or 2 -
Advancing Men's Reproductive Health in the US: Current
ADVANCING MEN’S REPRODUC TIVE HEALTH IN THE UNITED STATES Current Status and Future Directions Summary of Scientific Sessions and Discussions September 13, 2010 Atlanta, Georgia Table of Contents Introduction . .4 . Agenda . 7 Summary Report Overview of Chronic Disease Prevention, Health Promotion and Reproductive Health . 9 Overview of Men’s Reproductive Health . 10 CDC’s Past and Current Men’s Reproductive Health Activities . 11 CDC’s Sexual Health Activity . 12 Comprehensive Reproductive Health Services for Men Visiting STD Clinics . 14 Overview of Male Contraception . 15 Overview of Male Infertility . 17 Fertility Preservation in the Male Patient with Cancer . 18 Modifiable Lifestyle Issues and Male Reproductive Health . 20 Mental Health Issues in Male Reproductive Health . 22 The Importance of Men’s Reproductive Health on Women’s Health and Fertility . 23 Involving Men in Reproductive Health and Family Planning Services . 24 Panel Perspectives on Men’s Reproductive Health . 25 Attachment 1 Registrants . 32 Attachment 2 References Cited by Presenters and Others . 41 Advancing Men’s Reproductive Health Summary of Scientific essions 3 Introduction This report contains a summary of presentations and discussions from the meeting, “Advancing Men’s Reproductive Health in the United States: Current Status and Future Directions .” The meeting was originally planned to help CDC staff and our Federal colleagues gain insights into the emerging areas of public health activities related to male reproductive health . What began as a “brown bag” seminar for CDC staff quickly developed into a one-day meeting of scientists, program managers, and clinicians . Through word-of-mouth, the Meeting Planning Committee received emails and calls from professionals asking to be included as attendees . -
Fertility Outcome After Repeat Vasoepididymostomy
0022-5347/99/1625-1626/0 THE JOURNAL OF UROLOGY Vol. 162, 1626–1628, November 1999 Copyright © 1999 by AMERICAN UROLOGICAL ASSOCIATION,INC. Printed in U.S.A. FERTILITY OUTCOME AFTER REPEAT VASOEPIDIDYMOSTOMY FABIO F. PASQUALOTTO, ASHOK AGARWAL, MEENA SRIVASTAVA, DAVID R. NELSON AND ANTHONY J. THOMAS, JR.* From the Center for Advanced Research in Human Reproduction and Infertility, and Departments of Urology, and Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio ABSTRACT Purpose: Historically, epididymal obstruction has been treated with surgical reconstruction. We determine whether it is worthwhile for patients to undergo repeat surgical reconstruction after failed vasoepididymostomy or whether they should be advised only to undergo sperm acquisition for assisted reproductive technique. Materials and Methods: A total of 18 patients underwent repeat vasoepididymostomy per- formed by a single urologist (A. J. T.). Cases were divided based on the etiology of obstruction into groups 1—prior vasectomy (4), 2—congenital (7) and 3—inflammatory (7). Data were available regarding time of obstruction between initial and repeat vasoepididymostomy, quality of epidid- ymal fluid, levels of anastomoses, semen analyses at least 12 months after surgery for all 18 men and pregnancy rates based on more than 18 months of followup in 12. Results: Mean patient age at repeat vasoepididymostomy was 40.6 years (50.5, 36 and 39.4 years for groups 1, 2 and 3, respectively). Mean interval between vasectomy and initial vasoepi- didymostomy was 12.3 years (range 10 to 18). Mean interval between initial and repeat vaso- epididymostomy was 19 months (range 12 to 41). Of the patients 10 underwent unilateral and 8 bilateral anastomoses, for a total of 26 repeat anastomoses. -
AUA 2019 Key Words
AUA 2019 Key Words A Biochemical recurrence Biofeedback ACE Biologic predictors Acellular matrix Biomarkers Active surveillance Biopsy Acupuncture Bisphosphonates Adenocarcinoma Bladder Adenoma Bladder augmentation Adenovirus Bladder cancer Adrenal Bladder cells Adrenergic agonists Bladder contraction Adrenergic receptors Bladder dysfunction Adrenoceptor antagonists Bladder exstrophy Adverse events Bladder hyperactivity African Americans Bladder hypertrophy Age Bladder neck Algorithms Bladder neck obstruction Alpha-adrenergic blockade Bladder obstruction Alpha-blockers Bladder reconstruction Alpha-reductase inhibitor Bladder rupture Alpha-subtype selective compounds Bladder smooth muscle Ambiguous genitalia Bladder substitution Analgesia Bladder suspension Anatomy Bone Androgen Botulinum toxin Androgen antagonist BPH Andrology Brachytherapy Anesthesia Brain Angiogenesis Animal model C Antiangiogenesis Cadherin Antibiotics Calcium Antibody Calcium channel blocker Anticholinergics Calculi Antineoplastic agents Cancer Antioxidants Cardiovascular disease Antitumor effect Castration Apoptosis Catheterization Arteries and veins Artificial Cavernous nerve urinary sphincter Assisted Cell lines reproductive technology Cells Augmentation C-fiber Chemokines Autoimmune disease Chemotherapy Azoospermia Chromosomes Clinical protocols B Clinical trial Basic research Clusterin Behavioral modification Combination therapy Benign glands Complementary medicine Biochemical failure Complications Biochemical progression AUA 2019 Key Words Computer assisted