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Prediction of pediatric PCNL outcomes using contemporary scoring systems

Mon, 04/24/2017 - 00:00
To evaluate the applicability of contemporary percutaneous nephrolithotomy (PCNL) scoring systems in pediatric patients and to compare their predictive power for postoperative outcomes.
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Among Active Surveillance Candidates Does Obesity Influence Tumor Aggressiveness and/or Location?

Sat, 04/22/2017 - 00:00
The CDC (Centers for Disease Control and Prevention) estimates that more than a third of Americans are obese. In regard to prostate cancer (PC), obesity is linked to more aggressive cancers and increased PC mortality but a decreased risk of low grade PC.1 Indeed, at nearly every stage of disease obesity makes a more aggressive cancer. Obesity increases the risk of recurrence after surgery and radiation, and even increases the risk of castrate resistant PC after androgen deprivation therapy.1 The lone exception appears to be among men with metastatic castrate resistant PC.
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The optimal settings for non-contact Holmium-YAG stone fragmentation “pop corn” technique

Sat, 04/22/2017 - 00:00
The purpose of this study was to evaluate the “pop-corn” technique with a wide range of holmium laser settings and fiber sizes in a systematic in-vitro assessment.
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The Immediate Management of Pelvic Fracture Urethral Injury: Endoscopic Realignment or Cystostomy?

Sat, 04/22/2017 - 00:00
To determine whether endoscopic realignment or cystostomy provides the best immediate management of pelvic fracture urethral injury (PFUI).
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The utility of axial abdominal imaging after partial nephrectomy for T1 renal cell carcinoma surveillance

Sat, 04/22/2017 - 00:00
The overall recurrence rate of T1 renal cell carcinoma is low. We evaluated abdominal imaging after partial nephrectomy based on current guidelines for T1 renal cell carcinoma surveillance.
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Reply by Authors

Sat, 04/22/2017 - 00:00
The newer alternative approaches to treatment for congenital urological malformation need to be critically assessed and evaluated as recommended by the IDEAL group for the potential benefit of our patients (reference 28 in article). The compassion to treat children and reduce morbidity is the centerpiece of all these endeavors.
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A Laparoscopic Approach is Best for Retroperitoneal Lymph Node Dissection

Sat, 04/22/2017 - 00:00
Retroperitoneal lymph node dissection continues to evolve as a treatment option for men with testicular cancer. While open RPLND remains the standard for surgical removal of retroperitoneal lymph nodes, use of RPLND has declined recently.1 This has been an appropriate decline for cases better managed with surveillance, but the increase in the use of chemotherapy instead of RPLND may be a disservice to our patients given the now recognized long-term consequences of chemotherapy. When faced with the choice between chemotherapy and open RPLND, many young men may choose chemotherapy to avoid the morbidity associated with open surgery.
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A Laparoscopic Approach is Best for Retroperitoneal Lymph Node Dissection

Sat, 04/22/2017 - 00:00
The management of testicular cancer is a model for the successful multidisciplinary approach to a solid malignancy, with a projected 95% survival rate for newly diagnosed cases in 2017. With a high likelihood of cure, investigators have focused on treatment related morbidity and maintaining quality of life, and gained insight into previously underappreciated issues, such as late relapse, reoperation and the long-term sequelae of treatment. Radiation and medical oncologists have relied on prospective randomized trials to test the lower bound of efficacy and establish new treatment paradigms, thereby generating Level 1 evidence.
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Reply by Authors

Thu, 04/20/2017 - 00:00
We agree that more research is needed to solidify the role of the calcium-to-citrate ratio in predicting kidney stone recurrence in children. However, we want to clarify that although patients had received dietary advice, they were not administered pharmacological intervention during the observation period before collection of the 24-hour urine for metabolic profile.
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Editorial Comment

Thu, 04/20/2017 - 00:00
Prognostic factors predicting kidney stone recurrence in the pediatric population are lacking. Management decisions made in pediatric stone formers are often guided by adult data. Children have important differences in urinary risk factors relative to adults.1
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The Nonpalpable Testis: A Narrative Review

Thu, 04/20/2017 - 00:00
While the nonpalpable testis represents only a small portion of all cryptorchid testes, it remains a clinical challenge for pediatric urologists. Many controversies about the best evaluation and management exist. This narrative review serves as an update on what is known about the nonpalpable testis: etiology, pre-operative evaluation, the best surgical management, novel techniques, and ongoing controversies.
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Analysis of Complications of Pelvic Mesh Excision Surgery Using the Clavien-Dindo Classification System

Wed, 04/19/2017 - 00:00
To describe and categorize complications in patients undergoing vaginal mesh excision surgery using the Clavien-Dindo classification system.
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Partial gland treatment of prostate cancer utilizing high-intensity focused ultrasound in the primary and salvage setting: a systematic review

Wed, 04/19/2017 - 00:00
Advances in prostate imaging, biopsy and ablative technologies have been accompanied by growing enthusiasm for partial gland ablation, particularly using high-intensity focused ultrasound (HIFU) for treating prostate cancer. The preservation of non-cancerous prostate tissue and minimizing damage to the neurovascular bundles and external urethral sphincter may improve functional outcomes.
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Predicting non-muscle invasive bladder cancer recurrence and progression in a US population

Wed, 04/19/2017 - 00:00
To assess performance of The European Organization for Research and Treatment of Cancer (EORTC) and Club Urologico Español de Tratamiento Oncologico (CUETO) non-muscle invasive bladder cancer (NMIBC) predictive models compared to current US National Comprehensive Cancer Network (NCCN) treatment guidelines in a US population.
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Reply by Authors

Wed, 04/19/2017 - 00:00
Thank you for your shared interest in US for this patient population. Our findings that the majority of patients who undergo initial US did not go on to require CT was somewhat surprising when looking through the eyes of the urologist. Due to the known limitations of US, urologists often use the information provided by CT (stone size, number, location and density) to help guide management. In addition, the finding of hydronephrosis on ultrasound, which serves as a surrogate for ureteral stone obstruction, is not always predictive of such.
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Editorial Comment

Wed, 04/19/2017 - 00:00
The authors present a single institution, retrospective review of more than 10,000 stone episodes. Overall 20% of subjects underwent renal ultrasound as the first imaging and 80% of this group avoided CT entirely. It is unclear whether these trends are representative of other institutions but they provide an example of what is possible with a commitment to using ultrasound as a first line diagnostic test for stones.
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Home Study Course 2017 Volume 197/198

Mon, 04/17/2017 - 00:00
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Does Peak Urine Flow Rate Predict the Development of Incident Lower Urinary Tract Symptoms in Men with Mild to No Current Symptoms? Results from REDUCE

Mon, 04/17/2017 - 00:00
To determine whether decreased peak urine flow is associated with future incident lower urinary tract symptoms (LUTS) in men with mild to no LUTS.
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This Month in Adult Urology

Thu, 04/13/2017 - 00:00
When partial nephrectomy is planned, conversion to radical nephrectomy is a possibility regardless of surgical approach. With a laparoscopic or robotic approach, complete kidney removal typically can be accomplished without conversion to open surgery. In this retrospective analysis of 1,023 planned robotic partial nephrectomies by Kara et al (page 000) from Cleveland, Ohio conversion to radical nephrectomy was necessary in 32 patients (3.1%).1 Tumor related factors, such as hilar involvement, positive margins or advanced disease stage, were the most common reasons for conversion but failure to improve was the reason in 5 cases.
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This Month in Pediatric Urology

Thu, 04/13/2017 - 00:00
Although typically thought of as an adult issue, management decisions of pediatric conditions, such as varicocele surgery and exposure to gonadotoxins, in childhood and adolescence can have direct consequences as well as long-term effects on fertility. Currently, for these patients the options are limited but there are now advances in fertility preservation which hold great promise.
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