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The Veterans Health Administration (VHA) is the largest health care system in the United States, serving more than 8.9 million Veterans each year.1 It is estimated that sixty percent of all medical residents train within the 168 Veterans Affairs (VA) Medical Centers, making the VA the largest provider of healthcare training in the United States.1 Within the VA system, the Minneapolis VA Health Care System is one of the largest training programs. Many leaders in Urology have trained or served at the Section of Urology within the Minneapolis VA.
Hinman Syndrome is a rare disease with urodynamic findings and clinical course that resemble neuropathic bladder and no neuropathic etiology. Diffusion Tensor Imaging (DTI) is a special magnetic resonance imaging (MRI) technique that has recently been used for peripheral nerves but shown to be applicable for evaluation of lumbosacral plexus. Our aim was to evaluate the lumbosacral plexus using DTI, which was not previously performed in Hinman Syndrome.
Radical prostatectomy after vascular-targeted photodynamic therapy (VTP) with TOOKAD® : feasibility, early and intermediate results
and objectives: vascular-targeted photodynamic therapy with TOOKAD® (VTP) is a new therapeutic option for localized prostate cancer (PCa) management. The objectives are to assess the feasibility of radical prostatectomy (RP) after VTP and describe functional and oncological outcomes.
It is exciting to see studies such as this one in which elegant technology was applied to improve medical decision making by using presumably more accurate means of prediction. In this case the example is machine learning to predict stone-free status after single session shock wave lithotripsy to treat ureteral stones. If the idea of seeing what machine learning can do for decision making does not excite you, just watch AlphaGo (DeepMind, London, United Kingdom) on Netflix®!
The authors attempted to develop and validate a decision support model to predict treatment success after a single session of lithotripsy in patients with ureteral stones. They included 15 factors in decision making. While the stone characteristics included in the model, such as stone bulk, density and depth from the skin, have been significant in impacting fragmentation following lithotripsy, renal function, too, is a logical inclusion. However, the impact of patient characteristics like age, gender or body mass index on fragmentation following lithotripsy have been variable.
It is unfortunate that Gold and Ende have misinterpreted the findings of our study in an attempt to support the integral theory. We believe the integral theory has no scientific validity and consider it a fallacy.
We congratulate the authors for accurately obtaining and presenting these data in clear, easy to understand images. Unfortunately their conclusion, ie the data support the notion that the mid urethral sling mechanism of action is dynamic urethral compression, is incorrect.
Reply by the Authors: Shock-wave Lithotripsy for Pediatric Patients: Which Nomogram Can Better Predict Postoperative Outcomes?
The prediction of the success rate of SWL is an important issue, especially for pediatric patients. Therefore, clinicians should use these nomograms more often in daily practice to improve surgical planning. In our study, we compared the accuracy of the Onal and Dogan nomograms. We demonstrated that both nomograms are effective and independent predictors of stone-free rate. We used objective variables such as gender, age, stone size, number of stones, stone localization, and history of previous treatment.
Comparison of Post-Radical Cystectomy Ileus Rates Using GIA-80 versus GIA-60 Intestinal Stapler Device
To assess the impact on recovery of bowel function using an 80 mm versus 60 mm gastrointestinal anastomosis (GIA) stapler following radical cystectomy and urinary diversion (RC/UD) for bladder cancer.
Re: Shock-wave Lithotripsy for Pediatric Patients: Which Nomogram Can Better Predict Postoperative Outcomes? From Yanaral F, Ozgor F, Savun M, Agbas A, Akbulut F, Sarilar O
We read with great interest the article from Yanaral et Colleagues.1
Deputy Editor of Female Urology, Urodynamics, Incontinence, and Pelvic Floor Reconstructive Surgery: Craig Comiter
Dr. Comiter received his undergraduate degree from Harvard College, and his medical degree from Harvard Medical School. He stayed in Boston for his residency, serving as resident in general surgery at the Brigham and Women's Hospital, and then completed his urology residency at the Harvard Program in Urology. In 1998, Dr. Comiter served as Clinical Instructor and Fellow in Neurourology and Urodynamics at the University of California in Los Angeles.
This rapid review with practice recommendations on the treatment and prevention of recurrent lower urinary tract infections in women is timely as the number of women affected by this condition, especially the older group, is rapidly growing in all of our practices. The authors should be congratulated for their large and detailed search of the best available literature on this topic and for offering a succinct algorithm of the favored alternatives for rUTI prevention and treatment. Notably, a quick glance at reference 3 pointing out the lack of consensus in the definition of rUTIs, and at the quality rating (AMSTAR 2) column in table 3 documenting the “low or critically low” level of evidence in the presented data in 20 of 23 reviews, should be more than sufficient to convince the reader and the international scientific community of the vast gaps in knowledge of rUTIs.
Recurrent lower urinary tract infections in women are a frustrating problem for patient and provider. Patients suffer with these infectious episodes, often at inconvenient times, and have very bothersome symptoms. Repeat courses of antibiotics put them at risk for yeast vaginitis and gastrointestinal disturbances including C. difficile colitis. These women also suffer from constant worry about when their next infection is going to strike.
Urinary stone disease is a growing and important public health problem in the United States. Tundo et al report the results of a cross-sectional analysis of data from the 2007 to 2012 NHANES, the gold standard for nationally representative health estimates. Focusing on younger adults, the authors compared the prevalence of self-reported stone disease by gender, finding an equal prevalence of stones (approximately 1/16) among men and women. These findings persisted after controlling for important potential confounders.
Distal urethroplasty and glanuloplasty procedure can be suitable for all types of glanular / subcoronal hypospadias
To correct all types of glanular/subcoronal hypospadias, we performed surgery named the distal urethroplasty and glanuloplasty procedure (DUG procedure). We analyzed cases that we have experienced.
There are many possible causes of painful urination, or dysuria, including bacterial infections and health conditions that place extra pressure on the bladder. Fortunately, most of these potential causes are highly treatable. Learn more about 10 causes of dysuria here, as well as when to see a doctor.
The objective of this study was to investigate nationwide survival outcomes in men with localized prostate cancer managed on active surveillance.
To report 6-month efficacy and safety outcomes with selective bladder denervation in women with refractory OAB.
Active surveillance (AS) for intermediate-risk prostate cancer (PCa) is controversial. Many AS programs are limited to grade group (GG) 1 (Gleason 6) and PSA<10 ng/ml. However, recent guidelines state that AS can be considered for limited GG2 (Gleason 3+4), despite limited data on outcomes. Our objective was to compare prostatectomy outcomes between subgroups of intermediate-risk versus low-risk PCa.