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Detroit, MI, United States

The 2015 William H. Harridge lecture of the 2015 Midwest Surgical Association concentrated on the evolution and performance characteristics of nonoperative management of even severe renal injury. One of the first mentions of nonoperative renal trauma occurs after World War II. Since that time through the early 2000s, only 1 or fewer papers per year appeared in the literature. The mid-2000s had an explosion of interest and publications on the subject, resulting in our modern understanding of the principles. The principles of nonoperative management are as follows: (1) operate immediately if the patient is bleeding to death; (2) observe initially, but step in with metered responses as necessary; (3) use ureteral stents for symptomatic or growing urinoma; (4) use angioembolization for nonemergent bleeding or for urgent bleeding if your center can manage this; and (5) do open surgery when needed (not "never"). © 2016 Elsevier Inc. All rights reserved. Source


Burks F.N.,William Beaumont Hospital | Santucci R.A.,Building Detroit
Nature Reviews Urology | Year: 2010

Although straightforward male urethral stricture disease is commonly encountered in the scope of general urologic practice, complex urethral strictures are less common and require a more systematic approach. Complex urethral stricture surgery for long and panurethral strictures, after failed hypospadias repair, and for recurrent posterior urethral distraction defects requires a dynamic treatment paradigm. A multistaged urethral reconstruction is often necessary owing to hostile urethral tissue, especially after multiple previous procedures. A perineal urethrostomy sometimes offers improved quality of life for patients with complex urethral stricture disease, particularly if they have undergone previous failed repairs. Recurrent posterior urethral distraction defects are best treated with excision of the scarred urethral segment and re-anastomosis. Urethral stricture disease after treatment for prostate cancer requires multiple treatment approaches given the often poor tissue quality and likelihood of stricture recurrence. © 2010 Macmillan Publishers Limited. All rights reserved. Source


Lamont R.F.,Perinatology Research Branch | Lamont R.F.,Building Detroit | Sobel J.D.,Wayne State University | Akins R.A.,Wayne State University | And 5 more authors.
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2011

Vaginal microbiome studies provide information that may change the way we define vaginal flora. Normal flora appears dominated by one or two species of Lactobacillus. Significant numbers of healthy women lack appreciable numbers of vaginal lactobacilli. Bacterial vaginosis (BV) is not a single entity, but instead consists of different bacterial communities or profiles of greater microbial diversity than is evident from cultivation-dependent studies. BV should be considered a syndrome of variable composition that results in different symptoms, phenotypical outcomes, and responses to different antibiotic regimens. This information may help to elucidate the link between BV and infection-related adverse outcomes of pregnancy. Journal compilation © RCOG 2011 BJOG An International Journal of Obstetrics and Gynaecology. Source


Santucci R.A.,Building Detroit
Nature Reviews Urology | Year: 2010

Trauma is the leading cause of death between the ages of 1 and 44 years in the USA. While stabilization of life-threatening injuries is the primary goal in the evaluation of all trauma patients, subsequent diagnosis and treatment of secondary injuries are requirements for good trauma care. The genitourinary system is involved in 10% of trauma cases, and these injuries can be associated with considerable morbidity and mortality. Accordingly, physicians involved in the initial evaluation and subsequent management of trauma patients should be aware of the diagnosis and treatment of injuries that can occur in the genitourinary system. In 2009, the European Association of Urology provided specific recommendations for the evaluation, diagnosis and management of genitourinary trauma. Here, we review and discuss these recommendations in order to provide a concise summary for clinicians involved in the evaluation and management of trauma patients and their associated genitourinary injuries. © 2010 Macmillan Publishers Limited. All rights reserved. Source


Crane C.,Building Detroit | Santucci R.A.,Building Detroit
Archivos Espanoles de Urologia | Year: 2011

Approximately 4-14% pelvic fractures cause a posterior urethral injury. Pelvic fractures associated with straddle injuries or large trauma accidents are more frequently involved with this kind of lesions. Primary open repair of the urethral injury is discouraged in the acute setting. 3-6 months after urinary diversion a formal open reconstruction can be safely attempted. This gives time for scar maturation, reabsorption of pelvic hematomas, and relative restoration of anatomical fascial layers. The complexity of such interventions can be minimized following proper diagnostic and surgical protocols. Anastomotic urethroplasty under the precepts of the progressive perineal approach provides an excellent treatment option for these patients. The aim of this paper is the detailed description of the procedure for the treatment of such injuries. Source

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