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Journal Cover   Journal of Clinical Urology
  [SJR: 0.183]   [H-I: 5]   [7 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  [819 journals]
  • Editorial
    • Authors: Pearce; I.
      Pages: 232 - 232
      PubDate: 2015-06-02T06:39:26-07:00
      DOI: 10.1177/2051415815588419
      Issue No: Vol. 8, No. 4 (2015)
       
  • Vesico-vaginal and urethro-vaginal fistulae in the developed world
    • Authors: Kiosoglous, A. J; Greenwell, T. J.
      Pages: 233 - 239
      PubDate: 2015-06-02T06:39:26-07:00
      DOI: 10.1177/2051415815570781
      Issue No: Vol. 8, No. 4 (2015)
       
  • 'Carrying on the way we are is becoming shambolic' - An interview study
           with prostate cancer specialists about their usual practice of follow-up
    • Authors: Bulger, J. K; Hiscock, J, Neal, R. D, Stanciu, A, Makin, M, Wilkinson, C.
      Pages: 240 - 245
      Abstract: Aim: This study aims to clarify what practice for the follow-up of prostate cancer is occurring at present and to explain the reasons behind any variation. Background: Prostate cancer has been increasing in incidence in the UK for several years. It has been suggested that men with prostate cancer could be better managed, and that some aspects of care are duplicated by primary and secondary care professionals. Methods: This study aimed to interview the prostate cancer specialists identified as working within the district general hospitals of a large health board. The interviews used a qualitative semi-structured approach. Analysis was performed using The Framework method. Findings: Current practice for the follow-up of prostate cancer is variable both within and between hospitals. Patients are followed up in secondary care for longer than National Institute for Health and Care Excellence (NICE) recommends due to a lack of trust of general practitioners’ management. This inevitably impacts upon waiting lists, and many patients’ appointments are long overdue. A remote prostate-specific antigen (PSA) surveillance system may be beneficial. It is generally thought that change to the usual practice of follow-up of prostate cancer patients is required.
      PubDate: 2015-06-02T06:39:26-07:00
      DOI: 10.1177/2051415814545804
      Issue No: Vol. 8, No. 4 (2015)
       
  • Delays in the diagnosis and treatment of muscle invasive bladder cancer: A
           pilot project mapping the pathway
    • Authors: Iqbal, M. S; Pickles, R, Pedley, I, Frew, J, Azzabi, A, Heer, R, Thorpe, A, Johnson, M, Robson, L, McMenemin, R.
      Pages: 246 - 251
      Abstract: Background: The patient pathway for muscle invasive bladder cancer (MIBC) is multidisciplinary. Trans-urethral resection of bladder tumour (TURBT) counts as the first definitive treatment and subsequent definitive therapy thereafter is often delayed, which may adversely affect outcome. We elected to scrutinise the management pathway in detail to understand these delays and improve the patient experience. Method: A retrospective mapping analysis was conducted on 17 patients with MIBC. The causes of any delays and measures to avoid these were identified. A prospective study of 17 patients with MIBC was then undertaken to see if the strategies used to re-engineer the patient care pathway had been effective. Result: The median time from GP referral to first appointment was 9 days (range: 1–37) and from TURBT to subsequent radical treatment was 75 days (range: 27–105) in keeping with published literature. The median time for a referral letter from urology to oncology following MDT was 15 days. We therefore modified the MDT proforma to use as a formal referral, and a project manager proactively managed the patient pathway. Capacity issues were addressed by protecting clinical slots for bladder patients and establishing monthly evening clinics. After implementing the strategies, the median days from first appointment to TURBT improved from 31 to 23 days and time from TURBT to subsequent treatment improved from 75 to 66 days. The time from MDT referral to being seen by an oncologist or urologist significantly reduced from 32 to 15 days. Conclusion: Retrospective analysis identified delays between initial TURBT to definitive therapy and strategies adopted to reduce these were effective. TURBT is a diagnostic process and if acknowledged as first treatment results in delays of what is the definitive treatment. We found the initial diagnostic pathway to work well but non-muscle invasive bladder cancer (NMIBC) and MIBC are then managed very differently and warrant two separate pathways.
      PubDate: 2015-06-02T06:39:26-07:00
      DOI: 10.1177/2051415814557067
      Issue No: Vol. 8, No. 4 (2015)
       
  • Factors associated with surgical intervention in children with high-grade
           congenital hydronephrosis
    • Authors: Chalmers, D. J; Siomos, V. J, Gilsdorf, D. J, Torok, M. R, Vemulakonda, V. M.
      Pages: 252 - 260
      Abstract: Purpose: A lack of uniform guidelines regarding ureteropelvic junction obstruction may be associated with demographic variations in pyeloplasty timing. This study objective was to determine if children who undergo surgery are more likely to be of minority race. Materials and methods: Children with Society for Fetal Urology (SFU) 3–4 hydronephrosis were reviewed. Demographic and clinical characteristics were abstracted. Bivariable associations between clinical/demographic characteristics and pyeloplasty versus observation as well as follow-up findings were assessed with chi-square testing. The bivariable relationship between race and time from first clinic visit to surgery was evaluated by Kaplan-Meier curve. Multivariable logistic regression was performed to estimate the relationship between clinical characteristics and management decision. Results: Thirty-nine patients underwent pyeloplasty and 50 were observed. There were no differences in demographics, including race/ethnicity. Factors associated with surgery included higher SFU grade (p = 0.01), preoperative MAG3 (p = 0.02), and T1/2 >20 (p = 0.01). On multivariate analysis, MAG3 T1/2 >20 was associated with surgery (OR = 0.20, 95% CI: 0.07–0.61). Median time to surgery for whites versus non-whites was not significant (232 vs 208 days, p = 0.16). Conclusions: In our cohort, the decision to perform pyeloplasty is associated with clinical rather than demographic characteristics. Despite controversy regarding T1/2 interpretation, delayed radiotracer clearance remained a significant predictor of surgery.
      PubDate: 2015-06-02T06:39:26-07:00
      DOI: 10.1177/2051415814561333
      Issue No: Vol. 8, No. 4 (2015)
       
  • Conversion rates of abstracts to publications from the Irish Society of
           Urology Annual Meeting (2005-2011) - Questioning the scientific value of
           national urological meetings for smaller European nations
    • Authors: O'Kelly, F; Nason, G, Bell, S, Galbraith, A, McLoughlin, L, Quinlan, D, Thornhill, J.
      Pages: 261 - 267
      Abstract: Background: Large annual scientific meetings such as the American Urological Association (AUA) and the European Association of Urology (EUA) have abstract conversion rates into publication of 37%–48%. There are no data on the conversion rates from national meetings of smaller European countries. Our objective was to present the conversion rates and manuscript characteristics of the Irish Society of Urology (ISU) annual meeting over a seven-year period (2005–2011), and to demonstrate the value, viability and sustainability of such a meeting as a model for other small national research programmes. Methods: All abstracts presented at the ISU annual meeting between 2005 and 2011 were identified. The subsequent publication rate following the meetings was established for the corresponding studies based on a Medline scan. A range of characteristics associated with subsequent publication were analysed using the logistic regression of the dichotomous variable of publications vs. non-publication of each factor. Results: Overall, 46% of the 322 abstracts presented at the ISU meeting were followed by publication into Medline-indexed journals with a mean impact factor of 2.6. A total of 74% abstracts were published within two years. Oral presentations were more likely to be published than posters (p < 0.0001), and prospective clinical research was more likely to be published in a journal with a higher impact factor than retrospective analyses (p = 0.033); the mean time to publication was 16.7 months. Conclusions: Almost half the abstracts presented at the ISU were subsequently published in peer-reviewed journals, the majority within two years. This compares favourably with larger urological meetings, and provides an incentive to other smaller countries within Europe to continue with national research programmes.
      PubDate: 2015-06-02T06:39:26-07:00
      DOI: 10.1177/2051415814565200
      Issue No: Vol. 8, No. 4 (2015)
       
  • Day-case holmium laser enucleation of the prostate
    • Authors: Cynk, M; Georgiadis, G, Moore, E, Appleby, J, Griffiths, R, Hale, J.
      Pages: 268 - 273
      Abstract: In 2011 day-case prostate surgery was selected for financial incentives in the UK by the Department of Health Payment by Results (PbR) scheme, with a target of 30% of holmium laser enucleation of the prostate (HoLEP) procedures as day cases for 2011–2012, increasing to 90% within three years. The objective was to determine the feasibility and safety of day-case HoLEP. Patients and methods: All patients presenting to an experienced HoLEP surgeon and requiring prostatic surgery were considered for day-case HoLEP. We developed a four-hour postoperative discharge protocol with specialist urology nurse assessment and discharge. Results: Between April 2011 and March 2014, 188 patients (median age 74, range 48–92) were eligible for HoLEP surgery. Four patients did not undergo surgery, and 70 (38%) did not fit the day-case criteria. The remaining 114 (62%) were considered for day surgery, of which 91 (80%) were successful. There was one readmission with haematuria and blocked catheter, and two late readmissions with secondary bleeding. Conclusions: Day-case HoLEP is feasible and safe, even in patients with significant comorbidity. Our overall day-case rate of 49.5% exceeds the initial 30% target set by PbR, but suggests that the 90% target is overly optimistic.
      PubDate: 2015-06-02T06:39:26-07:00
      DOI: 10.1177/2051415814560188
      Issue No: Vol. 8, No. 4 (2015)
       
  • Can urodynamics distinguish between urethral strictures and Benign
           Prostatic Hyperplasia (BPH)'
    • Authors: Bishara, S; Foley, C, Peters, J, Philp, T, Malone-Lee, J.
      Pages: 274 - 278
      Abstract: Objectives: We tested whether pressure flow studies could distinguish between patients with Benign Prostatic Hyperplasia (BPH) and urethral strictures and hypothesised that urethral strictures were associated with a lower closure pressure and increased slope of the passive urethral relation compared to benign prostatic obstruction. Patients and method: Ninety patients who had Transurethral Resection of Prostate (TURP) and 45 male patients who had an optical urethrotomy or urethral dilatation for urethral stricture disease, who had a prior urodynamics study, were evaluated. Results: Patients with urethral stricture disease had lower closure pressures than those undergoing TURP (22.07 vs. 28.4 cmH2O, p=0.0039, r=0.61). However, the slope of the passive urethral relation was indistinguishable between the two groups. Only 60% of patients with symptomatic urethral strictures were categorised as unequivocally obstructed by the Abrams-Griffiths nomogram. Conclusion: Urethral strictures are associated with lower closure pressures than prostatic obstruction; however, there was no difference in the urethral resistance relation.
      PubDate: 2015-06-02T06:39:26-07:00
      DOI: 10.1177/2051415814565371
      Issue No: Vol. 8, No. 4 (2015)
       
  • Role of neoadjuvant chemotherapy in muscle-invasive bladder cancer:
           Clinical and cost effectiveness
    • Authors: Goonewardene, S. S; Bahl, A, Persad, R.
      Pages: 279 - 284
      Abstract: Background: Bladder cancer is one of the most common cancers in the Western world, with associated significant mortality. Once proven to be muscle invasive, radical therapy is required. Objective: We reviewed the literature associated with clinical effectiveness of neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer. Methods: We conducted a systematic literature review of papers related to the search terms neoadjuvant chemotherapy, muscle invasive bladder cancer and clinical effectiveness; from 1984 through April 2014. We used the search terms of (neoadjuvant chemotherapy) AND (muscle invasive bladder cancer). We included primary research, but only included secondary research if it was a systematic review or meta-analyses. Papers outside this category were not included. Results: From the literature review, we found that the benefits of neoadjuvant chemotherapy for muscle-invasive bladder cancer are wide-ranging. This includes a greatly improved response rate, including complete response and improved survival rate. Potential disadvantages of NAC include less accurate staging, delays in curative surgery (risk is greater, if delay > 12 weeks) in non-responders and the well-known fact that non-responders will fare worse, later on. Conclusions: In conclusion, NAC followed by radical therapy is the gold standard for muscle-invasive bladder tumours, for patients whom are sufficiently fit; however, there are many unanswered questions. As yet, this intervention has not been examined by the National Institute for Health and Care Excellence.
      PubDate: 2015-06-02T06:39:26-07:00
      DOI: 10.1177/2051415814554334
      Issue No: Vol. 8, No. 4 (2015)
       
  • Myxoid liposarcoma of the scrotum in a 27-year-old male successfully
           treated with primary excision and testis preservation
    • Authors: McGuinness, L. A; Floyd, M. S, Lucky, M, Azhar, U, Seneviratne, R, Cliff, A. M.
      Pages: 285 - 286
      PubDate: 2015-06-02T06:39:26-07:00
      DOI: 10.1177/2051415813514970
      Issue No: Vol. 8, No. 4 (2015)
       
  • Ureteral perigraft fistula: a case report and review of the literature
    • Authors: Najefi, A; Alleemudder, A, Mambu, L, Jones, S, Syed, I, Gujral, S.
      Pages: 287 - 289
      PubDate: 2015-06-02T06:39:26-07:00
      DOI: 10.1177/2051415813516952
      Issue No: Vol. 8, No. 4 (2015)
       
  • Corrigendum
    • Pages: 290 - 290
      Abstract: In the previous issue article "Social Media in Urology - what is all the fuss about'" (J Clin Urol Vol. 8(3); 160–165.
      DOI : 10.1177/2051415815581950), the International Urology Journal Club (@iurojc) Twitter hashtag used was incorrect. It is in fact #urojc (not #iurojc) which allows users comments to be seen by other involved in the discussion. This is a subtle, yet important difference for readers to note and the JCU apologise unreservedly for any confusion caused.
      PubDate: 2015-06-02T06:39:27-07:00
      Issue No: Vol. 8, No. 4 (2015)
       
 
 
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