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Urinary Tract Calculi VI: Surgical Management01:25

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Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
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Urinary Tract Calculi III: Medical Management01:30

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The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
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IntroductionIntravenous Urography (IVU) and Retrograde Pyelography (RP) are important diagnostic imaging techniques used to evaluate the urinary system. These methods help identify structural abnormalities, obstructions, and functional issues in the kidneys, ureters, and bladder. Both procedures use iodine-based contrast media to enhance the visibility of urinary tract structures on X-ray images, though they differ in their methods and indications.1. Intravenous Urography (IVU)Intravenous...
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Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations01:26

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Renal calculi, commonly termed kidney stones, are crystalline solid masses that form in the kidneys but can occur at any point within the urinary system, encompassing the kidneys, ureters, bladder, and urethra.The pathophysiology of renal stones involves several key factors: supersaturation of the urine with stone-forming constituents, changes in urine pH, a decrease in urine volume, and the presence of substances that promote or inhibit stone formation.Supersaturation of Urine: This is the...
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Urodynamic Studies: Uroflowmetry01:19

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Uroflowmetry is a non-invasive urodynamic test designed to measure various aspects of urination, including volume, flow rate, and the time to void. This test is crucial for diagnosing and assessing conditions such as bladder outlet obstruction, bladder dysfunction, incomplete bladder emptying, incontinence, and urinary tract blockages caused by benign prostatic hyperplasia (BPH) and urethral strictures.Pre-Test Instructions:Before a uroflowmetry test, patients are typically advised to drink...
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The genitourinary system is critical to maintaining fluid balance, waste elimination, and reproductive function. Nurses play a vital role in assessing this system, beginning with a thorough health history. This process involves gathering patient information, identifying risk factors, and recognizing symptoms of genitourinary disorders. Early detection is vital for timely interventions and management.1. Gathering Patient InformationA complete health history includes the patient’s personal,...
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Have urinary function outcomes after radical prostatectomy improved over the past decade?

Matthew B Clements1, Caroline C Gmelich1, Emily A Vertosick2

  • 1Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.

Cancer
|November 1, 2021
PubMed
Summary

Despite advances in radical prostatectomy, patient-reported urinary function showed no consistent improvement over a decade. While severe incontinence improved, other outcomes like no incontinence worsened, indicating a need for better evaluation of surgical techniques.

Keywords:
patient-reported outcomesprostatectomyurinary functionurinary incontinence

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Area of Science:

  • Urology
  • Surgical Outcomes
  • Patient-Reported Outcomes

Background:

  • Radical prostatectomy (RP) has seen numerous surgical and postoperative care advancements.
  • Despite these changes, consistent improvements in patient-reported functional outcomes after RP are not well-documented.

Purpose of the Study:

  • To evaluate if practice changes over a decade improved patient-reported urinary function after radical prostatectomy.
  • To use radical prostatectomy as an index case for assessing temporal trends in surgical outcomes.

Main Methods:

  • Analysis of 3945 patients undergoing radical prostatectomy from 2008-2019.
  • Assessment of four urinary function outcomes at 6 and 12 months post-surgery using validated instruments.
  • Multivariable logistic regression to identify changes in outcomes correlated with surgical date.

Main Results:

  • No consistent observable improvements in overall urinary function were found over the decade.
  • Good urinary function at 12 months did not improve (P = .087).
  • No incontinence worsened (P = .005), while severe incontinence improved (P = .003).

Conclusions:

  • Despite a decade of surgical and postoperative care advances, only severe incontinence showed measurable improvement.
  • The study highlights a need for systematic evaluation of surgical techniques and patient selection for improved urinary function post-prostatectomy.
  • Current approaches to studying innovations in surgical technique require modification to enhance functional outcomes.