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If a sacrocolpoperineopexy is planned pain treatment center llc order 10 mg toradol amex, dissection continues beyond the rectal reflection to the level of the perineal body (Reddy et al pain treatment center kingston ny purchase toradol. The selection of the sacrocolpopexy graft is a preference of the surgeon, in general if using synthetic mesh it should be lightweight, flexible, and porous (Brown et al. Once the initial dissection has been performed, the robotic instruments are switched to robotic needle drivers with the addition of a bowel-safe grasper. The suture is placed in full-thickness fashion without entering the vaginal lumen. Studies have shown equivalent long-term outcomes with the use of absorbable suture compared with permanent suture for sacrocolpopexy mesh fixation (Shepherd et al. The vaginal stent is then directed posteriorly toward the promontory and maximally extended cephalad. Tension on the stent is then released, allowing the apex to lie in a normal apical position with the prolapse reduced. Excessive tension should be avoided because it can result in pain or de novo stress urinary incontinence (Nygaard et al. The apical suspension should reduce the prolapse of the apex as well as the segments of the anterior and posterior vaginal walls. The tail of the graft is sutured to the anterior longitudinal ligament at the level selected by the surgeon. Traditionally sutures are placed at the S1 vertebral body or at the level of the sacral promontory (Nygaard et al. Suture placement at S3 or S4 vertebral body increases the risk of injury to the presacral venous plexus, whereas placement sutures at the upper portion of the sacral promontory risks laceration of the middle sacral vessel or the left common iliac vein (Wieslander et al. However, at the level of S1 the middle sacral vessels are readily visible and can be easily isolated and avoided; two to three monofilament permanent sutures are used to fixate the graft to the anterior longitudinal ligament. Cystoscopy is performed to rule out injury to the bladder, intravesical suture, or mesh perforation and to confirm ureteral patency. As stated earlier, sacrocolpopexy may be performed with a minimally invasive technique using laparoscopy or robotic surgery. After administration of general anesthesia, the patient is properly positioned in Allen stirrups in low lithotomy position, the arms are properly tucked to the side, and all bony prominences are padded, a pelvic exam is performed, the abdomen and vagina are surgically prepared, and a Foley catheter is inserted into the bladder. A 0-degree laparoscope is inserted through the umbilical trocar and careful inspection of the peritoneal cavity is performed, delineating all the pertinent anatomy to performing the sacrocolpopexy. Depending on the anatomy and whether adhesiolysis is necessary, trocar placement can be performed. There are many variations of trocar placement described, but in general trocar placement involves two additional trocars placed under direct visualization in the right and left lower quadrants, lateral to the inferior epigastric vessels, and one or two additional 5-mm ports are placed at the level of the umbilicus, lateral to the rectus muscle. Commonly used instruments are a unipolar scissors, bipolar cautery graspers, and laparoscopic blunt-tipped dissectors. The patient is placed in Trendelenburg position, and the bowel is gently swept out of the pelvis. In a similar fashion as described in the robotic sacrocolpopexy section, the vagina is elevated via the vaginal stent, and the peritoneum covering the vagina is incised transversely. Sharp and blunt dissection is used to separate the peritoneum and bladder from the anterior vaginal wall. Dissection should progress to the depth just above the fibromuscular layer of the vaginal wall. Dissecting in the appropriate plane will decrease the risk of accidental entry into the vagina. As stated earlier, if the vaginal wall is opened, it should be irrigated copiously followed by a two-layer closure with 2-0 or 3-0 delayed absorbable suture. The vaginal apex is redirected anteriorly, and the peritoneum covering the posterior wall is open. The rectovaginal spaces are identified, and blunt dissection further opens this space to the level of the rectal reflection for distance of about 7 to 9 cm. To avoid injury to the rectum, care is taken not to detach the perirectal fat tissue from the rectum. Once the anterior and posterior dissections have been performed, the presacral dissection can begin. The peritoneum overlying the sacral promontory is elevated and opened on the right side of midline in a longitudinal fashion with laparoscopic scissors and extended to the cul-de-sac. The peritoneum is excised superficially and parallel to the sigmoid to create the retroperitoneal leaves that will be used later to cover the mesh. The loose fatty adipose tissue is dissected until the anterior longitudinal ligament is exposed. Bleeding during the dissection is encountered; coagulation or clips can be used to achieve hemostasis. A lightweight, macroporous, polypropylene, prefabricated Y mesh can be used and is cut to surgeon preference. Extracorporeally knot tying with either an open-ended or closed-ended knot pusher depends on surgeon preference. The suture should incorporate the full thickness of the vaginal wall without entering the vaginal lumen. As noted earlier, studies have shown equivalent long-term outcomes with the use of absorbable suture compared with permanent suture for sacrocolpopexy mesh fixation (Shepherd et al. Options for the management of exposed mesh after colpopexy may include transvaginal mesh excision with or without partial colpocleisis (Quiroz et al. The objective failure rate for recurrence at any other vaginal site was 14 out of 44 in the fascial group and 4 out of 45 in the mesh group (Culligan et al.
Toradol dosages: 10 mgToradol packs: 60 pills, 90 pills, 120 pills, 180 pills, 270 pills, 360 pills
Although age-adjusted incidence and mortality rates initially declined in the 1990s and early part of 2000s pain treatment for ra effective toradol 10 mg, these rates have plateaued in recent years (Dy et al pain treatment center riverbend calgary 10 mg toradol purchase mastercard. Between 2005 and 2015 unadjusted incidence rates of bladder cancer grew 31%, which has been attributed to aging and population growth (Fitzmaurice et al. This increase in incidence has been attributed to the increase in life expectancy over time and the resultant aging of the global population. The odds of developing bladder cancer are highest in high-income countries (1 in 36 men and 1 in 165 women) and lowest in low-income countries (1 in 122 men and 1 in 310 women). However, since 1990, developing countries have had an increasing burden of bladder cancer incidence compared with developed countries, which has been attributed to a narrowing gap in life expectancy between low- and high-income countries, with subsequent higher rates of cancer in an older population (Dy et al. Although incidence rates are highest in Europe and North America, more than 60% of all bladder cancer incidence, and nearly half of bladder cancer deaths occur in the developing world (Antoni et al. The global 5-year prevalence of bladder cancer is estimated to be 1,319,749, with 243,867 coming from the United States (Ferlay et al. However, 5-year prevalence may not fully reflect the number of bladder cancer survivors managing disease sequel, as an estimated 571,518 bladder cancer survivors lived in the United States in 2011 (Malats and Real, 2015). Among cancers affecting both sexes, bladder cancer ranks as the fourth most prevalent cancer globally, and in the top 5 in prevalence in individual countries of all income levels and all regions, including the United States (96. In Europe, the highest world age-standardized incidence rates for bladder cancer are in Belgium for men and Hungary for women (Ferlay et al. Gender, Racial, and Age Differences Bladder cancer typically arises from chronic, constant insults to the urinary tract over time. The average age of diagnosis is 73 in the United States with approximately 9 of 10 patients diagnosed after the age of 55. Age-specific incidence rates rise gradually around age 50 to 54 in males and females, with a sharper rise in males age 60 to 64. Nearly three-quarters of bladder cancer cases occur in males, who have a higher incidence rate (9. Several hypotheses have been proposed for increased bladder cancer rates among men. First, globally smoking is much more common in men in comparison with women, with age-standardized prevalence declining in men from 41. However, even when controlling for smoking, gender-related incidence disparities persist (Hartge et al. It has been hypothesized that although carcinogen exposure may not account for differences between genders, cellular metabolism of carcinogens may be different (Hemelt et al. Both enzymes have been shown to be differentially expressed in men and women (Karagas et al. As a result, gender differences in carcinogen metabolism may explain why even among similar carcinogen exposures. In addition, gender differences have been explained by differences in sex steroid production and receptor expression. Although men lose 26% of their remaining life expectancy to bladder cancer, women lose 36% (Scosyrev et al. The differences in stage presentation only account for approximately 30% of gender disparities in bladder cancer prognosis and mortality; women fare worse than men stage for stage (Aydin Mungan et al. These delays in diagnosis may partially explain why women are more likely to present with advanced stage disease. Bladder cancer is most common among Caucasian Americans, with an incidence rate 1. However, similar to gender differences, African-American patients are more likely to have muscle-invasive disease compared with Caucasian patients (Scosyrev et al. In addition, for reasons that are unclear, African-Americans, and African-American women in particular, have increased rates of non-urothelial histology. Stage for stage, 5-year relative survival rates are worse for African-Americans with localized disease (61% vs. Annual directed medical costs are estimated to exceed $4 billion in the United States and 4. However, bladder cancer health care costs vary widely between countries and disease states. For example in Latvia 2257 is spent per bladder cancer case compared with 11 937 in France (Leal et al. These variations between countries and between patients in the same country can be attributed to regional variations in the management of bladder cancer, particularly non muscle-invasive disease. Five-year relative survival rates for selected cancers by race and stage at diagnosis, United States, 2007 to 2013. The survival rate for carcinoma in situ of the urinary bladder is 96% in all races, 96% in whites, and 91% in blacks. Aromatic amines (2-naphthylamine, 4-aminobiphenyl, and benzidine) are thought to be the central causative agent in carcinogen-mediated bladder carcinogenesis. Tobacco smoking and occupation account for the two most frequent routes of environmental exposure. Tobacco smoke is full of aromatic amines, as are other environmental carcinogens implicated in bladder cancer. Furthermore, among patients already diagnosed with bladder cancer, obesity appears to attenuate prognosis and is associated with an increased risk of tumor recurrence and a shorter time interval to recurrence (Wyszynski et al. The mechanism of excess weight contributing to cancer risk includes insulin resistance, chronic hyperinsulinemia, increased bioavailability of steroid hormones, and localized inflammation. Elevated insulin production may drive tumor growth and stimulate pro-inflammatory cytokines. The exact mechanism by which excess weight may contribute to bladder cancer risk is unknown and likely includes a multitude of inflammatory mediators. Both of these genes are associated with the ability to metabolize aromatic amines and thus play an important role in the subset of individuals with environmental carcinogen exposure.
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In cases in which angiography is pursued for diagnosis pain hypersensitivity treatment order toradol 10 mg with amex, an endovascular stent graft may be placed (Aarvold et al pain medication for dogs ibuprofen order toradol 10 mg with amex. Endovascular stenting is the preferred initial treatment, but open surgical interventions with urologic and vascular reconstructions may be necessary (Das et al. A systematic literature review found reports of 139 cases of ureteroarterial fistula published from 1899 to 2008 (van den Bergh et al. Almost all patients had a relevant past surgical history, particularly pelvic cancer surgery (54%) and arterial surgery with graft insertion (31%), and 61% had a ureteric stent in situ. The majority affected the iliac segment, and preoperative imaging was not always diagnostic. Many vascular and urologic interventions were used either alone or in combination. Later cases suggested that endovascular repair of the arterial defect gave the best results with lower mortality. Another, more recent, case series of 20 patients also showed a high mortality of 10% to 20% but did not find any difference in outcome between open or endovascular graft insertion techniques (Fox et al. In one study, 536 women underwent a radical hysterectomy for invasive cervical cancer. More advanced stage of disease, obesity, diabetes, and postoperative surgical infection were predisposing factors to urinary tract complications. In a similar report, 1092 women with cervical cancer underwent a radical hysterectomy with obligatory pelvic lymphadenectomy. For example, in one report of 479 women undergoing different methods of radical hysterectomy for cervical cancer over a 15-year period, 52 (10. In contrast, one institution reported that, with modifications and careful dissection, ureteric and bladder injury have almost been eliminated (Draca, 1979). In two recently published case series, one of fistulae specifically associated with gynecologic cancers (Narayanan et al. Operations carried out with the intention of curing malignant disease will inevitably carry a higher risk of subsequent fistula formation as compared with those undertaken with less radical intent. After radical hysterectomy for cervical cancer (Wertheim-Meigs procedure) the rate of fistula formation reported from case series is between 0. Where they are reported separately, the rates of vesicovaginal and ureterovaginal fistula appear to be of the same magnitude with both being reported in between 0. Overall, the rate of urogenital fistula appears to be approximately 9 times higher after radical hysterectomy in women with malignant disease as compared with that after simple hysterectomy (abdominal or vaginal) in women with benign conditions (Hilton and Cromwell, 2012). The risk of visceral injury or subsequent fistula formation after radical hysterectomy undertaken in pregnancy, or immediately after cesarean section is not obviously increased over those carried out electively in nonpregnant individuals. Monk and Montz (1992) described inadvertent cystotomy followed by vesicovaginal fistula in 1 of 21 women operated on during or immediately after pregnancy. In a further series of cases specifically related to gynecologic malignancy, 15 of 20, or 75%, had undergone previous radiotherapy (Narayanan et al. In both series most cases followed radiation used for the treatment of cervical cancer, although, 5 of 34, or 15%, followed treatment of endometrial cancer, and 1 of 34, or 3%, followed treatment of a multifocal gynecologic cancer in 1 series (Hilton, 2011). Among a series of 216 radiation-induced fistulae, the time to diagnosis of the fistula was made between 3 months and 10 years (mean 21 months) after radiation (Pushkar et al. In other series fistulae have been reported to develop or present up to 30 years after the "causative" influence (Hilton, 2011; Zoubek et al. The incidence of any deleterious clinical impact on the gastrointestinal and urinary tracts after radiation varies in the literature between 1% and 12% (Cochrane et al. In a retrospective review of 2096 patients treated for cervical cancer over a 10-year period using unspecified regimen(s) of radiotherapy, 38 patients (1. Of these cases, approximately three-fourths involved the rectum, with one-third being combined rectovaginal and vesicovaginal fistulae; one-fourth were vesicovaginal only (Emmert and Kohler, 1996). Following a clearly defined regimen of external beam radiation plus brachytherapy for the treatment of primary squamous cell carcinoma of vagina in 91 women, de Crevoisier et al. Unsurprisingly, they found anterior tumor location to be correlated with increased risk of bladder toxicity and decreased rectal toxicity. Two women in this series developed rectovaginal fistulae (2%) and one ureterovaginal fistula (1%) (de Crevoisier et al. In a series of 28 women treated by brachytherapy for recurrent corpus or cervix cancer, four patients developed chronic morbidities related to treatment. These data tend to suggest a higher rate of fistula formation after the application of radiotherapy in locally recurrent disease than in primary disease. From a small series of urologic complications after radiotherapy for gynecologic cancers, 14 patients had developed vesicovaginal fistula; of these, 4 (29%) had evidence of tumor recurrence (Krause et al. In prostate cancer patients, recto-urethral fistula are described after cryotherapy (0. When a fistula occurs after radiotherapy, it is considered good clinical practice to exclude tumor recurrence before attempting a fistula closure. Elevated radiotherapy doses to the rectum, advanced tumor stage, and post-radiotherapy biopsy were considered risk factors for fistula formation. Several modifications to the conventional Wertheim-Meig procedure of radical hysterectomy have been described in an effort to reduce the associated morbidity. Given the increased risk associated with radical surgery for malignancy, it is intuitive that the risks would increase with the stage of disease and with the extent of the surgery undertaken.
Syndromes
- Blue color to the whites of the eyes
- Damage to the nerves and muscles around the voice box (from trauma or surgery
- MRI of the heart
- Fatigue
- Stop normal physical activity for the first few days. This helps calm your symptoms and reduce inflammation.
- Ask your surgeon which drugs you should still take on the day of the surgery.
In addition pain treatment of the bluegrass trusted 10 mg toradol, after ureteral mobilization we do not find that it is necessary to control and transect the ureter at the detrusor hiatus at this point in the procedure pain management for old dogs 10 mg toradol fast delivery. Instead we advocate for completion of the lymphadenectomy first while maintaining antegrade flow of urine into the bladder. Extended Pelvic Lymphadenectomy Although the pelvic lymphadenectomy can be performed after completion of the radical cystectomy, we feel this unnecessarily necessitates ureteral occlusion for potentially prolonged periods of time. In addition to the potential adverse effects on renal function postoperatively, occlusion of the ureters disadvantages the anesthesia team by withholding a valuable clinical indication of the patients resuscitative status. We have also found no reliable advantage to occlusion-induced dilation the ureters in aiding the ureteral anastomoses. Last, we have found no hindrance to visualization or access to the lymphadenectomy field with the ureters in continuity. The anatomic landmarks for a complete extended pelvic lymphadenectomy are described earlier and do not differ when performed robotically as compared with open. However, visual clues are interpreted differently because of the differences in the visual angle of the camera as opposed to the overhead view while the surgery is performed via a laparotomy. We provide some technical pointers to ensure a meticulous dissection is performed. External Iliac Lymphadenectomy the external iliac lymph nodes frequently extend behind the spermatic cord. Without this lateral retraction maneuver on the spermatic cord, a dissection across this tissue could lead to inadvertent transection of lymph nodes. Care should be taken to avoid inadvertent injury to the genitofemoral nerve, which has a variable branch point. Many times the femoral branch (parallel to the external iliac artery) and inguinal branches (traveling into the internal inguinal ring) will be recognized and should be released from the lymph node packet as needed. In cases of advanced disease if there is dense adherence of the nerve to the lymph node packet, an en bloc resection may be required. The use of a 15-mm assistant port provides ample capacity to remove large lymph node packets, eliminating the need for dissection of the packet into smaller pieces. Carefully the packet is released from the lateral pelvic sidewall attachments, and bipolar cautery is used to control lateral perforators. As the packet is released off the hypogastric vein wall, a complete dissection is ensured. Although this approach may capture a portion of the hypogastric lymph nodes with the obturator specimen, we have found that an attempt to dissect the packet at the level of the obturator nerve laterally frequently leads to nodal transection and as such is ill advised. Hypogastric Lymphadenectomy Attention is then paid to the internal iliac lymph node packet. The right-sided common iliac dissection is performed in a similar fashion (not shown). Oncologic considerations may dictate an alteration to the lymphadenectomy described earlier. For example, the dissection can be extended into the retroperitoneum, or portions of this dissection may be omitted. For example, in nonmuscle-invasive disease in which nerve sparing is planned, a presacral dissection may be avoided to mitigate the risk of interrupting the hypogastric plexus proximal to the neurovascular bundles. As discussed earlier in this chapter, the decision regarding the extent of lymphadenectomy is made based on specific cancer characteristics and functional goals. Ureteral Control and Posterior Pedicle Dissection After completion of the pelvic lymphadenectomy the ureters are controlled at the detrusor hiatus. If there is oncologic involvement of the trigone, or suspected disease in the intramural ureters, the placement of clips and transection of the ureters can be moved proximally. Adequate space is provided between clips Presacral Lymphadenectomy the initial dissection posterior to the sigmoid mesentery performed during the early mobilization is now fully appreciated. We have not found sutures attached to the ureteral clips, as tethers, to be necessary or helpful. If an adequate release of the sigmoid mesentery has been performed transposition of the left ureter should not be difficult. After the ureters have been dissected free the posterior vascular pedicle should be controlled before release of the urachus and anterior space of Retzius. In this demonstration the vessel sealer is used but can be easily substituted for clips if nerve sparing is desired. Female Radical Cystectomy As with open surgery, a female radical cystectomy presents unique challenges surgically. A traditional en bloc resection with the uterus and ovaries can be accomplished in the same manner robotically as with an open technique. To aid in the identification of the posterior cervical fornix, or the apex of the vagina if a hysterectomy had been Male Apical Dissection Male radical cystoprostatectomy can then be completed in a manner similar to radical prostatectomy. These circular sizers can be placed vaginally by the beside assistant and manipulated easily to provide ample countertraction. This provides retraction in the desired direction but also distends the vaginal wall, which can aid in the development of the vaginal sparing plane, described later. If an en bloc resection of the gynecologic organs and anterior vagina are to be performed after the posterior cervical fornix is opened, the vessel sealer can be used to control the anteriolateral wall of the vagina toward the introitus. Once the dissection reaches the urethral meatus, a useful technique to ensure a complete resection of the urethra and an adequate surrounding vaginal cuff is to detach the Foley catheter from the drainage bag and have the assistant place a clip across the catheter to occlude any urine outflow. The catheter is then passed intracorporally and can be used to retract and visualize the urethral meatus with the robotic instruments. At this point if a neobladder is planned, the apical dissection can be completed after release of the urachus and anterior attachments.
Usage: ut dict.
Urethrovaginal fistula is an uncommon but distressing complication of urethral diverticulectomy and deserves special mention pain treatment for osteoporosis purchase 10 mg toradol mastercard. A urethrovaginal fistula located beyond Bladder and Female Urethral Diverticula 2991 the sphincteric mechanism should not be associated with symptoms other than perhaps a split urinary stream and/or vaginal voiding pain treatment modalities order cheapest toradol. Therefore an asymptomatic distal urethrovaginal fistula may not require repair, although some patients may request repair. Conversely, a proximal fistula located at the bladder neck or at the mid-urethra in patients with an incompetent bladder neck will likely result in considerable symptomatic urinary leakage. These patients should undergo repair with consideration for the use of an adjuvant tissue flap, such as a Martius flap, to provide a well-vascularized additional tissue layer if needed. The actual timing of the repair relative to the initial procedure is controversial. One small series suggested that large diverticula (>4 cm) or those associated with a lateral or horseshoe configuration may be associated with a greater likelihood of postoperative complications (Porpiglia et al. A B Modified from Dmochowski R: Surgery for vesicovaginal fistula, urethrovaginal fistula, and urethral diverticulum. Diagrams demonstrating the importance of preserving and reconstructing the periurethral fascia. Popat and Zimmern (2016) reported a series of 12 patients with horseshoe diverticula with recurrence in 1 patient with a mean follow-up of 52 months. In a meta-analysis of contemporary series, Cameron (2015) reported the rate of diverticulum recurrence after surgical repair to be 9. Repeat urethral diverticulectomy surgery can be challenging because of altered anatomy, scarring, and the difficulty in identifying the proper anatomic planes. Adachi M, Nakada T, Suzuki H, et al: Successful repair of huge bladder diverticulum with a transurethral fulguration. Adachi M, Nakada T, Yamaguchi T, et al: Transurethral treatment of bladder diverticula, Eur Urol 19:104108, 1991b. Afshar K, Malek R, Bakhshi M, et al: Should the presence of congenital para-ureteral diverticulum affect the management of vesicoureteral reflux Amar A: Vesicoureteral reflux associated with congenital bladder diverticulum in boys and young men, J Urol 107:966968, 1972. Andersen M: the incidence of diverticula in the female urethra, J Urol 98:9698, 1967. Babbitt D, Dobbs J, Boedecker R: Multiple bladder diverticula in Williams "elfin-facies" syndrome, Pediatr Radiol 8:2931, 1979. Bade J, Ypma A, van Elk P: A pelvic mass: bladder diverticulum with haemorrhage in Ehlers-Danlos patient, Scand J Urol Nephrol 28:319321, 1994. Baert L, Willemen P, Oyen R: Endovaginal sonography: new diagnostic approach for urethral diverticula, J Urol 147:464466, 1992. Baniel J, Vishna T: Primary transitional cell carcinoma in vesical diverticula, Urology 50:697699, 1997. Beall M, Berger M: Congenital bladder diverticula in adult twins, Urology 11:498499, 1978. Blander D, Rovner E, Schnall M: Endoluminal magnetic resonance imaging in the evaluation of urethral diverticula in women, Urology 57:660665, 2001. Bodner-Adler B, Halpern K, Hanzal E: Surgical management of urethral diverticula in women: a systematic review, Int Urogynecol J 27:9931001, 2016. Bourgi A, Ayoub E, Merhej S: Diverticulectomy in the management of intradiverticular bladder tumors: a twelve-year experience at a single institution, Adv Urol 2016:2016. Castillo-Vico M, Checa-Vizcaíno M, Payà-Panadés A: Periurethral granuloma following injection with dextranomer/hyaluronic acid copolymer for stress urinary incontinence, Int Urogynecol J Pelvic Floor Dysfunct Floor Dysfunct 18:9597, 2007. Chertin B, Prat O: Iatrogenic bladder diverticula following caesarean section, Int Urogynecol J Pelvic Floor Dysfunct 19:17071709, 2008. Dai Y, Wang J, Shen H, et al: Diagnosis of female urethral diverticulum using transvaginal contrast-enhanced sonourethrography, Int Urogynecol J Pelvic Floor Dysfunct 24:14671471, 2013. Fortunato P, Schettini M, Gallucci M: Diagnosis and therapy of the female urethral diverticula, Int Urogynecol J Pelvic Floor Dysfunct 12:5157, 2001. Gerrard E, Lloyd L, Kubricht W: Transvaginal ultrasound for the diagnosis of urethral diverticulum, J Urol 169:13951397, 2003. Gilbert C, Rivera Cintron F: Urethral diverticula in the female; review of the subject and introduction of a different surgical approach, Am J Obs Gynecol 67:616627, 1954. Gillon G, Nissenkorn I, Servadio C: Bladder diverticula in elderly females with urgency, dysuria and incontinence, Eur Urol 14:3436, 1988. Ginesin Y, Bolkier M, Nachmias J, et al: Primary giant calculus in urethral diverticulum, Urol Int 43:4748, 1988. Ginsburg D, Genadry R: Suburethral diverticulum: classification and therapeutic considerations, Obstet Gynecol 61:685688, 1983. Goldfarb S, Mieza M, Leiter E: Postvoid film of intravenous pyelogram in diagnosis of urethral diverticulum, Urology 17:390392, 1981. Dmochowski R: Urethral diverticula: evolving diagnostics and improved surgical management, Curr Urol Rep 2:373378, 2001. Dmochowski R, Blaivas J, Gormley E, et al: Female stress urinary incontinence update panel of the American Urological Association Education and Research, Inc. Dragsted J, Nilsson T: Urothelial carcinoma in a bladder diverticulum evaluated by transurethral ultrasonography, Scand J Urol Nephrol 19:153154, 1985. Ellick M: Diverticulum of the female urethra: a new method of ablation, J Urol 77:243246, 1957. Fall M: Vaginal wall bipedicled flap and other techniques in complicated urethral diverticulum and urethrovaginal fistula, J Am Coll Surg 180:150156, 1995. Gotoh T, Koyanagi T, Tokunaka S: Pathology of ureterorenal units in various ureteral anomalies with particular reference to the genesis of renal dysplasia, Int Urol Nephrol 19:231243, 1987. Greiman A, Rittenberg L, Freilich D, et al: Outcomes of treatment of stress urinary incontinence associated with female urethral diverticula: a selective approach, Neurourol Urodyn 37:478484, 2018.
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