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Letter to the Editor: The Effect of Male Circumcision on Sexuality UroToday encourages any questions and comments you may have for our editors via publisher@urotoday.com Response to: The Effect of Male Circumcision on Sexuality, Editorial "The authors did not mention their technique of circumcision, nor did they mention leaving the inner lining or techniques used around the frenulum. They did report that 20% of men reported a worse sex life after circumcision and that the reason for these reports were insufficient skin leading to uncomfortable erections, erectile curvature secondary to uneven skin removal, pain and bleeding upon erection/manipulation, severe scarring, and reduced penile size." Dear Editors, Indeed rhabdomyolysis is a potential and probable complication following a prolonged procedure like laparoscopic nephrectomy. It has also been reported as a true and life threatening complication in a number of laparoscopic donor nephrectomy cases. The propensity to develop such a severe complication may be precipitated also by an acute and sudden loss of functioning nephrons. In this aspect, it is definitely a cause of concern and should raise the urologist\'s attention to details in terms of proper padding during positioning. It is the recommendation of some that time of use of the kidney rest should be limited to the placements of the ports and not further. Some have opted not to use them at all. A high index of suspicion is indispensable in its early detection. Urinary myoglobin determination as well as MRI studies may be used to confirm the diagnosis. This will help the clinician to treat the condition as soon as possible and avoid the severe consequence which is acute renal failure and even death. Dr. Jose Benito A. Abraham UCI Fellow in Endourology Reference Article Letter to Editor Dear Editors, Ablatherm users presented the latest clinical results obtained using EDAP\'s Ablatherm HIFU technology for the treatment of prostate cancer at Harvard Medical School in January 2005. This included a follow up period of 8 years. Dr. Stefan Thuroff, from Harlaching Hospital, Munich, Germany, presented a follow-up study of more than 1,000 patients treated with Ablatherm. The results showed a success rate up to 93.7% based on negative biopsies and a Nadir PSA down to 0 for low and intermediate risk patients. These results were achieved just two months post treatment, a significant improvement in the time to confirmable results as compared to other therapies. Additionally, the results indicate that 70% of the patients who opted for partial ablation of the prostate remained potent, once again well above the normal ranges of other therapies. Indeed no survival data is yet available for this kind of treatment but there appears to be a cancer free benefit of up to 84% without additional adjunctive therapy. To date, over 8000 patients have been treated with HIFU for localized prostate cancer and durable results have been seen with a stable nadir PSA and negative postoperative prostate biopsies. jbamd2000@yahoo.com Fellow in Endourology and Laparoscopy University of California Irvine Medical Center Reference Article Ablatherm® Method (There's A Problem) Sirs, You seem to be bragging a lot about Ablatherm®, but that method, though it may be good, certainly isn’t the answer ! A prostate is like a strawberry with many little spots on it. When you sample from that strawberry, so to speak , you are not necessarily seeing all the cancer spots to attack. Hence, although you may have a fairly good method, it certainly isn’t the Silver bullet that everyone is looking for. P. Trimble Response to Editor: Further to your answer to Dr. S. Lieberman (Response to: Glubran 2 or Cyanoacrylic Glue, Editorial), we would like to precise that: GLUBRAN 2 is a synthetic surgical glue CE certified for internal and endovascular use. It is a co-monomer of two monomers NBCA (N-butyl 2 cyanoacrylate) and MS (our know how). It is manufactured in Italy by the company GEM Srl addressed in Viareggio (LU) Via dei Campi 2, web site www.gemitaly.it and e-mail address: info@gemitaly.it Thanking in advance for providing this information on your Editorial, Kind Regards Dr. L. Barsanti Response to: Glubran 2 or Cyanoacrylic Glue, Editorial Dear S. Lieberman, Glubran 2 or Cyanoacrylic Glue is sold for medical use in the United States under the brand name DERMABOND and is manufactured by Ethicon, Inc. a Johnson and Johnson Company. The press release for the FDA approval is available at http://www.jnj.com/news/jnj_news/20020404_1303.htm. You may also find prescribing and additional information on their website at www.dermabond.com. I hope this information is of assistance. Kindest Regards, Letter to the Editor:
UroToday encourages any questions and comments you may have for our editors via publisher@urotoday.com Response to: Trans-catheter embolization, Editorial Trans-catheter embolization should be considered a first-line treatment option for all AML's at risk for spontaneous hemorrhage. AML's over 4 cm have been shown to have a higher incidence of spontaneous rupture and should be considered for prophylactic treatment by removal or embolization. For those AML's that present with hemorrhage, selective angioembolization is a great treatment option which allows you to avoid the inflammatory reaction that will undoubtedly be present during a surgical exploration and partial nephrectomy. Embolization is particularly useful for those patients with TS complex as multiple AML's are usually present and a nephron sparing treatment should be the goal. Post-operative discomfort with embolization is directly correlated with the size of the lesion being treated. Some aspect of post-embolization syndrome (high fever, pain, leukocystosis) can be seen if large lesions are treated. Complications can include nephron loss, particularly if the interventional radiologist isn't particularly schooled at super-selective techniques. Trans-catheter embolization In regard to the study by Ewalt and others--Long term outcome of transcatheter embolization of renal angiomyolipoms due to Tuberous Sclerosis complex, is Transcatheter embolization still the first treatment option for patient with 4.3 cm angiomyolipoma in the (L) kidney in the hilim, but without hx of tuberous sclerosis complex? How long does pain usually last after the procedure? What are the complication? A Note Of Thanks For Knowledge Gained From UroToday Web Site And Particular Contribution Of Dr. Christopher P. Evans Dear UroToday Publisher, As a prostate cancer survivor I would like to express my deepest appreciation for the wealth of knowledge that UroToday provides in general and the contribution of Dr. Evans in particular. Knowledge is the ultimate true power. Prostate cancer research is unfolding many aspects of this disease and the information that your web site provides is of immense help for cancer survivors such as myself. Dr. Evans, who is also my cancer doctor, aside from being an outstanding surgeon, has an extraordinary resume of accomplishments in his field. With his background and dedication he not only provides the latest in prostate cancer research, but also is able to put each research result in perspective by providing any applicable history of previous research in the subject matter and prevailing opinion of medical field related to it. One may not truly grasp the feeling of appreciation and gratitude one feels toward all involved in cancer research until one faces this dreaded disease oneself. It is due to such work that there is now real hope that within a decade there may be enough advancement that cancer may become less of a lethal disease and more like a chronic disease such as cardiovascular and diabetes. This can only be possible through effective means of communication such as your UroToday web site. Thank you and Best Regards, |
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