Dianne Sacco

Corticosteroid use after prostate brachytherapy reduces the risk of acute urinary retention.

To evaluate the role of short‐term steroids after prostate brachytherapy to reduce oedema and thus the risk of urinary retention associated with brachytherapy, as this can require surgical intervention and may even result in incontinence.

Repeat Knot Formation in a Patient with an Indwelling Ureteral Stent

A patient treated for nephrolithiasis formed knots in 2 occasions, in 2 separate indwelling ureteral stents. This rare complication may make stent removal difficult. To our knowledge, this is the first case report of repeat knot formation in a single patient.

Minimally Invasive Surgical Treatment for Kidney Stone Disease

Minimally invasive interventions for stone disease in the United States are mainly founded on 3 surgical procedures: extracorporeal shock wave lithotripsy, ureteroscopic lithotripsy, and percutaneous nephrolithotomy. With the advancement of technology, treatment has shifted toward less invasive strategies and away from open or laparoscopic surgery. The treatment chosen for a patient with stones is based on the stone and patient characteristics. Each of the minimally invasive techniques uses an imaging source, either fluoroscopy or ultrasound, to localize the stone and an energy source to fragment the stone. Extracorporeal shock wave lithotripsy uses a shock wave energy source generated outside the body to fragment the stone. In contrast, with ureteroscopy, laser energy is placed directly on the stone using a ureteroscope that visualizes the stone. Percutaneous nephrolithotomy requires dilation of a tract through the back into the renal pelvis so that instruments can be inserted directly onto the stone to fragment or pulverize it. The success of the surgical intervention relies on performing the least invasive technique with the highest success of stone removal.

Ureteral stenting and retrograde pyelography in the office: clinical outcomes, cost effectiveness, and time savings.

OBJECTIVES To examine the clinical outcomes and cost-effectiveness of endourologic procedures performed in the office using standard fluoroscopy and topical anesthesia. METHODS We performed a retrospective review of all patients who underwent primary ureteral stent placement, ureteral stent exchange, or ureteral catheterization with retrograde pyeolography or Bacillus Calmette-Guerin (BCG) instillation under fluoroscopic guidance in the office. For an evaluation of potential time savings, we compared this to a cohort of similar procedures performed in the operating room during the same time period. RESULTS Procedures were attempted in 65 renal units in 38 patients (13 male, 25 female) with a mean age of 62.2 years (range 29.1-95.4 years). Primary ureteral stent placement was successful in 23/24 (95.8%) renal units. Ureteral stent exchange was successful in 19/22 (86.4%) renal units. Ureteral catheterization with retrograde pyelography or BCG instillation was successful in 19/19 (100%) renal units. The total cost savings for the 38 patients in this study, including excess cost from failure in the office, was approximately

Organ conservation in invasive bladder cancer by transurethral resection, chemotherapy and radiation: results of a urodynamic and quality of life study on long-term survivors.

91,496, with an average cost savings of

Positive stone culture is associated with a higher rate of sepsis after endourological procedures

1,551 per procedure. Office-based procedures were associated with a nearly three-fold reduction in total hospital time as a result of reduced periprocedure waiting times. CONCLUSIONS Ureteral stent placement, ureteral stent exchange, and ureteral catheterization can be performed safely and effectively in the office in both men and women. This avoids general anesthesia and provides significant savings of time and cost for both patients and the health care system.