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2.
Urol Int ; 78(3): 198-201, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17406126

RESUMO

AIM: To assess operative and functional outcomes, including morbidity, after using the trans-obturator tape for stress incontinence. PATIENTS AND METHODS: The first 24 consecutive patients undergoing trans-obturator tape insertion in a single centre were included in this retrospective study. All patients were female with a mean age of 63 (range 40-83) years. Fifteen patients (62.5%) suffered from pure stress incontinence, and 9 patients (37.5%) had mixed incontinence. Of the latter, 2 patients also had nocturnal enuresis. Each patient was followed up for between 3 and 12 months postoperatively and again at 36 months. The patients were assessed by clinical examination, ultrasound for residual urinary volume, and subjective satisfaction which was assessed at 3 and 12 months. At 36 months, all patients completed a validated incontinence questionnaire (International Consultation on Incontinence Questionnaire: ICIQ) which assessed female lower urinary tract symptoms and their impact on the quality of life. RESULTS: All operations were performed under epidural anaesthesia in day surgery, and the mean operative time was 20 (range 15-38) min. Nineteen patients (79.2%) showed significant improvement postoperatively, with 16 of those (66.6%) being completely cured of their incontinence. The remaining 5 patients (20.8%) were considered to have had failed procedures. There were no vascular, bladder, or urethral injuries. One patient had perforation of the vaginal fornix, and 3 patients developed vaginal erosion. CONCLUSIONS: The trans-obturator tape is a safe and effective treatment for stress incontinence and has a low morbidity after a 3-year follow-up period; however, it should only be performed by clinicians with the relevant surgical expertise and experience in treating female incontinence.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
3.
Eur J Surg Oncol ; 33(7): 824-31, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17317082

RESUMO

AIMS: To review the management of Wilms' tumour. METHODS: A search of the literature was performed using the PubMed database (1966 to May 2006) with the search terms 'Wilms' and either 'tumour/tumor' or 'cancer' or 'carcinoma'. This was augmented by manual searches of publications. FINDINGS: The success of clinical trials in Wilms' tumour patients over the past 30 years has led to an overall survival of 85% and the introduction of less aggressive chemotherapeutic regimes for patients. Large randomised controlled trials have been published on the management of Wilms' tumour by various collaborative groups, including the National Wilms' Tumour Study Group (NWTSG) in North America and the Société Internationale d'Oncologie Pédiatrique (SIOP) plus the United Kingdom Children's Cancer Study Group (UKCCSG) in Europe. CONCLUSIONS: Controversy exists as to the best approach to the management of these children with regard to neoadjuvant chemotherapy. Challenges remain in the identification of histological and molecular risk factors for the stratification of treatment intensity.


Assuntos
Neoplasias Renais/terapia , Tumor de Wilms/terapia , Terapia Combinada/tendências , Humanos , Resultado do Tratamento
5.
Postgrad Med J ; 82(964): 89-94, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16461470

RESUMO

Priapism is a pathological condition of penile erection that persists beyond, or is unrelated to, sexual stimulation. Pathologically and clinically, two subtypes are seen-the high flow (non-ischaemic) variety and the low flow (ischaemic) priapism. The low flow type is more dangerous, as these patients are susceptible to greater complications and the long term recovery of erectile function is dependent on prompt and urgent intervention. Many of the causes of priapism are medical, including pharmacological agents, and as such, priapism should be considered as a medical and surgical emergency.


Assuntos
Priapismo/terapia , Adulto , Fatores Etários , Algoritmos , Criança , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Priapismo/diagnóstico , Priapismo/etiologia , Recuperação de Função Fisiológica
6.
Surg Oncol ; 14(2): 91-104, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15993579

RESUMO

Prostate cancer is one of the most commonly diagnosed and potentially devastating cancers in men, throughout the world. However, the clinical manifestation of this disease varies greatly, from indolent tumours, requiring little or no treatment, to those aggressive cancers which require radical therapies. Prostate cancer, like all other cancers, develops and progresses as a consequence of an accumulation of genetic changes. While several putative genes have been isolated for the development of breast, ovarian and colon cancer, the aetiology and pathogenesis of prostate cancer remains poorly understood. In this review, we discuss important genetic markers in early, metastatic and hormone refractory prostate cancer which may, in the future, be used as markers for diagnosis and prognosis, as well as targets for therapeutic intervention.


Assuntos
Neoplasias da Próstata/genética , Biomarcadores Tumorais , Perfilação da Expressão Gênica , Marcadores Genéticos , Predisposição Genética para Doença/genética , Humanos , Masculino , Mutação , Polimorfismo Genético , Neoplasias da Próstata/fisiopatologia
7.
Postgrad Med J ; 81(954): 232-5, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15811886

RESUMO

Autonomic dysreflexia is an important clinical diagnosis that requires prompt treatment to avoid devastating complications. The condition may present itself to all members of medical and surgical specialties, who may not be accustomed to treating it. It is the clinician's responsibility to have a basic understanding of the pathophysiology of the condition and the simple steps required to treat it.


Assuntos
Disreflexia Autonômica/terapia , Doença Aguda , Disreflexia Autonômica/diagnóstico , Disreflexia Autonômica/etiologia , Emergências , Tratamento de Emergência , Humanos
9.
Int J Clin Pract ; 57(9): 848, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14686581

RESUMO

Benign intratesticular cysts are rare, but recognition is essential to prevent unnecessary surgical intervention. The diagnostic dilemma is to differentiate these cysts from testicular malignancy. As they are extremely uncommon, experience of their management is limited and controversial. We present a case of a simple intratesticular cyst and discuss the diagnostic and management principles.


Assuntos
Cistos/diagnóstico por imagem , Doenças Testiculares/diagnóstico por imagem , Idoso , Cistos/terapia , Humanos , Masculino , Doenças Testiculares/terapia , Ultrassonografia
11.
Int J Clin Pract ; 57(4): 353, 2003 May.
Artigo em Inglês | MEDLINE | ID: mdl-12800474

RESUMO

Testicular torsion is a surgical emergency that requires prompt exploration if testicular viability is to be maintained. Although rare, it is essential to be aware that it may occur despite previous fixation (orchidopexy). Testicular torsion occurring after previous orchidopexy is rare, but recognition of this possibility is essential to prevent testicular infarction and subsequent orchidectomy. During scrotal exploration a wide variety of methods for orchidopexy exist. We present a case of testicular torsion despite previous fixation and discuss the merits of various techniques available for orchidopexy.


Assuntos
Torção do Cordão Espermático/cirurgia , Técnicas de Sutura , Doença Aguda , Adulto , Emergências , Humanos , Masculino , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
13.
Hosp Med ; 63(8): 456-9, 2002 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12212415

RESUMO

Testicular torsion is a true vascular emergency-prompt diagnosis and surgical management is critical. If treatment is not instigated within 4-6 hours of the onset of pain, irreversible testicular infarction may result, necessitating orchidectomy. This review presents the key features, management principles and medicolegal considerations of this serious condition.


Assuntos
Torção do Cordão Espermático , Diagnóstico Diferencial , Humanos , Jurisprudência , Masculino , Torção do Cordão Espermático/diagnóstico por imagem , Torção do Cordão Espermático/etiologia , Torção do Cordão Espermático/cirurgia , Ultrassonografia
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