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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  [827 journals]
  • Editorial
    • Authors: Pearce; I.
      Pages: 368 - 368
      PubDate: 2015-11-11T03:41:07-08:00
      DOI: 10.1177/2051415815612640
      Issue No: Vol. 8, No. 6 (2015)
  • When ignorance is not bliss - a study of poor awareness of radiation
    • Authors: Poullis, C; Mackay, A, Ahmed, M.
      Pages: 369 - 373
      Abstract: Introduction and objective: Patient safety is at the forefront of quality of care. Radiation exposure secondary to diagnostic imaging is increasing rapidly. Coupled with clinicians’ lack of awareness concerning radiation, doses incurred during these common procedures mean patients are being exposed to substantial cumulative radiation. Recent publications have indicated a significant minority of cancers are secondary to medical ionising radiation. The purpose of this study was to establish physician knowledge of radiation dosages. Methods: Clinician knowledge of radiation doses was determined by a questionnaire distributed to 40 doctors across all specialties in a District General Hospital in England. Clinicians were asked to estimate the radiation dose incurred during common diagnostic investigations, environmental exposure and the relation to increased cancer risk. The results were correlated against seniority and previous formal education on ionising radiation. Results: Clinician knowledge of radiation doses was poor with a mean score of 17% (range 0–44%). There was, on average, more than a 12-fold underestimation of radiation exposure levels across all grades and specialties of doctors. Those with previous formal education outperformed those without, but not significantly (p > 0.05). Conclusions: Clinician awareness surrounding radiation doses of common diagnostic modalities is poor, grossly underestimating the true values. Increasing seniority or prior formal radiology training did not significantly alter the outcome. There is a need to educate clinicians, raise radiation dose awareness and avoid the financial, medico-legal and health delivery implications of unnecessary patient exposure to radiation.
      PubDate: 2015-11-11T03:41:07-08:00
      DOI: 10.1177/2051415813518918
      Issue No: Vol. 8, No. 6 (2015)
  • Metabolic abnormalities in patients treated with percutaneous
    • Authors: Nandwani, G; Stoves, J, Azhar, M, Pereni, C, Shah, T.
      Pages: 374 - 382
      Abstract: Objectives: To assess metabolic abnormalities in patients with percutaneous nephrolithotomy (PCNL) that could pose a risk for stone recurrence. Materials and methods: The data was collected retrospectively on all patients who had PCNL and metabolic studies, between January 2000 and September 2012. Results: There were 144 patients; median age and follow up were 49.5 (15– 4) years and 80.2 (16–180) months, respectively. Nearly half of the patients had staghorn calculus. Metabolic abnormalities (MAs) were found in 55 (38.2%). The 31 (21.5%) of these had multiple metabolic abnormalities (MMA) while 24 (16.6%) had a single metabolic abnormality (SMA). Uricosuria was found in 24 (16.6%), hyperoxaluria in 22 (15.3%), hyperphosphaturia in 18 (12.5%), hypercalciuria in 10 (7%), hypomagnesuria in 6 (4.2%), cystinuria in 5 (3.5%) and hypocitraturia in 5 (3.5%). Hyperuricaemia was present in 10 (7%), hypercalcaemia in 5 (3.5%), hyperphosphataemia in 7 (5%) and renal tubular acidosis in 1 (0.7%). In non-staghorn, MAs were found in 25 (35.2%) and 16 (64%) of these had MMA. In patients with staghorn, MAs were present in 30 (41%) patients. Half of the patients 15 (50%) in this group had MMA. A high proportion of the first time stone formers requiring surgical treatment had MAs and 57% of these had MMA. Stone analysis was available for 69 (48%) and 37 (53.6%) of these had mixed composition. The highest proportion of patients with uric acid stones had MA 89% followed by cystine stones 80%, matrix stones 50%, calcium oxalate 36.6%, carbonate apatite 36.4% and triple phosphate 33.3% . Conclusion: A high proportion of first time stone formers, staghorn and non-staghorn stone formers with PCNL had MA. These findings suggest that the treatment of metabolic abnormalities can play an important role in reducing the risk of stone recurrences and management may include referral to dedicated metabolic stone clinics.
      PubDate: 2015-11-11T03:41:07-08:00
      DOI: 10.1177/2051415814556335
      Issue No: Vol. 8, No. 6 (2015)
  • Radiation dosage in the urolithiasis population: Do we over-radiate our
    • Authors: Omar, I; Finch, W, Wynn, M, Winterbottom, A, Wiseman, O. J.
      Pages: 383 - 389
      Abstract: Introduction: There is increasing concern about the amount of radiation that patients with urolithiasis receive. Ensuring patients are exposed to the minimum necessary radiation is imperative. Here we review the radiation dosages that newly diagnosed urolithiasis patients received in the year following their presentation, both those presenting acutely and those referred electively. Patients and methods: A retrospective study of 95 treatment-naïve patients (47 acute, 48 elective) referred for management of urolithiasis was undertaken. The analysis included all imaging modalities related to stone disease for both patient groups within one year following presentation. The total effective dose (mSV) in one year was calculated by summing the dose for each individual radiation exposure. Results: An average of 5.6 radiological investigations (range 1–14) was carried out for acute patients and 4.57 for elective patients (range 1–11). The mean total effective dose was 14.45 mSV for the acute cases and 12.87 mSV for the elective cases. The maximum radiation dose reached 30.1 mSV in acute patients and 36.51 mSV in elective ones. None of the patients exceeded the maximal annual dose recommended by the International Commission on Radiological Protection (ICRP) of 50 mSV. Conclusion: Management of acute and elective urolithiasis patients can be achieved with acceptable radiation dose exposure. It is extremely important to keep the hazards of radiation in mind whilst managing patients with urolithiasis and clinicians need to remember adherence to the ALARA principle.
      PubDate: 2015-11-11T03:41:07-08:00
      DOI: 10.1177/2051415814567706
      Issue No: Vol. 8, No. 6 (2015)
  • CT urography as the first line investigation for haematuria: is it truly
           indicated' A single centre analysis of the use of CT urography in the
           haematuria clinic
    • Authors: Devlin, C. M; Hull, G, Coupland, A, Gill, K, Browning, A.
      Pages: 390 - 395
      Abstract: Introduction: Computed tomographic urography (CTU) is gaining popularity as the first line investigation for haematuria. It can be used to produce a ‘true’ one-stop clinical assessment. However, a large number of investigations can be negative, exposing patients to a number of risks. Objective: We set out to evaluate the use of CTU in our one-stop haematuria clinic to see if it supported the utilisation of CTU as a triage investigation for haematuria. Methods: Retrospective analysis of all CT urograms performed (508) in our trust in 2013 took place. CTUs requested from the haematuria clinic were identified and analysed further. Results: A total of 1086 patients attended the haematuria clinic in 2013. 168 males and 78 females (median age 64, range 25 to 90) went on to have further CTU investigation after ultrasonography (USS) and cystoscopy. Visible haematuria (VH) was reported in 95% of cases. All 9 confirmed cases of upper tract urothelial carcinoma lesions presented with VH (age > 50); 8 out of 9 had reported hydronephrosis on USS. The overall negative predictive CTU rate was 96%. Conclusion: Our results show that a large number of CTUs are negative. The use of risk stratification, with particular emphasis on the ultrasonography result, gives adequate guidance on the cases that require further CTU investigation, supportive of the current European Association of Urology guidelines. Our results do not support the use of CTU as a first line or triage investigation for haematuria.
      PubDate: 2015-11-11T03:41:07-08:00
      DOI: 10.1177/2051415815584116
      Issue No: Vol. 8, No. 6 (2015)
  • PSA doubling time as a screening test to predict bone scan positivity
    • Authors: Preece, P; Yao, H. H, Chew, S, Liew, D, McMullin, R.
      Pages: 396 - 401
      Abstract: Aims: The aim of this article is to compare the effectiveness of PSADT and tPSA as predictors of bony metastases in patients’ with prostate cancer pre-definitive treatment, and help guide clinicians with the selective ordering of bone scans (BS). Materials and methods: PSA measurements were retrospectively analysed for 330 men with prostate cancer, investigated with BS between 2009 and 2012. Exclusion criteria included previous positive BS, other malignancy, prostatectomy/radiotherapy and any prostate-specific condition or treatment initiated between the PSA levels used to calculate doubling time. PSADT (months) = log2 x dT/(log(PSA1)–log(PSA2)). Results: A total of 273 men had negative BS and 57 had positive findings of metastases. Those with positive BS had significantly (p < 0.05) faster median PSADT (4.5 vs 15.2 months) and higher median tPSA (94 vs 24.5 ng/ml). On ROC curve analysis, PSADT outperformed tPSA as a predictor of bone scan result, with area-under-the-curve of 0.85 vs 0.76 (p = 0.02). A ratio (R) of tPSA/PSADT was no better than PSADT alone (p = 0.65). Conclusions: In the absence of clinical reasons to suspect metastatic disease, it is appropriate to withhold ordering a BS for non-prostatectomy/radiotherapy patients with rising PSA levels, until the PSADT is less than 18 months. This has a sensitivity of 100.0% and a specificity of 41.0%.
      PubDate: 2015-11-11T03:41:07-08:00
      DOI: 10.1177/2051415815581097
      Issue No: Vol. 8, No. 6 (2015)
  • Management of epididymo-orchitis in three different clinical settings:
           Streamlining pathways and improving care
    • Authors: Blach, O; Ali, A, Goubet, S, Nawrocki, J, Richardson, D, Thomas, P.
      Pages: 402 - 408
      Abstract: Objective: This study represents the first direct comparison of management of epididymo-orchitis (EO) by Accident and Emergency (A&E), Urology and Genito-Urinary Medicine (GUM) departments in a large tertiary care centre, and their compliance with international guidelines. Methods: Case notes of patients with EO who attended A&E, Urology and GUM between January and June 2014 were analysed retrospectively. Results: A total of 127 men were seen (median age: 33, range: 15–79). Forty-four attended A&E (median age: 35), 30 Urology (median age: 37), and 53 GUM (median age: 31). MSU was sent in 17/44 (38.6%) of A&E, 11/30(36.7%) of Urology, and 35/53(66%) of GUM patients. Fifty-three of 53 (100%) of GUM, 14/44 (31.8%) of A&E and four of 30 (13.3%) of Urology patients had chlamydia and gonorrhoea NAAT testing. Of these, 90.9% of A&E, 93.3% of Urology and 100% of GUM patients were prescribed antibiotics. Twelve A&E and one Urology patient were referred to GUM. Conversely, only three of 11 A&E and zero of five GUM patients aged over 50 were referred for urological follow-up. Conclusion: The management of EO, especially in younger men at risk of STIs by A&E and Urology, and older men at risk of urological problems by GUM, is an area for significant improvement. Closer co-operation between departments, unifying local management protocols, abandoning the traditional demographic divide, and ensuring effective referral pathways are essential to improving care.
      PubDate: 2015-11-11T03:41:07-08:00
      DOI: 10.1177/2051415815586489
      Issue No: Vol. 8, No. 6 (2015)
  • Framing a research question: The first and most vital step in planning
    • Authors: Anastasiadis, E; Rajan, P, Winchester, C. L.
      Pages: 409 - 411
      Abstract: Posing the right research question is essential for consolidating your ideas from something that has piqued your interest into a focused, clinically relevant and achievable piece of research. This question should lead to results that can impact upon patient benefit by addressing a gap in your field, such as understanding the molecular basis of disease, developing biomarkers and diagnostics to improving established or identifying novel treatments. The question needs to be clear and precise in order to address a specific issue and to produce meaningful results. In this article we provide guidance on how to refine your initial idea to frame a research question by considering current knowledge, clinical utility and feasibility.
      PubDate: 2015-11-11T03:41:07-08:00
      DOI: 10.1177/2051415815612049
      Issue No: Vol. 8, No. 6 (2015)
  • The contemporary management of primary urethral carcinoma
    • Authors: Blick, C; Sahdev, V, Mitra, A, Nigam, R, Muneer, A.
      Pages: 412 - 419
      Abstract: Primary urethral cancer is a rare malignancy; the most common histological subtype is squamous cell carcinoma. The aetiology of this cancer is similar to penile cancer and the human papilloma virus (HPV) is thought to be an important factor in tumourigenesis. Surgery with or without chemoradiotherapy is the accepted treatment for primary urethral cancer. Current practice supports penile-sparing surgery, to maximise functional and psychological outcomes. We have reviewed the literature to summarise the pathogenesis and management of primary urethral cancer.
      PubDate: 2015-11-11T03:41:07-08:00
      DOI: 10.1177/2051415815584129
      Issue No: Vol. 8, No. 6 (2015)
  • Active surveillance for low-risk prostate cancer
    • Authors: Hadjipavlou, M; Promponas, J, Madaan, S.
      Pages: 420 - 428
      Abstract: Overtreatment of prostate cancer has become evident as studies comparing radical prostatectomy vs watchful waiting have shown that radical treatment benefits only a proportion of patients. Active surveillance was introduced as a management option for prostate cancer at low-risk of progression with the aim to closely observe for disease progression or change of tumour characteristics and offer active treatment if and when necessary. Active surveillance has been reserved for patients with Gleason 6 localised disease and low PSA; however, selection criteria may be widened as intermediate-term outcomes demonstrate excellent safety, efficacy and patient acceptance.
      PubDate: 2015-11-11T03:41:07-08:00
      DOI: 10.1177/2051415815592816
      Issue No: Vol. 8, No. 6 (2015)
  • An avid cyclist presenting with a 'third testicle'
    • Authors: Amer, T; Thayaparan, A, Tasleem, A, Aboumarzouk, O, Bleehen, R, Jenkins, B.
      Pages: 429 - 431
      PubDate: 2015-11-11T03:41:07-08:00
      DOI: 10.1177/2051415814529284
      Issue No: Vol. 8, No. 6 (2015)
  • Knotted proximal loop of ureteric stents: Review of the literature and
           five case reports
    • Authors: Ahmadi, N; Tran, M, Elms, M, Ko, R.
      Pages: 432 - 437
      PubDate: 2015-11-11T03:41:07-08:00
      DOI: 10.1177/2051415814532810
      Issue No: Vol. 8, No. 6 (2015)
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