Introduction to Ureteroceles: Presentation, Diagnosis, and Initial Management

2018 ◽  
Author(s):  
Joseph W McQuaid ◽  
David A Diamond
Keyword(s):  
Minimally Invasive ◽  
Key Words ◽  
Treatment Strategy ◽  
Treatment Options ◽  
Significant Proportion ◽  
Single Treatment ◽  
Ectopic Ureterocele ◽  
Initial Management ◽  
Unrealistic Expectation ◽  
Transurethral Incision

The diagnosis and treatment of ureteroceles continue to evolve. Not only are the majority of patients diagnosed prenatally, but a significant proportion of cases can be dealt with in a minimally invasive, endoscopic fashion. Although a single treatment strategy for all ureteroceles is an unrealistic expectation, more valuable to the practicing urologist is an understanding of the variable anatomy and presentation of this entity and an appreciation for the breadth of treatment options at his or her disposal. This, the first of our two reviews on ureteroceles, provides the necessary background.   This review contains 10 figures, 6 tables and 35 references Key words: bladder trigone, cecoureterocele, ectopic ureterocele, extravesical ureterocele, intravesical ureterocele, lower tract approach, obstructed ureterocele, reflux, transurethral incision, transurethral puncture, upper tract approach, ureterocele, ureterocele algorithm

Introduction to Ureteroceles: Presentation, Diagnosis, and Initial Management

2018 ◽  
Author(s):  
Joseph W McQuaid ◽  
David A Diamond
Keyword(s):  
Minimally Invasive ◽  
Key Words ◽  
Treatment Strategy ◽  
Treatment Options ◽  
Significant Proportion ◽  
Single Treatment ◽  
Ectopic Ureterocele ◽  
Initial Management ◽  
Unrealistic Expectation ◽  
Transurethral Incision

The diagnosis and treatment of ureteroceles continue to evolve. Not only are the majority of patients diagnosed prenatally, but a significant proportion of cases can be dealt with in a minimally invasive, endoscopic fashion. Although a single treatment strategy for all ureteroceles is an unrealistic expectation, more valuable to the practicing urologist is an understanding of the variable anatomy and presentation of this entity and an appreciation for the breadth of treatment options at his or her disposal. This, the first of our two reviews on ureteroceles, provides the necessary background.   This review contains 10 figures, 6 tables and 35 references Key words: bladder trigone, cecoureterocele, ectopic ureterocele, extravesical ureterocele, intravesical ureterocele, lower tract approach, obstructed ureterocele, reflux, transurethral incision, transurethral puncture, upper tract approach, ureterocele, ureterocele algorithm

scholarly journals TNF-Alpha Inhibitors for Chronic Urticaria: Experience in 20 Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Freja Lærke Sand ◽  
Simon Francis Thomsen
Keyword(s):  
Side Effects ◽  
Chronic Urticaria ◽  
Treatment Options ◽  
Significant Proportion ◽  
Response Duration ◽  
Immunosuppressive Drugs ◽  
Tnf Alpha ◽  
High Dose ◽  
Duration Of Treatment ◽  
Durable Response

Patients with severe chronic urticaria may not respond to antihistamines, and other systemic treatment options may either be ineffective or associated with unacceptable side effects. We present data on efficacy and safety of adalimumab and etanercept in 20 adult patients with chronic urticaria. Twelve (60%) patients obtained complete or almost complete resolution of urticaria after onset of therapy with either adalimumab or etanercept. Further three patients (15%) experienced partial response. Duration of treatment ranged between 2 and 39 months. Those responding completely or almost completely had a durable response with a mean of 11 months. Six patients (30%) experienced side effects and five patients had mild recurrent upper respiratory infections, whereas one patient experienced severe CNS toxicity that could be related to treatment with TNF-alpha inhibitor. Adalimumab and etanercept may be effective and relatively safe treatment options in a significant proportion of patients with chronic urticaria who do not respond sufficiently to high-dose antihistamines or in whom standard immunosuppressive drugs are ineffective or associated with unacceptable side effects.

scholarly journals EAU, AUA and NICE Guidelines on Surgical and Minimally Invasive Treatment of Benign Prostate Hyperplasia: A Critical Appraisal of the Guidelines Using the AGREE-II Tool

2021 ◽  
pp. 1-10
Author(s):  
Dmitry Enikeev ◽  
Vincent Misrai ◽  
Enrique Rijo ◽  
Roman Sukhanov ◽  
Denis Chinenov ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Treatment Options ◽  
Stakeholder Involvement ◽  
Minimally Invasive Treatment ◽  
Invasive Treatment ◽  
Agree Ii ◽  
Prostate Hyperplasia ◽  
Assessment Score ◽  
Nice Guideline ◽  
Agree Ii Tool

<b><i>Objective:</i></b> To critically appraise the methodological rigour of the clinical practice guidelines (CPGs) vis-à-vis BPH surgery as used by specialist research associations in the US, Europe and UK, and to compare whether the guidelines cover all or only some of the available treatments. <b><i>Methods:</i></b> The current guidelines issued by the EUA, AUA and NICE associations have been analyzed by 4 appraisers using the AGREE-II instrument. We also compared the recommendations given in the guidelines for surgical and minimally invasive treatment to find out which of these CPGs include most of the available treatment options. <b><i>Results:</i></b> According to the AGREE II tool, the median scores of domains were: domain 1 scope and purpose 66.7%, domain 2 stakeholder involvement 50.0%, domain 3 rigor of development 65.1%, domain 4 clarity of presentation 80.6%, domain 5 applicability 33.3%, domain 6 editorial independence 72.9%. The overall assessment according to AGREE II is 83.3%. The NICE guideline scored highest on 5 out of 6 domains and the highest overall assessment score (91.6%). The EAU guideline scored lowest on 4 out of 6 domains and has the lowest overall assessment score (79.1%). <b><i>Conclusions:</i></b> The analyzed CPGs comprehensively highlight the minimally invasive and surgical treatment options for BPH. According to the AGREE II tool, the domains for clarity of presentation and editorial independence received the highest scores. The stakeholder involvement and applicability domains were ranked as the lowest. Improving the CPG in these domains may help to improve the clinical utility and applicability of CPGs.

scholarly journals The Investigation and Management of Adenomyosis in Women Who Wish to Improve or Preserve Fertility

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Jin-Jiao Li ◽  
Jacqueline P. W. Chung ◽  
Sha Wang ◽  
Tin-Chiu Li ◽  
Hua Duan
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Treatment Options ◽  
Management Strategies ◽  
Definitive Treatment ◽  
Surgical Approaches ◽  
Child Bearing ◽  
Fertility Sparing

The management of adenomyosis remains a great challenge to practicing gynaecologists. Until recently, hysterectomy has been the only definitive treatment in women who have completed child bearing. A number of nonsurgical and minimally invasive, fertility-sparing surgical treatment options have recently been developed. This review focuses on three aspects of management, namely, (1) newly introduced nonsurgical treatments; (2) management strategies of reproductive failures associated with adenomyosis; and (3) surgical approaches to the management of cystic adenomyoma.

scholarly journals Diagnosis and initial management in psoriatic arthritis: a qualitative study with patients

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Emma Dures ◽  
Clive Bowen ◽  
Mel Brooke ◽  
Jane Lord ◽  
William Tillett ◽  
...  
Keyword(s):  
Functional Limitations ◽  
Treatment Options ◽  
Joint Stiffness ◽  
Self Management ◽  
Easy Access ◽  
Specialist Care ◽  
Structured Interviews ◽  
Psychosocial Burden ◽  
Initial Management ◽  
Presenting Symptoms

Abstract Objectives PsA is an inflammatory condition that can cause pain, fatigue, swelling and joint stiffness. The consequences include impaired physical function, a high psychosocial burden, reduced quality of life and work disability. The presenting symptoms can be non-specific and varied, leading to delays in diagnosis or referral to specialist teams. The aim of this study was to explore patients' experiences of being diagnosed and the initial management of PsA. Methods The study used a qualitative design, with data collected in one-to-one, face-to-face semi-structured interviews. Results Fifteen newly diagnosed patients (<24 months) from three hospital sites in the southwest of England participated. Interviews were transcribed, anonymized and analysed using inductive thematic analysis. The following two main themes with sub-themes represent the data: symptom onset to specialist care: ‘it was the blind leading the blind’ (making sense of symptoms; mis-diagnosis and missed opportunities; and fast and easy access to expertise); and diagnosis as a turning point: ‘having somebody say you've got something wrong with you, I was euphoric’ (validation and reassurance; weighing up treatment options; taking on self-management; and acknowledging loss and change). Conclusion Participants were already dealing with functional limitations and were highly distressed and anxious by the time they received their diagnosis. Physical and mental outcomes could be improved by the implementation of existing psoriasis management guidelines and strategies for earlier referral from primary care to rheumatology and by the development of guidelines on educational, self-management and psychological support provision soon after diagnosis.

scholarly journals Is there a role for adjuvant therapy after surgery in “high risk for recurrence” kidney cancer? An update on current concepts

2018 ◽  
Vol 25 (5) ◽  
Author(s):  
T. Sharma ◽  
C. Tajzler ◽  
A. Kapoor
Keyword(s):  
Clinical Trials ◽  
Targeted Therapy ◽  
High Risk ◽  
Adjuvant Therapy ◽  
Patient Population ◽  
Treatment Options ◽  
Significant Proportion ◽  
High Risk Patient ◽  
Disease Free Survival ◽  
Cochrane Reviews

BackgroundAlthough surgical resection remains the standard of care for localized kidney cancers, a significant proportion of patients experience systemic recurrence after surgery and hence might benefit from effective adjuvant therapy. So far, several treatment options have been evaluated in adjuvant clinical trials, but only a few have provided promising results. Nevertheless, with the recent development of targeted therapy and immunomodulatory therapy, a series of clinical trials are in progress to evaluate the potential of those novel agents in the adjuvant setting. In this paper, we provide a narrative review of the progress in this field, and we summarize the results from recent adjuvant trials that have been completed.MethodsA literature search was conducted. The primary search strategy at the medline, Cochrane reviews, and http://ClinicalTrials.gov/ databases included the keywords “adjuvant therapy,” “renal cell carcinoma,” and “targeted therapy or/and immunotherapy.”ConclusionsData from the s-trac study indicated that, in the “highest risk for recurrence” patient population, disease-free survival was increased with the use of adjuvant sunitinib compared with placebo. The assure trial showed no benefit for adjuvant sunitinib or sorafenib in the “intermediate- to high-risk” patient population. The ariser (adjuvant girentuximab) and protect (adjuvant pazopanib) trials indicated no survival benefit, but subgroup analyses in both trials recommended further investigation. The inconsistency in some of the current results can be attributed to a variety of factors pertaining to the lack of standardization across the trials. Nevertheless, patients in the “high risk of recurrence” category after surgery for their disease would benefit from a discussion about the potential benefits of adjuvant treatment and enrolment in ongoing adjuvant trials.

scholarly journals EMBOLIZATION OF RENAL ANGIOMYOLIPOMA: CASE SERIES

2015 ◽  
Vol 1 (2) ◽  
Author(s):  
Ghania Masood ◽  
Iffat Rehman ◽  
Saquib Khawar ◽  
Khurram A Mufti ◽  
Imran K. Niazi
Keyword(s):  
Minimally Invasive ◽  
Key Words ◽  
Case Series ◽  
Invasive Procedure ◽  
Standard Of Care ◽  
Renal Angiomyolipoma ◽  
Minimally Invasive Procedure ◽  
Benign Lesions ◽  
Current Standard ◽  
Spontaneous Haemorrhage

Renal angiomyolipomas (AML) are benign lesions usually left alone. However, lesions larger than 4 cm carry the risk of spontaneous haemorrhage and need treatment. Angiography and embolisation are the current standard of care particularly in patients with high operative risks. Angio-embolisation is a safe, minimally invasive procedure preserving maximum renal parenchyma, with the added advantage of preventing peri-procedural morbidity. Two cases of AML are presented in this case series. Key words: Angiomyolipoma, embolisation, renal 

scholarly journals Endodontic Microsurgical Instruments - A Review

2021 ◽  
Vol 10 (20) ◽  
pp. 1532-1538
Author(s):  
Prathap M.S. ◽  
Reshma Pradeep
Keyword(s):  
Clinical Outcome ◽  
Minimally Invasive ◽  
Success Rate ◽  
Key Words ◽  
Success Rates ◽  
Invasive Treatment ◽  
Biomimetic Materials ◽  
Endodontic Surgery ◽  
Endodontic Microsurgery ◽  
Root Treatment

Indications for endodontic surgery include failed nonsurgical treatment or retreatment, anatomical problems or iatrogenic errors. Endodontic surgery was considered as the last option with instruments that were unsuitable, surgical sites with inadequate vision and increased incidence of post-operative complication. But today endodontic surgery has evolved into endodontic microsurgery with the advancement in illumination, magnification, instruments and materials. Higher magnification and micro-instruments have increased the clinical outcome of endodontic surgery. Traditional instruments used in endodontic surgery are too large for the small osteotomy sites of microsurgery. Few of the instruments used for microsurgery are the smaller version of the traditional instruments. Endodontic microsurgery represents a minimally invasive treatment option with predictable outcome with the use of micro-instruments. A high success rate of nearly 93.5 % is reported, thus, making microsurgery a predictable option for the management of periapical pathology where surgical root treatment is not possible. The advanced techniques developed to overcome the barriers seen in traditional endodontic surgery have allowed the clinicians to achieve higher success rates. Along with the micro-instruments, the introduction of biomimetic materials has also led to the favourable results after endodontic surgery. This article discusses the different microsurgical instruments available for microsurgical procedures. KEY WORDS Curette, Microblade, Microsurgery, Piezotomes, Retractor, Ultrasonic.

scholarly journals Complications of laparoscopic cholecystectomy: an analysis of 1,695 laparoscopic operations

2017 ◽  
Vol 4 (9) ◽  
pp. 3049
Author(s):  
Dasharadha Jatothu ◽  
Rajkumar Sade ◽  
Kirthana Sade ◽  
. Taruni ◽  
Nagababu Pyadala
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Conservative Treatment ◽  
Minimally Invasive ◽  
Treatment Options ◽  
Gallstone Disease ◽  
Minimally Invasive Treatment ◽  
Medical Sciences ◽  
Invasive Treatment ◽  
Gold Standard Method ◽  
Operative Complication

Background: Laparoscopic cholecystectomy (LCs) is the gold standard method to treat gallstone disease. But there are some complications which occur frequently as compared to open cholecystectomy.Methods: The prospective study was conducted in the Department of Surgery, Kamineni Institute of Medical Sciences, Telengana during the period of 2 years; March 2015 to February 2017. A total of 1,695 laparoscopic cholecystectomy cases were included in this study. Several treatment options such as, conservative treatment, minimally invasive treatment and open surgery was performed based on the severity of the disease.Results: Majority of patients were female (83.9%) and most common age group affected was above 40 years. Intra-operative and post-operative complication occurred in 4.5% and 1.9% patients respectively. Majority complications were treated by conservative treatment and minimally invasive treatment. So, in conclusion, we can use conservative and minimally invasive treatment to manage the complications from laparoscopic cholecystectomy.Conclusions: Conservative treatment options and minimally invasive treatment was more efficient to overcome the post-operative complication of laparoscopic cholecystectomy.

scholarly journals Mesh complications: best practice in diagnosis and treatment

2020 ◽  
Vol 12 ◽  
pp. 175628722094299
Author(s):  
Paulina Bueno Garcia Reyes ◽  
Hashim Hashim
Keyword(s):  
Urinary Tract ◽  
Minimally Invasive ◽  
Best Practice ◽  
Treatment Options ◽  
Urinary Stress Incontinence ◽  
Mesh Complications ◽  
Treatment Pathways ◽  
Mesh Placement ◽  
Minimally Invasive Surgical Procedure ◽  
Tract Infections

Mesh was a promising, minimally invasive, and ‘gold standard’ treatment for urinary stress incontinence. Time has shown that complications from these devices can happen early, or even several years, after mesh placement and can be catastrophic. Pain, erosion, voiding dysfunction, infection, recurrent UTIs [urinary tract infections (UTIs)], fistulae, organ perforation, bleeding, vaginal scarring, neuromuscular alterations, LUTS (lower urinary tract symptoms), bowel complications and even immune disorders have been linked to mesh. Various tools, such as imaging, endoscopic and functional studies, are available for diagnosis of mesh complications. Since the spectrum of complications is wide, involvement of other specialties is usually beneficial in the diagnosis and management of these complications. There is still much to learn on the accuracy and utility of diagnostic studies in each type of complication. Evidence on the best diagnostic and treatment pathways for these complications is scarce but continuously growing as information is being reported, and we continue to gain expertise in dealing with patients affected by mesh. Treatment options include conservative and medical management initially and then open or minimally invasive surgical procedure approaches. This article will describe diagnostic and treatment pathways for mesh complications.

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