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Moschouris H, Tsetsou I, Kaniaris A, Stamatiou K. Transradial Prostatic Artery Embolization as a Salvage Procedure in a Patient With Severe Deformities and Refractory Hematuria of Prostatic Origin. Cureus 2024; 16:e59894. [PMID: 38854172 PMCID: PMC11160449 DOI: 10.7759/cureus.59894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 06/11/2024] Open
Abstract
Benign prostatic hyperplasia is a common condition causing urinary symptoms in older men. It can sometimes lead to hematuria of prostatic origin, due to increased vascularity of the enlarged gland. If this type of hematuria is severe and refractory to conservative measures, it can be life-threatening. Prostatic artery embolization (PAE) serves as a minimally invasive alternative to traditional surgical interventions, particularly in patients with comorbidities and contraindications to surgery. We present a case of a 79-year-old male with refractory hematuria of prostatic origin (RHPO), multiple comorbidities, and significant deformities of the left upper and both lower limbs. The patient was treated with PAE via the right radial artery, a less common approach in interventional radiology. The procedure was successful and led to a complete resolution of hematuria, with no complications. This report highlights the importance of adapting treatment for complex patients and shows that PAE can be safe and effective in such cases.
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Affiliation(s)
| | - Ilianna Tsetsou
- Imaging and Interventional Radiology, "Sotiria" General and Chest Diseases Hospital of Athens, Athens, GRC
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Tasaki H, Eriguchi M, Yoshida H, Uemura T, Fukata F, Nishimoto M, Kosugi T, Matsui M, Samejima KI, Iseki K, Asahi K, Yamagata K, Konta T, Fujimoto S, Narita I, Kasahara M, Shibagaki Y, Moriyama T, Kondo M, Watanabe T, Tsuruya K. Synergistic effect of proteinuria on dipstick hematuria-related decline in kidney function: The Japan Specific Health Checkups (J-SHC) Study. Clin Exp Nephrol 2023; 27:990-1000. [PMID: 37603115 DOI: 10.1007/s10157-023-02390-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND The effect of isolated hematuria without proteinuria on kidney function decline, and the modification by the severity of proteinuria in general population are not fully elucidated. METHODS Participants were included in the Japan Specific Health Checkups Study between 2008 and 2014. The exposure of interest was the frequency of dipstick hematuria during the observation. In each proteinuria frequency category (non-, occasional, persistent), hematuria-related decline in the eGFR rate was examined by analysis of covariance (ANCOVA). eGFR decline trajectories were also assessed using mixed-effects models. RESULTS Among the 552,951 participants, 146,753 (26.5%) had hematuria, and 56,021 (10.1%) and 8,061 (1.5%) had occasional and persistent proteinuria, respectively. During the median follow-up of 3.0 years, annual change in eGFR decline in participants with hematuria was significantly faster than in those without hematuria (mean [95% confidence interval]: - 0.95 [- 0.98 to - 0.92] vs - 0.86 [- 0.87 to - 0.84] mL/min/1.73 m2/year; P < 0.001). In ANCOVA, the hematuria-related annual eGFR decline rate increased as proteinuria frequency categories increased (differences in annual eGFR decline rate between participants with and without hematuria: 0.08 [0.06 to 0.09] in participants with non-proteinuria category, 0.17 [0.15 to 0.18] in occasional proteinuria category, and 0.68 [0.65 to 0.71] mL/min/1.73 m2/year in persistent proteinuria category; P for interaction < 0.001). Similar results were obtained by the linear mixed-effect model. CONCLUSIONS Proteinuria has a synergistic effect on dipstick hematuria-related decline in kidney function. Among the general population without proteinuria throughout the observational period, the "isolated hematuria"-related eGFR decline was statistically significant but the difference was small.
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Affiliation(s)
- Hikari Tasaki
- Department of Nephrology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
| | - Masahiro Eriguchi
- Department of Nephrology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan.
| | - Hisako Yoshida
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takayuki Uemura
- Department of Nephrology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
| | - Fumihiro Fukata
- Department of Nephrology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
| | - Masatoshi Nishimoto
- Department of Nephrology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
| | - Takaaki Kosugi
- Department of Nephrology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
| | - Masaru Matsui
- Department of Nephrology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
| | - Ken-Ichi Samejima
- Department of Nephrology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
| | - Kunitoshi Iseki
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment By Specific Health Check, Fukushima, Japan
| | - Koichi Asahi
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment By Specific Health Check, Fukushima, Japan
| | - Kunihiro Yamagata
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment By Specific Health Check, Fukushima, Japan
| | - Tsuneo Konta
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment By Specific Health Check, Fukushima, Japan
| | - Shouichi Fujimoto
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment By Specific Health Check, Fukushima, Japan
| | - Ichiei Narita
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment By Specific Health Check, Fukushima, Japan
| | - Masato Kasahara
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment By Specific Health Check, Fukushima, Japan
| | - Yugo Shibagaki
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment By Specific Health Check, Fukushima, Japan
| | - Toshiki Moriyama
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment By Specific Health Check, Fukushima, Japan
| | - Masahide Kondo
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment By Specific Health Check, Fukushima, Japan
| | - Tsuyoshi Watanabe
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment By Specific Health Check, Fukushima, Japan
| | - Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
- Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment By Specific Health Check, Fukushima, Japan
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Boateng K, Cohen A, Nelson M. A case of life-threatening hematuria. J Am Coll Emerg Physicians Open 2023; 4:e12992. [PMID: 37324047 PMCID: PMC10267952 DOI: 10.1002/emp2.12992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/13/2023] [Indexed: 06/17/2023] Open
Affiliation(s)
- Kingsley Boateng
- Department of Emergency MedicineDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
- Department of Emergency MedicineNorth Shore University HospitalManhassetNew YorkUSA
| | - Allison Cohen
- Department of Emergency MedicineDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
- Department of Emergency MedicineNorth Shore University HospitalManhassetNew YorkUSA
| | - Mathew Nelson
- Department of Emergency MedicineDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
- Department of Emergency MedicineNorth Shore University HospitalManhassetNew YorkUSA
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Zhang J, Wang Q, Zhao H, Yuan B, Sun X, Guan Y, Fang Z, Wang M. Safety and efficacy of transcatheter arterial embolization for management of refractory hematuria of prostatic origin. J Interv Med 2022; 5:84-88. [PMID: 35936661 PMCID: PMC9349008 DOI: 10.1016/j.jimed.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To estimate the safety and efficacy of transcatheter arterial embolization (TAE) in the treatment of refractory hematuria of prostatic origin (RHPO). Methods This retrospective study included 23 patients who underwent TAE for RHPO between May 2013 and August 2021. Technical and clinical success rates were calculated, and arteriogram findings and complications were detected. Results Embolization was performed 24 times in 23 patients. Technical success was achieved in 24/24 (100%) embolization procedures. Contrast agent extravasation was detected during 2 of the 24 angiographic procedures. Bilateral embolization was performed in 23 (95.8%) of the 24 procedures. The clinical success rate was 21/23 (91.3%), and hematuria stopped 1–4 days after TAE. No serious complications were observed. Conclusion TAE is a safe and effective minimally invasive technique for treating patients with RHPO.
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Affiliation(s)
- Jinlong Zhang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Quanyu Wang
- Interventional Department, Huabei Petroleum General Hospital, Renqiu, 062552, China
| | - Hongwei Zhao
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Bing Yuan
- Departments of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Xuedong Sun
- Departments of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Yang Guan
- Departments of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Zhuting Fang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350122, PR China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001, PR China
- Corresponding author. Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350122, PR China; Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001, PR China.
| | - Maoqiang Wang
- Departments of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, PR China
- Corresponding author. Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, PR China
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Kably I, Acharya V, Richardson AJ, Bhatia S. Prostatic Artery Embolization in Refractory Hematuria of Prostatic Origin. Tech Vasc Interv Radiol 2020; 23:100694. [PMID: 33308527 DOI: 10.1016/j.tvir.2020.100694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hematuria of prostatic origin has multiple etiologies including benign prostatic hyperplasia (BPH), iatrogenic urological trauma, prostate cancer, and radiation therapy. Hematuria secondary to benign prostatic hyperplasia can occur because of the increased vascularity of the primary gland, itself, or because of the vascular re-growth following a transurethral resection of the prostate. Prostatic hematuria usually resolves with conservative measures; however, refractory hematuria of prostatic origin may require hospitalization with treatment with blood transfusions, repeated indwelling urinary catheterization, and continuous bladder irrigation. Prostate artery embolization is an emerging minimally invasive procedural therapy for men with BPH that was originally utilized for the treatment of refractory hematuria of prostatic origin . This article aims to summarize the currently available evidence around prostate artery embolization for the treatment of refractory hematuria of prostatic origin.
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Affiliation(s)
- Issam Kably
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, FL
| | - Vedant Acharya
- University of Miami Miller School of Medicine, Miami, FL.
| | - Andrew J Richardson
- Department of Diagnostic and Interventional Radiology, Jackson Memorial Hospital, Miami, FL
| | - Shivank Bhatia
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, FL
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Selim A, Nottingham CU, York NE, Dauw CA, Borofsky MS, Boris RS, Lingeman JE. Holmium laser enucleation of the prostate in Jehovah's Witness patients. Int Urol Nephrol 2019; 52:455-460. [PMID: 31745707 DOI: 10.1007/s11255-019-02331-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/29/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate if HoLEP is a viable option for male patients with medication-refractory urinary symptoms due to an enlarged prostate who are surgical candidates, but do not accept blood product transfusion. MATERIALS AND METHODS Between August 2008 and March 2019, nine Jehovah's Witness patients were undergoing HoLEP for relief of lower urinary tract symptoms and urinary retention. We described change in hemoglobin, change in PSA, enucleated prostate weight, enucleation and morcellation times, length of stay, and postoperative retention rate. RESULTS The average age was 71.4 years (range 53-87). Urinary retention requiring catheterization was present in seven patients (78%). Two patients had a known diagnosis of prostate cancer preoperatively. The mean preoperative PSA on average was 21.6 ng/dL. Patients had a wide range of gland sizes, with a mean enucleated weight of 141 g (range 18-344 g). Mean reduction in hemoglobin was 16.9% following HoLEP. All patients managed to void postoperatively. All but one patient went home on postoperative day 1, and this patient went home on postoperative day 2. No patients required blood product transfusion or return to the operating room for clot irrigation postoperatively. CONCLUSION HoLEP is a reasonable option for Jehovah's Witness and other patients with contraindications to blood product transfusion requiring surgical management of urinary symptoms due to enlarged prostate.
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Affiliation(s)
- Ashraf Selim
- Department of Urology, University College London, London, UK
| | - Charles U Nottingham
- Department of Urology, Indiana University School of Medicine, 1801 Senate Blvd. Suite 220, Indianapolis, IN, 46202, USA.
| | - Nadya E York
- Urology, Auckland City Hospital, 2 Park Road, Grafton, 1023, Auckland, New Zealand
| | - Casey A Dauw
- Department of Urology, University of Michigan Health Systems, 1500 E Medical Center Dr SPC 5330, Ann Arbor, Michigan, 48109, USA
| | - Michael S Borofsky
- Department of Urology, University of Minnesota, 420 Delaware Street SE, Minneapolis, Minnesota, 55455, USA
| | - Ronald S Boris
- Department of Urology, Indiana University School of Medicine, 1801 Senate Blvd. Suite 220, Indianapolis, IN, 46202, USA
| | - James E Lingeman
- Department of Urology, Indiana University School of Medicine, 1801 Senate Blvd. Suite 220, Indianapolis, IN, 46202, USA
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Betschart P, Babst C, Schmid S, Rothermundt C, Abt D, Schwab C, Gillessen S, Engeler DS, Klingbiel D, Schmid HP, Omlin A. Shared Decision-Making for Patients with Advanced Urological Malignancies: Evaluation of a Joint Urological-Oncological Clinic Model. Oncol Res Treat 2019; 42:366-374. [PMID: 31170721 DOI: 10.1159/000499721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 03/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND To provide rapid evaluation of patients with advanced urological malignancies, a joint urological-oncological clinic was initiated at our institution in January 2015. We present the first 3-year evaluation of this joint urological-oncological clinic in Switzerland. METHOD We performed a retrospective analysis of the characteristics and treatment of all patients reviewed at the joint clinic between January 2015 and December 2017. Statistical analysis was performed by survival analysis. A patient satisfaction questionnaire was handed out to new patients (from April to September 2017). RESULTS A total of 135 new patients were counseled in the joint clinic and 563 consultations were performed in the period from January 2015 to December 2017. The majority were men with prostate cancer (85%), followed by bladder cancer (9%), and renal cell carcinoma (4%). Men with newly diagnosed metastatic prostate cancer (n = 69) received ADT alone (57%), ADT with docetaxel or abiraterone (33%), and metastasis-directed therapy (10%). High rates of patient satisfaction were reported based on the questionnaire. CONCLUSIONS The joint clinic model has been successfully implemented at our institution and continues on a weekly basis. The clinic is increasingly used, not only for newly diagnosed metastatic prostate cancer, but also for other complex uro-oncological cases. The clinic allows optimized oncological treatment without delay and with a reduced effort for patients.
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Affiliation(s)
- Patrick Betschart
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland,
| | - Christa Babst
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Sabine Schmid
- Department of Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Christian Rothermundt
- Department of Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Dominik Abt
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Christoph Schwab
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Silke Gillessen
- Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, University of Bern, Bern, Switzerland.,Division of Cancer Sciences, University of Manchester and The Christie Hospital, Manchester, United Kingdom
| | | | - Dirk Klingbiel
- Coordinating Centre, Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Aurelius Omlin
- Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, University of Bern, Bern, Switzerland
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Chen JW, Shin JH, Tsao TF, Ko HG, Yoon HK, Han KC, Thamtorawat S, Hong B. Prostatic Arterial Embolization for Control of Hematuria in Patients with Advanced Prostate Cancer. J Vasc Interv Radiol 2017; 28:295-301. [DOI: 10.1016/j.jvir.2016.10.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/09/2016] [Accepted: 10/14/2016] [Indexed: 11/29/2022] Open
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Abstract
Microscopic and gross hematuria present unique and difficult diagnostic and management challenges in the already complex general surgery patient. This article provides the general surgeon with relevant knowledge in the pathophysiology, anatomy, etiologies, workup, and treatments of hematuria. In addition common causes of hematuria that may be encountered by the general surgeon (including trauma, urinary tract infection, urolithiasis, and malignancy), the difficult to manage clinical situation of clot urinary retention is presented. This article provides a urologic framework of thinking for the clinician to best manage a general surgery patient who has hematuria.
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Affiliation(s)
- Gabriella J Avellino
- Department of Urology, Boston Medical Center, Boston University School of Medicine, 725 Albany Street, Suite 3B, Boston, MA 02118, USA
| | - Sanchita Bose
- Department of Urology, Boston Medical Center, Boston University School of Medicine, 725 Albany Street, Suite 3B, Boston, MA 02118, USA
| | - David S Wang
- Department of Urology, Boston Medical Center, Boston University School of Medicine, 725 Albany Street, Suite 3B, Boston, MA 02118, USA.
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Pereira K, Halpern JA, McClure TD, Lewis NA, Kably I, Bhatia S, Hu JC. Role of prostate artery embolization in the management of refractory haematuria of prostatic origin. BJU Int 2016; 118:359-65. [DOI: 10.1111/bju.13524] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Keith Pereira
- Department of Interventional Radiology; St. Louis University Hospital; St. Louis MO USA
| | - Joshua A. Halpern
- Department of Urology; Weill Cornell Medical College; New York NY USA
| | | | | | - Isaam Kably
- Department of Interventional Radiology; Jackson Memorial Hospital/University of Miami Hospital; Miami FL USA
| | - Shivank Bhatia
- Department of Interventional Radiology; Jackson Memorial Hospital/University of Miami Hospital; Miami FL USA
| | - Jim C. Hu
- Department of Urology; Weill Cornell Medical College; New York NY USA
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Berent AC, Weisse CW, Branter E, Adams LG, Aarhus A, Smee N, Berg R, Bagley DH. Endoscopic-guided sclerotherapy for renal-sparing treatment of idiopathic renal hematuria in dogs: 6 cases (2010–2012). J Am Vet Med Assoc 2013; 242:1556-63. [DOI: 10.2460/javma.242.11.1556] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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