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Urinary Tract Calculi VI: Surgical Management01:25

Urinary Tract Calculi VI: Surgical Management

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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 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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Urinary Bladder01:23

Urinary Bladder

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The urinary bladder is a hollow, muscular sac that temporarily stores urine before it is expelled from the body. It can hold approximately 600 mL of urine prior to micturition. The bladder is retroperitoneal and located behind the pubic symphysis in the pelvic floor.
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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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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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Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care01:30

Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care

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A healthcare provider can diagnose a urinary tract infection (UTI) through several methods:Medical History and Symptoms: The provider will take a detailed medical history and ask about symptoms such as frequent urination, burning sensation during urination, and lower abdominal pain.Urinalysis: A clean-catch urine sample is collected in a sterile container and tested for the presence of bacteria, white blood cells (leukocytes), nitrites, blood, and protein. The presence of leukocytes and...
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Latest Evidence on Post-Prostatectomy Urinary Incontinence.

Mauro Gacci1,2, Cosimo De Nunzio3, Vasileios Sakalis4

  • 1Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy.

Journal of Clinical Medicine
|February 11, 2023
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Summary

Post-prostatectomy urinary incontinence (PPI) is a common complication after prostate cancer surgery. Management strategies range from lifestyle changes and medication to surgical interventions like slings or artificial urinary sphincters.

Keywords:
PPIantimuscarinicsartificial urinary sphincterbeta-3 agonistsduloxetine trans-obturator slingspad testpost prostatectomy incontinenceprostate cancerradical prostatectomyrobotic prostatectomyurinary incontinencevoiding diary

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Area of Science:

  • Urology
  • Oncology
  • Surgical Science

Background:

  • Radical prostatectomy is a primary treatment for prostate cancer.
  • Persistent urinary incontinence (PPI) is a significant adverse event following surgery.
  • Understanding PPI is crucial for improving patient quality of life.

Purpose of the Study:

  • To conduct a comprehensive literature review on post-prostatectomy urinary incontinence (PPI).
  • To synthesize current knowledge on PPI prevalence, etiology, diagnosis, and management.
  • To provide expert consensus on addressing PPI in men.

Main Methods:

  • Systematic literature search on non-neurogenic lower urinary tract symptoms, focusing on PPI.
  • Expert panel review of gathered data.
  • Analysis of prevalence, timing, and multifactorial etiology of PPI.

Main Results:

  • Prevalence and timing data for PPI are highly variable.
  • PPI etiology is multifactorial, influenced by patient, functional, and surgical factors.
  • Diagnostic approaches include medical history, physical exam, validated questionnaires, voiding diaries, and pad tests.

Conclusions:

  • Conservative management involves lifestyle interventions and urinary containment.
  • Pharmacological options include antimuscarinics, beta-3 agonists, and duloxetine for overactive bladder symptoms.
  • Surgical options for stress urinary incontinence (SUI) include slings for mild-to-moderate cases and artificial urinary sphincters for moderate-to-severe cases.