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Urologic Clinics of North America

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https://www.readbyqxmd.com/read/29169456/urinary-diversion-nutritional-evolution-and-surgical-revolution
#1
EDITORIAL
Michael S Cookson
No abstract text is available yet for this article.
February 2018: Urologic Clinics of North America
https://www.readbyqxmd.com/read/29169455/re-creating-the-urinary-tract-an-art-derived-from-science
#2
EDITORIAL
Samir S Taneja
No abstract text is available yet for this article.
February 2018: Urologic Clinics of North America
https://www.readbyqxmd.com/read/29169454/secondary-tumors-after-urinary-diversion
#3
REVIEW
Roger Li, Janet E Baack Kukreja, Ashish M Kamat
It has been known that urinary diversions juxtaposing the urinary and intestinal tracts lead to increased incidence of secondary malignancies. Although tumorigenesis in ureterosigmoidostomies follows the typical course from adenomas to adenocarcinomas, secondary malignancies arising from isolated intestinal diversions are much more heterogeneous. Research over the last half century has unveiled patterns of incidence and progression, while also uncovering possible mechanisms driving the neoplastic changes. In this review, we summarize the current understanding of these unique tumors, with the hope that the knowledge gained may shed light on the etiologies of other cancers arising from the urinary and intestinal tracts...
February 2018: Urologic Clinics of North America
https://www.readbyqxmd.com/read/29169453/surgical-complications-of-urinary-diversion
#4
REVIEW
Christopher B Anderson, James M McKiernan
Urinary diversion (UD) with an intestinal segment has significant risks of short- and long-term complications. With modern reporting criteria, understanding of the true prevalence and spectrum of these complications has improved. Methods to minimize early postoperative complications include enhanced recovery pathways, restricted intraoperative fluid protocols, and referral to high-volume centers. With long-term follow-up after UD, the risk of complications steadily rises. Late surgical complications include ureterointestinal anastomotic strictures, urolithiasis, and stomal issues...
February 2018: Urologic Clinics of North America
https://www.readbyqxmd.com/read/29169452/robotic-cystectomy-with-intracorporeal-urinary-diversion-review-of-current-techniques-and-outcomes
#5
REVIEW
Tyler M Thress, Michael S Cookson, Sanjay Patel
This article reviews the current techniques and outcomes of robot-assisted radical cystectomy with totally intracorporeal urinary diversion. Discussion includes techniques for port placement and methods for urinary diversion for neobladder, ileal conduit, and one case of continent cutaneous diversion. The outcomes analyzed include operative time, estimated blood loss, transfusion rate, conversion to open surgery, and early or late postoperative complications.
February 2018: Urologic Clinics of North America
https://www.readbyqxmd.com/read/29169451/continent-cutaneous-diversion
#6
REVIEW
Shane M Pearce, Siamak Daneshmand
Techniques in continent cutaneous urinary diversion (CCUD) have evolved significantly over the last 30 years resulting in several well-established procedures. CCUD is well suited for patients in whom the urethra cannot be used for orthotopic diversion due to preexisting incontinence, radiation damage, or malignancy. Reservoirs are constructed with adherence to basic principles of continent urinary diversion, including the use of detubularized bowel in a spherical conformation for pouch creation with either ileum or the right colon...
February 2018: Urologic Clinics of North America
https://www.readbyqxmd.com/read/29169450/orthotopic-urinary-diversion-for-women
#7
REVIEW
Dimitar V Zlatev, Eila C Skinner
Orthotopic neobladder is a viable option for women undergoing cystectomy for bladder cancer, with excellent oncologic outcomes and a low incidence of urethral recurrence. Careful patient selection is important, as is developing a clear understanding by the patient and her family in what to expect with an orthotopic diversion. Surgical technique is also important in optimizing functional outcomes, such as continence, sexual function, and decreased rate of vaginal fistula formation, and urinary retention.
February 2018: Urologic Clinics of North America
https://www.readbyqxmd.com/read/29169449/male-neobladder
#8
REVIEW
Eugene J Pietzak, Timothy F Donahue, Bernard H Bochner
Successful outcome with orthotopic neobladders begins in the preoperative phase with appropriate patient selection and extensive patient counseling. Meticulous attention to surgical and oncological principles is required to optimize neobladder outcomes. Long-term follow-up is needed not only for oncological purposes but also to monitor for the late complications, such as ureterointestinal strictures, renal deterioration, infections, and voiding dysfunction.
February 2018: Urologic Clinics of North America
https://www.readbyqxmd.com/read/29169448/conduit-urinary-diversion
#9
REVIEW
Daniel J Lee, Mark D Tyson, Sam S Chang
This review summarizes the salient aspects of the ileal conduit with 3 pedagogical objectives in mind: (1) to describe the surgical steps emphasizing important surgical principles, (2) to provide insight on various preoperative and postoperative considerations, and (3) to summarize the risks of the long-term complications and quality of life. We aim to inform a broad medical readership.
February 2018: Urologic Clinics of North America
https://www.readbyqxmd.com/read/29169447/metabolic-and-nutritional-consequences-of-urinary-diversion-using-intestinal-segments-to-reconstruct-the-urinary-tract
#10
REVIEW
Joshua D Roth, Michael O Koch
Intestinal segments in various forms have been used to reconstruct the urinary tract since the mid-1800s. Currently, many different forms of continent and incontinent diversion options exist. Incorporating bowel mucosa within the urinary tract leads to predictable metabolic and nutritional consequences. The use of ileum or colon can cause a hyperchloremic metabolic acidosis, vitamin B12 deficiency, osteoporosis, fat malabsorption, urinary calculi, and ammoniagenic encephalopathy. Due to metabolic and nutritional consequences associated with the use of jejunum and gastric segments, the use of these bowel segments is not recommended...
February 2018: Urologic Clinics of North America
https://www.readbyqxmd.com/read/29169446/tissue-engineering-and-conduit-substitution
#11
REVIEW
Scott C Johnson, Zachary L Smith, Bryan S Sack, Gary D Steinberg
Radical cystectomy (RC) with urinary diversion is associated with significant morbidity, much of which arises from the interposition of bowel segments in the urinary system. A tissue-engineered alternative for urinary diversion could dramatically reduce the perioperative and long-term morbidity associated with RC. Attempts at developing a tissue-engineered incontinent urinary conduit (TEUC) have involved mechanical scaffolds and promoting tissue growth within them. Despite some preclinical success, significant obstacles remain before a TEUC is ready for clinical use...
February 2018: Urologic Clinics of North America
https://www.readbyqxmd.com/read/29169445/advances-in-pediatric-urinary-diversion
#12
REVIEW
Jeffrey D Browning, Heidi A Stephany
Pediatric urinary diversion is performed for a unique set of indications with many options to consider. Although surgical intervention has decreased in necessity overall due to advances in expectant management, it remains an important tool. There are many options and various factors to consider in choosing the right type of diversion for an individual and these patients require lifelong follow-up with a pediatric urologist and eventually an adult urologist. This article provides a detailed review of the most relevant techniques used by pediatric urologists for urinary diversion...
February 2018: Urologic Clinics of North America
https://www.readbyqxmd.com/read/29169444/urinary-diversion-in-renal-transplantation
#13
REVIEW
Mohamed Eltemamy, Alice Crane, David A Goldfarb
Renal transplantation involving anatomically or functionally altered recipient urinary reservoirs is a challenging procedure. Initial reports discouraged kidney transplantation in patients with urinary diversion due to inferior outcomes. However, more recent studies have shown that although there are more infectious complications, patients with urinary diversions have comparable long-term graft survival with those with native anatomy. Careful preoperative assessment of these candidates is mandatory. Unique technical and surgical concepts must be considered before embarking on transplanting this specific cohort of kidney transplantation candidates...
February 2018: Urologic Clinics of North America
https://www.readbyqxmd.com/read/29169443/perioperative-preparation-and-nutritional-considerations-for-patients-undergoing-urinary-diversion
#14
REVIEW
Jessie R Gills, Jeffrey M Holzbeierlein
Patients undergoing urinary diversion are at high risk for complications in the perioperative period. The exact cause of these complications remains poorly defined but is likely multifactorial. Current efforts to optimize patients in the perioperative period, including prehabilitation, smoking cessation, recognition and treatment of comorbid conditions and malnutrition, immunonutrition supplementation, carbohydrate loading, and prevention of known complications and implementation of enhanced recovery after surgery pathways, seem beneficial in helping to improve outcomes in this at-risk population...
February 2018: Urologic Clinics of North America
https://www.readbyqxmd.com/read/29169442/quality-of-life-and-urinary-diversion
#15
REVIEW
Scott M Gilbert
Health-related quality-of-life outcomes after urinary diversion vary significantly. Preserving and even improving health-related quality of life are highly relevant to urinary diversion. Life after urinary diversion is fundamentally different than before.
February 2018: Urologic Clinics of North America
https://www.readbyqxmd.com/read/29169441/patient-selection-and-counseling-for-urinary-diversion
#16
REVIEW
Elysia Sophia Spencer, Matthew D Lyons, Raj S Pruthi
Patient selection and preoperative counseling are critical aspects of determining which urinary diversion to perform and should be emphasized at each stage of preoperative planning. The surgeon must have a thorough understanding of the patient's disease process, functional and psycho-emotional status, and social support network so that they can set appropriate expectations. It is also crucial to have a multidisciplinary team of individuals who are experienced with all aspects of urinary diversion care, including ostomy nurses, nurse navigators, and urologic surgeons skilled at teaching and trouble-shooting self-catheterization for continent cutaneous diversion and orthotopic diversion in the setting of hypercontinence...
February 2018: Urologic Clinics of North America
https://www.readbyqxmd.com/read/29107281/prostate-cancer
#17
EDITORIAL
Marc A Bjurlin, Samir S Taneja
No abstract text is available yet for this article.
November 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/29107280/castration-resistant-prostate-cancer-an-algorithmic-approach
#18
REVIEW
Kelly Stratton, Michael Cookson
Since 2010, 5 new agents have been approved for advanced prostate cancer treatment. The American Urologic Association (AUA) published guidelines for the management of castration-resistant prostate cancer in 2013. These guidelines identify 6 index patients to consider when selecting the most appropriate treatment. No comparative trials have provided an approach to optimize the sequencing of these drugs. For the urologist, incorporating the guidelines into clinical practice typically requires a multidisciplinary team...
November 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/29107279/approach-to-the-patient-with-high-risk-prostate-cancer
#19
REVIEW
Matthew Mossanen, Ross E Krasnow, Paul L Nguyen, Quoc D Trinh, Mark Preston, Adam S Kibel
Men classified as having high-risk prostate cancer warrant treatment because durable outcomes can be achieved. Judicious use of imaging and considerations of risk factors are essential when caring for men with high-risk disease. Radical prostatectomy, radiation therapy, and androgen deprivation therapy all play pivotal roles in the management of men with high-risk disease, and potentially in men with metastatic disease. The optimal combinations of therapeutic regimens are an evolving area of study and future work looking into therapies for men with high-risk disease will remain critical...
November 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/29107278/the-role-of-local-therapy-for-oligometastatic-prostate-cancer-should-we-expect-a-cure
#20
REVIEW
Rajesh Nair, Benjamin W Lamb, Nicolas Geurts, Omar Alghazo, Wayne Lam, Nathan Lawrentschuk, Declan G Murphy
The role of local treatment in oligometastatic prostate cancer remains contentious. Treatment of the prostate in metastatic disease may confer benefit, but prospective data are lacking. With improvements in treatments, aggressive strategies directed at metastases have increasingly become of clinical interest. Current evidence suggests good local control can be achieved; however, further data are required to determine overall cancer outcomes. This article evaluates the evidence available and consider whether local treatment of oligometastatic disease is a feasible, safe, and a positive strategy in this disease cohort...
November 2017: Urologic Clinics of North America
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