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Journal Cover   Journal of Clinical Urology
  [SJR: 0.183]   [H-I: 5]   [9 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 2051-4158 - ISSN (Online) 2051-4166
   Published by Sage Publications Homepage  [813 journals]
  • Editorial
    • Authors: Pearce; I.
      Pages: 159 - 159
      PubDate: 2015-04-24T02:05:20-07:00
      DOI: 10.1177/2051415815582164
      Issue No: Vol. 8, No. 3 (2015)
  • Social media in urology - what is all the fuss about'
    • Authors: Modgil, V; Cashman, S, Bedi, N, Rukin, N. J, Pearce, I.
      Pages: 160 - 165
      PubDate: 2015-04-24T02:05:20-07:00
      DOI: 10.1177/2051415815581950
      Issue No: Vol. 8, No. 3 (2015)
  • Useful urological parameters from the neonate to the adolescent
    • Authors: Allen, S; Green, J.
      Pages: 166 - 171
      PubDate: 2015-04-24T02:05:20-07:00
      DOI: 10.1177/2051415815570782
      Issue No: Vol. 8, No. 3 (2015)
  • Factors influencing length of stay and suitability for early community
           discharge in the management of acute pyelonephritis
    • Authors: Hsu, R; Shergill, P, Gnanapragasam, V.
      Pages: 172 - 176
      Abstract: Objectives: We assessed factors influencing length of stay and suitability for early discharge to community care in acute pyelonephritis (APN). Methods: APN patients admitted in 2011–2012 to a tertiary hospital were included in a retrospective study. Data collected included patient demographics, Charlson Comorbidity Index (CCI), admitting speciality, imaging, length of stay and any intervention. Results: A total of 266 patients were analysed with 83.1% managed by urologists and the rest by other specialties. Urology patients had a shorter mean stay of 4.7 days compared to 8.8 days for non-urology patients (p < 0.001). The mean time to imaging was 0.5 days and 1.4 days for urology and other specialties, respectively (p < 0.001). Twenty per cent of patients had urinary tract abnormalities on imaging but only 2.0% required intervention; 9.4% (25/266) had repeated imaging following an initial scan but none resulted in an intervention. A high CCI was a predictor of longer stays regardless of admitting speciality (p < 0.001). Admission to non-urological specialities remained a significant predictor both of delayed imaging (p = 0.001) and longer stays (p < 0.001) even after correction for CCI. Conclusion: Time to imaging, comorbidity and admitting speciality are key factors influencing APN management. Rapid urological review and imaging could identify patients suitable for safe early discharge to community management.
      PubDate: 2015-04-24T02:05:20-07:00
      DOI: 10.1177/2051415814551192
      Issue No: Vol. 8, No. 3 (2015)
  • Consent information leaflets - readable or unreadable'
    • Authors: Graham, C; Reynard, J. M, Turney, B. W.
      Pages: 177 - 182
      Abstract: Objective: The objective of this article is to assess the readability of leaflets about urological procedures provided by the British Association of Urological Surgeons (BAUS) to evaluate their suitability for providing information. Methods: Information leaflets were assessed using three measures of readability: Flesch Reading Ease, Flesch-Kincaid and Simple Measure of Gobbledygook (SMOG) grade formulae. The scores were compared with national literacy statistics. Results: Relatively good readability was demonstrated using the Flesch Reading Ease (53.4–60.1) and Flesch-Kincaid Grade Level (6.5–7.6) methods. However, the average SMOG index (14.0–15.0) for each category suggests that the majority of the leaflets are written above the reading level of an 18-year-old. Using national literacy statistics, at least 43% of the population will have significant difficultly understanding the majority of these leaflets. Conclusions: The results suggest that comprehension of the leaflets provided by the BAUS is likely to be poor. These leaflets may be used as an adjunct to discussion but it is essential to ensure that all the information necessary to make an informed decision has been conveyed in a way that can be understood by the patient.
      PubDate: 2015-04-24T02:05:20-07:00
      DOI: 10.1177/2051415814555947
      Issue No: Vol. 8, No. 3 (2015)
  • Precision of computed tomography urography in diagnosing transitional cell
    • Authors: Horsburgh, B; Belfield, J, Lynch, C.
      Pages: 183 - 187
      Abstract: Introduction: Computed tomography urography (CTU) has largely replaced excretion urography. Indications for CTU include patients with haematuria and for upper tract surveillance in those with known transitional cell carcinoma (TCC). Reporting of a possible TCC can lead to complex clinical decisions regarding further investigation and management. The aim of this study is to ascertain the positive predictive value (PPV) of such reports in a large tertiary centre. Methods: Examinations performed from January 2010 to August 2012 were retrospectively identified. Subsequent diagnosis of TCC was confirmed by histology, cytology or accepted by uro-oncology MDT with absence of histological proof. The PPV of reported TCCs was calculated overall, by tumour site and presentation. Results: A total of 1199 CTU investigations were performed. Analysis revealed the PPV of a reported TCC was 67% for kidney, 44% for ureteric and 85% for bladder lesions. Overall PPV was 68% and 51% for the upper tracts. In patients who attended the haematuria clinic, the PPV was 82% and 88% when positive cytology was included. Conclusion: CTU is an appropriate replacement for excretion urography. However, prompt invasive assessment of the entire urinary tract still remains necessary to confirm a suspected TCC.
      PubDate: 2015-04-24T02:05:20-07:00
      DOI: 10.1177/2051415814551380
      Issue No: Vol. 8, No. 3 (2015)
  • Indicative operative numbers in urology training in the UK and Ireland
    • Authors: Robinson, R; O'Flynn, K. J.
      Pages: 188 - 195
      Abstract: Objectives: In 2011 the Joint Committee on Surgical Training (JCST) issued guidelines for the award of a Certificate of Completed Training (CCT) in urology, including a list of 15 operative procedure groups for which a trainee must have achieved a minimum level of exposure (termed indicative number) and competence. This study evaluated whether the expected exposure correlated with that achieved by UK and Irish trainees. Methods: The operative logbooks of trainees who applied for a CCT in urology from 2010 to 2012 were reviewed. All exposure for each operative group, irrespective of the degree of supervision, was combined to give total operative experience. Results: Data on 154 trainees were available. More than 75% achieved the indicative number for radical prostatectomy, nephrectomy, ureteroscopy, PCNL and inguino-scrotal surgery. Only 70%, 68%, 64%, 25%, 21% and 8% reached the required level for cystectomy, TURBT, TURP, andrology, female and paediatric groin surgery, respectively. There was significant geographical variation in exposure, with the majority of trainees not achieving the minimum level for some procedure groups in certain training regions. Conclusions: There is a disparity between the operative exposure expected by the JCST and that achieved by urology trainees. To prevent large numbers of trainees failing to meet JCST requirements, an urgent and significant change to urology training, or further modification of the current guidelines, is required.
      PubDate: 2015-04-24T02:05:20-07:00
      DOI: 10.1177/2051415814568134
      Issue No: Vol. 8, No. 3 (2015)
  • Psychological distress in out-patients undergoing flexible cystoscopy for
           the investigation of bladder cancer
    • Authors: Ellis, G; Pridgeon, S, Lamb, B, Awsare, N, Osaghae, S, Smith, S, McNicholas, T, Green, J.
      Pages: 196 - 201
      Abstract: Objectives: Flexible cystoscopy can cause patients significant psychological distress, especially when utilised in the diagnostic pathway for suspected bladder cancer. We aimed to assess the prevalence of general anxiety and depression, as well as procedure-related worry and pain in patients undergoing local anaesthetic flexible cystoscopy and to determine whether these conditions occur more frequently in subsets of the population. Patients and methods: Patients referred for flexible cystoscopy were invited to participate. Patients were asked to complete a questionnaire containing the Hospital Anxiety and Depression Scale (HADS), a worry score and a question regarding the most stressful event in the diagnostic pathway. Following the procedure patients were also asked to complete a pain score. Results: A total of 175 patients participated in the study. The prevalence of significant anxiety was 15% and depression 3.5%. This was higher in younger, female and unmarried patients. Procedure-related worry and pain were generally low. Conclusions: We found the prevalence of anxiety and depression in patients undergoing flexible cystoscopy to be raised compared to a similar cohort of patients undergoing TRUS-guided prostate biopsy. We have identified subgroups more likely to experience these symptoms and have also identified the sections of the diagnostic pathway that are most likely to cause anxiety and depression. By doing this we can target those patients who are more likely to suffer during the diagnostic process and aim to improve their experience. We can also implement targeted changes to the pathway to reduce the impact it may have on patients’ mental health.
      PubDate: 2015-04-24T02:05:21-07:00
      DOI: 10.1177/2051415814551821
      Issue No: Vol. 8, No. 3 (2015)
  • Living with a 100 ml prostate: Outcomes over a decade
    • Authors: Hobbs, C. P; Henderson, J. M, Malone, P. R.
      Pages: 202 - 208
      Abstract: Objective: The objective of this article is to determine outcomes and guide the management of patients with a prostate volume of 100 ml or greater. Patients and methods: A database of patients undergoing transrectal ultrasound (TRUS)-guided biopsy from 1994 to 1999 was analysed. Records of those with a prostate of 100 ml or greater were reviewed. Results: A total of 63 patients were included in the study with a mean follow-up of 11 years. Initial TRUS-guided biopsy yielded prostate cancer (CaP) in six of 63 (10%). Twenty-six of 63 (41%) underwent repeat biopsies. CaP was ultimately diagnosed in 13/63 (21%). Prostate-specific antigen (PSA) levels were erratic over time, making monitoring difficult. The PSA coefficient of variation in benign prostates ranged from 8.9% to 48.6% in the year following biopsy. Twenty-one of 50 (42%) with benign prostates experienced acute urinary retention (AUR), 31/50 (62%) haematuria and 43/50 (86%) received treatment for lower urinary tract symptoms (LUTS). Twenty-six of 50 (52%) received 5-alpha reductase inhibitors (5ARI), 11/50 (22%) α-blockers and 28/50 (56%) surgery. Thirteen of 15 (87%) experienced further symptoms when treated for less than two years with 5ARI versus five of 16 (31%) receiving long-term treatment (mean duration 8.1 years). Fifteen of 25 (60%) experienced haematuria following TURP and 14/25 (56%) required further treatment. Conclusion: Large prostates cause considerable symptoms prompting multiple medical consultations and investigations. PSA monitoring in this group is difficult, leading to repeated biopsies of benign prostates. Long-term 5ARI treatment should be considered to reduce progression to AUR, the incidence of haematuria and to facilitate PSA monitoring. Newer treatment modalities such as holmium laser enucleation (HoLEP) should be considered ahead of TURP. When TURP is performed, 5ARI treatment should be considered post-operatively. This group of men should have close urological follow-up.
      PubDate: 2015-04-24T02:05:21-07:00
      DOI: 10.1177/2051415814554851
      Issue No: Vol. 8, No. 3 (2015)
  • Long-term outcome of radical cystectomy - metropolitan Australia
    • Authors: Chen, E. C; McCahy, P, Ranashinha, S, Frydenberg, M.
      Pages: 209 - 214
      Abstract: Objective: The objective of this article is to review the 10-year clinical outcomes of radical cystectomy (RC) for the treatment of localised bladder cancer from a major Australian metropolitan urology unit. Material and methods: A retrospective analysis identified prognostic factors that contributed to survival outcome in the 120 patients that underwent RC between 1998 and 2008. Patients with benign disease of the urinary bladder (n = 10) and those with inadequate follow-up information (n = 11) were excluded. Results: Complete data were available for 99 patients. The five-year survival for pT1, pT2, pT3 and pT4 was 36%, 47%, 22% and 0, respectively. Lymphadenectomy was not routinely performed as part of RC early in the study period. Multiple surgeons were involved in the cystectomy program. Conclusion: Long-term outcome of RC was considerably different from other published cystectomy series. Postulated reasons include: delay to surgery, surgeon/unit volume and underuse of pelvic lymphadenectomy and neoadjuvant chemotherapy. The establishment of a bladder cancer registry as well as practice guidelines are needed to improve future outcomes.
      PubDate: 2015-04-24T02:05:21-07:00
      DOI: 10.1177/2051415814551820
      Issue No: Vol. 8, No. 3 (2015)
  • Comparative outcomes of open and robotic-assisted radical cystectomy in an
           enhanced recovery programme era
    • Authors: Pai, A; Nair, R, Ayres, B, Tsoi, H, Sooriakumaran, P, Issa, R, Perry, M.
      Pages: 215 - 221
      Abstract: Aim: The aim of this study was to determine the added value of robotic surgery for radical cystectomy in the context of an established enhanced recovery programme (ERP). Background: We have previously reported on ERP in open radical cystectomy (ORC) and shown that it is safe and not associated with an increase in complications or readmissions. Further, it is associated with reductions in ICU stay, length of hospital stay and duration of postoperative ileus. The recent introduction of robotic-assisted radical cystectomy (RARC), with its perceived benefit of minimal invasiveness, has led to the question of whether patients who have their radical cystectomy in the environment of ERP would experience an added benefit if the surgery were performed robotically. We implemented the ERP for all patients undergoing radical cystectomy in 2008. In 2010 we started to offer RARC as the first line treatment for all bladder cancer patients with an indication for bladder extirpation. In this study we compare the perioperative results of the last 50 RARC patients with the last 50 ORC. The same ERP protocol was implemented in all patients. Patients and methods: We used our prospectively kept electronic database to identify the last 50 ORC and 50 RARC patients (we excluded the first 10 RARC in our series to reduce learning curve effect). We compared preoperative (age, sex, comorbidity), intraoperative (diversion type, fluid loss, blood transfusion, conversion and number of lymph node dissections (LND)) and post-operative (length of stay LOS, nodal yield and pathological T stage) variables. We also reported on the 30 day complications according to Clavien–Dindo classification. Results: The two groups did not differ significantly in their preoperative variables, number of LND performed and pathological T and N stage. Patients in the RARC arm were more likely to have continent diversion and had significantly less intraoperative fluid loss. LOS and lymph nodal yield was no worse in the RARC cohort in comparison to the ORC patients. The RARC patients had significantly lower transfusion rates and overall 30-day complication rates. Conclusions: We have shown that robotic surgery offers an added value to patients undergoing radical cystectomy for bladder cancer in addition to the benefits gained from enrolling in an ERP. This is likely due to the minimally invasive nature of robotic surgery, and thus an attenuation of its physiological insult, which is the cornerstone of ERP theory.
      PubDate: 2015-04-24T02:05:21-07:00
      DOI: 10.1177/2051415814553650
      Issue No: Vol. 8, No. 3 (2015)
  • Recurrent perinephric and intra-peritoneal sepsis from dropped gall stones
           at laparoscopic cholecystectomy
    • Authors: Eli, N; Christodoulidou, M, Pantelides, M, Smajer, B.
      Pages: 222 - 223
      PubDate: 2015-04-24T02:05:21-07:00
      DOI: 10.1177/2051415813512649
      Issue No: Vol. 8, No. 3 (2015)
  • Hepatic portal vein gas in a patient with a parastomal hernia in
           association with an ileal loop diversion
    • Authors: Hejj, R; Moore, K. C.
      Pages: 224 - 226
      PubDate: 2015-04-24T02:05:21-07:00
      DOI: 10.1177/2051415813515479
      Issue No: Vol. 8, No. 3 (2015)
  • Corrigendum
    • Pages: 227 - 227
      Abstract: For the following paper published in the s sections of the November edition of Journal of Clinical Urology, the co-authors section was incorrect. The amended authorship is below: Thomas BMK, Brown F, Elbaroni W, et al. Nicorandil-induced eroding foreskin ulcer: Three case reports. J Clin Urol 2014: 7; 430.
      DOI : 10.1177/2051415814558177.
      PubDate: 2015-04-24T02:05:21-07:00
      Issue No: Vol. 8, No. 3 (2015)
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