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Journal Cover Journal of Clinical Urology
   [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  [738 journals]
  • Editorial
    • Authors: Pearce I.
      Pages: 226 - 227
      PubDate: 2014-06-18T06:10:26-07:00
      DOI: 10.1177/2051415814540820|hwp:resource-id:spuro;7/4/226
      Issue No: Vol. 7, No. 4 (2014)
  • The future shape of urological training
    • Authors: O'Flynn, K; Payne, S, Joyce, A.
      Pages: 232 - 238
      Abstract: The recent publication of the ‘Shape of Training Review’ by Professor David Greenaway has re-ignited the debate about the direction of UK postgraduate training in an era where there is significant challenges delivering high-quality care to an ageing population. This article sets out a vision of how BAUS believes that care should develop to meet the anticipated increase need for urological care, ensuring the right balance between specialist and generalist care.
      PubDate: 2014-06-18T06:10:26-07:00
      DOI: 10.1177/2051415814521611|hwp:master-id:spuro;2051415814521611
      Issue No: Vol. 7, No. 4 (2014)
  • Localised prostate cancer: clinical and cost-effectiveness of new and
           emerging technologies
    • Authors: Philippou, Y; Hadjipavlou, M, Khan, S, Ahmed, K, Rane, A.
      Pages: 239 - 251
      Abstract: In contrast to pharmacological interventions that undergo rigorous clinical testing, recent technological advances in the treatment of prostate cancer (PCa) have particularly been introduced and driven by economic incentives rather than high-quality clinical evidence. In this review we summarise the clinical and cost-effectiveness of new and emerging technologies for localised PCa. We emphasise particularly on robotic prostatectomy, new developments in radiotherapy, novel technologies in focal therapy such as cryosurgery and high-intensity focused ultrasound (HIFU). Robotic-assisted laparoscopic radical prostatectomy (RALRP) has similar oncologic outcomes to open radical retropubic prostatectomy (RRP); however, patients who undergo RALRP are more likely to have improved short-term potency rates. Intensity-modulated radiotherapy (IMRT) and proton-beam therapy (PBT) have similar oncologic outcomes to external-beam radiotherapy (EBRT). IMRT has exhibited an improved gastrointestinal side effect profile compared to EBRT. PBT is not cost-effective compared to other radiotherapy modalities. Early studies of focal therapies in localised PCa have yielded positive results. Treatment decisions should be driven by cancer risk and patient preference rather than by financial incentives or availability of technology.
      PubDate: 2014-06-18T06:10:26-07:00
      DOI: 10.1177/2051415813519628|hwp:master-id:spuro;2051415813519628
      Issue No: Vol. 7, No. 4 (2014)
  • Managing difficult emergency catheterization: what do urologists want'
    • Authors: Jones, A. L; Armitage, J. N, Srirangam, S. J.
      Pages: 252 - 255
      Abstract: Objectives: Acute urinary retention (AUR) is a common urological emergency; however, when approaching a difficult catheterization, this is an evidence-free zone. Our objective is to investigate current practice with the intent to reach a workable consensus for the management of patients in AUR who cannot be easily catheterized urethrally. Subjects: We performed a hypothetical scenario-based, multideanery survey with urology consultants and ST3+ trainees. Participants were asked how they would manage three patients who prove difficult to catheterize using standard methods: benign prostatic obstruction (BPO), urethral stricture, and meatal stenosis. Results: Of respondents, 38% (n=23) indicated that a 16F curved-tip silicone catheter would be their first choice in managing a patient with BPO, followed by a suprapubic catheter (SPC) (20%, n=12) if this failed. SPC would be the first-line option for patients with a urethral stricture for 67% (n=40) consultants, and for those with meatal stenosis, 60% would use a meatal dilator followed by SPC (22%, n=13) if this failed. Conclusion: Although there are general trends in preference towards managing a patient who is difficult to catheterize with AUR, there still remains considerable variation in practice due to lack of evidence in this area. We would recommend further multicentre data determining guidelines for best practice.
      PubDate: 2014-06-18T06:10:26-07:00
      DOI: 10.1177/2051415813514969|hwp:master-id:spuro;2051415813514969
      Issue No: Vol. 7, No. 4 (2014)
  • An introductory course in urology: results of a novel course for
           foundation doctors and medical students
    • Authors: Abboudi, H; Chetwood, A, Nair, R, Bolgeri, M, Coker, C, Larner, T, Green, J.
      Pages: 256 - 260
      Abstract: Objective: The objective of this article is to critically assess the value of a medical student and junior doctor weekend introduction to urology course. Materials and methods: All UK medical students and foundation doctors were invited to attend an introductory course held at The Royal Society of Medicine, London, organised by the Section of Urology. The course included consultant-delivered lectures, practical skills sessions and an academic competition. Pre- and post-course feedback questionnaires were used to assess (a) perceptions of urology as a specialty, (b) career aspirations and (c) confidence performing basic urological surgical skills. Results: Sixty delegates attended from a variety of UK medical schools and hospitals. Seventy-three per cent of respondents were more likely to pursue a career in urology post-course. The most common negative perceptions included being a competitive career with long training and lacking glamour. Confidence in suturing, knot tying, suprapubic catheterisation, basic laparoscopy and cystoscopy were significantly improved following this course (p < 0.005). Conclusion: A short urology course should be offered to medical students by urology departments and surgical societies; it will benefit students as well as the specialty. It is important that medical students are exposed early to urology given both positive and negative perceptions. Such initiatives may help strengthen the positive perceptions and dispel negative perceptions while increasing delegates’ desire to pursue a urology career.
      PubDate: 2014-06-18T06:10:26-07:00
      DOI: 10.1177/2051415813519627|hwp:master-id:spuro;2051415813519627
      Issue No: Vol. 7, No. 4 (2014)
  • Fournier's gangrene: outcome analysis of 62 consecutive cases
    • Authors: El-Shazly, M; Sultan, M, Salem, S, Alkandari, I, Shebl, M.
      Pages: 261 - 265
      Abstract: Objectives: The objective of this article is to study the outcome of management of 62 consecutive cases of Fournier’s gangrene (FG). Patients and methods: We conducted an observational study of all cases of FG admitted to the Urology and General Surgery departments of Farwaniya Hospital, Kuwait, between 2004 and 2013. We recorded the laboratory and clinical findings on admission. Operative and postoperative data were also recorded. Results: Our study included 62 cases of FG. Patients were divided into two groups: Group A (survival) consisted of 55 cases and Group B (mortality) of seven cases. The mean duration of symptoms before admission was significantly longer in the mortality group (3.86 days versus 1.96 days in survival group) (p < 0.05). The mean duration of symptoms until time of first debridement was also significantly longer in the mortality group (4.39 days versus 2.35 days in survival group) (p < 0.05). There was also a statistically significant difference between the two groups regarding the percentage of the affected area in relation to total body surface area (4.6% in Group A versus 8% in Group B) (p < 0.05). The Fournier Gangrene Severity Index score (FGSI) was significantly higher in Group B (10.26) in comparison to Group A (6) (p < 0.01). The mean duration of hospital stay was significantly higher in the survival group (22.24 days versus 14.28 days) (p < 0.01). Diabetes and renal failure were significantly higher in the mortality group (100% and 57.1% in Group B versus 54.5% and 9.1% in Group A, respectively) (p < 0.05). The number of patients presenting with severe sepsis was higher in the mortality group (71.4% in Group B versus 12.7% in Group A) (p < 0.05). Conclusion: We concluded that FG is a serious, potentially fatal disease. Higher mortality is related to severe sepsis on admission, renal failure, diabetes, extensive disease involving extra-genital areas and late presentation. A multidisciplinary approach in diagnosis and management of the disease can achieve good outcome with low mortality rate.
      PubDate: 2014-06-18T06:10:26-07:00
      DOI: 10.1177/2051415813518331|hwp:master-id:spuro;2051415813518331
      Issue No: Vol. 7, No. 4 (2014)
  • Predicting female ureteral length: a mathematical model
    • Authors: Bozzini, G; Casellato, S, Vigano, A, Maruccia, S, Picozzi, S, Carmignani, L.
      Pages: 266 - 271
      Abstract: Aim: Ureteral double J stent placement is a common urological procedure. A stent placement is performed for multiple conditions but some of them are contraindicated, mainly in pregnant female patients, because of X-rays. This work aims to suggest a mathematical model to predict female ureteral length by finding a link among different physical data. Materials and methods: Between June 2007 and July 2009, 100 female patients who had undergone ureteral stent placement were enrolled in the present study with the exception of those with septic conditions, history or evidence of TCC, congenital and acquired kidney or ureteral malformations, and previous ureteral surgery. The physical data of each patient were collected (mean age 55.8 years, range 18–89 SD 15.27, mean height 173 cm, range 160–182 SD 6.31, mean weight 75.33 kg, range 62–94 SD 8.81). A previous ureteral retrograde pyelography was performed during the procedure to individualise the pyeloureteral junction. Ureteral length was estimated through a graduated ureteral catheter with a final result between 24 and 27 cm. The length was read in cystoscopy examining the ureteral orifice while the catheter tip reached the pyeloureteral junction. The collected data were then analysed. Results: A link between the female patients’ ureteral length and height was observed. The following mathematical model can predict female ureteral length starting from the patient’s height: Result: y = 0.151712487 (height expressed in cm) ± 0.12; correlation coefficient: r = 0,973, residual sum of squares: rss = 5.285. No link was found between ureteral length and patients’ age and weight. Conclusions: A good estimation of the length of the ureter to be cannulated enables us to choose in advance the proper one to use. Female patient height correlates with ureteral length. A cost reduction can also be obtained, avoiding an intra-operative X-ray control. An X-ray-free ureteral stenting procedure can be described simply through an ultrasound control mainly in pregnant women. Further studies are needed to obtain a similar mathematical model for male patients.
      PubDate: 2014-06-18T06:10:26-07:00
      DOI: 10.1177/2051415814520868|hwp:master-id:spuro;2051415814520868
      Issue No: Vol. 7, No. 4 (2014)
  • Sex: the new postcode lottery
    • Authors: Kalejaiye, O; Parsons, B, Pearcy, R.
      Pages: 272 - 276
      Abstract: Background: A list of all the Primary Care Trusts (PCTs) in England, Scotland and Wales was obtained from the websites of National Health Service (NHS) choices’, NHS Scotland and NHS Wales. Methods: Each PCT’s website was visited to find the email address for their Freedom of Information (FOI) department. FOI requests were made to each PCT asking questions regarding their criteria for funding and the number of requests made and implants funded in the previous 12 months. Results: A total of 129 PCTs were emailed with a 95% response rate. Thirty-one per cent of the PCTs that replied funded penile prostheses and 22% did not. A further 45% of PCTs would fund under exceptional circumstances, but only 20% of these had any clinical criteria on which to base their decision making. Twenty-three per cent of clinical criteria used were based on guidelines. Non-funding PCTs were spread in patches throughout the country, but the West Midlands stood out as a particularly black spot. On reviewing PCTs that had received requests for funding in the preceding 12 months, 46% did not fund any of the requests, 17% funded 50% or less and 37% funded all the requests received. Of the PCTs funding under exceptional circumstances, only 37% actually funded any of the requests received. Conclusion: Despite guidelines on the management of erectile dysfunction, there remains variability in access to penile prosthesis surgery. The West Midlands and the Southeast (excluding London) are the worst places to live with regards to access to prostheses; Scotland and Wales appear to be the best. Guidelines are rarely used in decision making. Funding remains an important factor in determining who receives potentially life-changing treatment for erectile dysfunction refractory to all other management options. A patient’s address and personal wealth appear to have a larger impact than guidelines.
      PubDate: 2014-06-18T06:10:26-07:00
      DOI: 10.1177/2051415813514577|hwp:master-id:spuro;2051415813514577
      Issue No: Vol. 7, No. 4 (2014)
  • Cleaning and re-using intermittent self catheters: a questionnaire to
           gauge patient's perceptions and prejudices
    • Authors: Moore, K; Lester, M, Robinson, E, Bagulay, N, Pearce, I.
      Pages: 277 - 282
      Abstract: Introduction: An estimated 60,000 people in the UK are currently performing some form of intermittent catheterisation, using 57.5 million catheters yearly. Current policy in the UK is to utilise single use, disposable catheters: however, this is not worldwide policy as repeated catheter use is common in many nations. The aim of this study was to determine UK patients’ views on re-using catheters and their willingness to re-use catheters. Method: Patients attending the clean intermittent self catheterisation [CISC]/urethral dilatation (UD) clinic over an eight-month period were asked to prospectively complete a standard, anonymous questionnaire. Results: A total of 100 questionnaires were returned, of which two-thirds were from men. Mean age was 61 years, (median 63 years). Indications for CISC/UD were urethral or meatal stenosis (7%), urethral stricture (25%) and residual volume in (67%). The majority of patients (71%) are unwilling to reuse catheters. Women were statistically very significantly more likely to refuse to re-use their catheters, (p
      PubDate: 2014-06-18T06:10:27-07:00
      DOI: 10.1177/2051415814526594|hwp:master-id:spuro;2051415814526594
      Issue No: Vol. 7, No. 4 (2014)
  • Is repeat prostatic biopsy in active surveillance a justifiable increase
           in workload for a district general hospital'
    • Authors: Pai, A; Jones, A.
      Pages: 283 - 285
      Abstract: Objectives: In February 2008 the National Institute for Clinical Excellence introduced guidelines for active surveillance of prostate cancer, with close monitoring including at least one set of repeat biopsies 12 months after diagnosis. We aim to establish the impact on workload caused by repeat biopsy rate in active surveillance and whether they impacted on management. Methods: We retrospectively reviewed all transrectal (TRUS) ultrasound biopsies (n=1105) in our institution from 2009 to 2010 to determine which were repeat biopsies for active surveillance (n=107). We reviewed the histology and case notes of these active surveillance patients to determine whether there was histological progression and change of management. Results: Some 9.7% (n=107) of TRUS biopsies were for active surveillance. Histological disease progression (Gleason score 6 to ≥7) was seen in 32% (n=23) cases. One patient (1%) developed locally advanced prostate cancer on restaging and was started on hormone therapy; 35% patients (n=25) were changed from active surveillance to radical treatment post repeat biopsy. Conclusions: Repeat prostatic biopsy in active surveillance, although a considerable workload, has a justifiable outcome on treatment. One patient, who initially had intermediate-risk prostate cancer (Gleason 7) and had been preferentially offered radical treatment, developed incurable disease.
      PubDate: 2014-06-18T06:10:27-07:00
      DOI: 10.1177/2051415814525153|hwp:master-id:spuro;2051415814525153
      Issue No: Vol. 7, No. 4 (2014)
  • Patient-reported outcomes after prostate cancer treatment
    • Authors: Grover, S; Metz, J. M, Vachani, C, Hampshire, M. K, DiLullo, G. A, Hill-Kayser, C.
      Pages: 286 - 294
      Abstract: Objective: Our aim was to understand patient-reported toxicities resulting from treatment of prostate cancer using various different modalities that have similar oncological endpoints. Methods and materials: An Internet-based survivorship care plan tool was used to collect patient-reported toxicity data for men who had undergone prostate cancer treatment. Results: A total of 127 users of the survivorship care plan tool reported to have been treated for prostate cancer. The median age of the patients at diagnosis in this group was 60 years (range = 25–74 years) and median time since diagnosis was 4 years (range 1–15 years); 61 (48%) received radiation as primary treatment, 44 (35%) received surgery as primary treatment and 22 (17%) received both surgery and radiation (adjuvant or salvage). Hormonal treatment was given to 50 (39%) patients. Some 15% (7/48) in the radiation group versus 50% (21/42) in the surgery group (p < 0.001) developed urinary incontinence; 61% (33/54) in the radiation group and 86% (37/43) in the surgery group (p = 0.02) reported having erectile dysfunction since treatment. Most users (84%) had not been offered a survivorship care plan previously. Conclusion: Men with prostate cancer experience significant urinary and sexual sequelae from treatment regardless of the modality used. Patients treated with surgery reported more urinary and sexual side effects than those treated with radiation. The majority of these men are not offered a survivorship care plan to deal with these long-term effects. Survivorship planning tools to assess such side effects and design long-term individualized plans are essential for all prostate cancer patients.
      PubDate: 2014-06-18T06:10:27-07:00
      DOI: 10.1177/2051415814523269|hwp:master-id:spuro;2051415814523269
      Issue No: Vol. 7, No. 4 (2014)
  • Retroperitoneal lymph node dissection in post-chemotherapy residual mass
           with 360-degree involvement of the aorta
    • Authors: Regmi, S. K; Seth, A, Choudhary, S. K, Singh, A.
      Pages: 295 - 298
      Abstract: Post-chemotherapy retroperitoneal lymph node dissection in cases with encasement of major vessels is a formidable surgery. A 25-year-old man presented to us after a right high inguinal orchidectomy that showed a mixed germ cell tumor with predominant embryonal cell carcinoma elements. Following four cycles of bleomycin, etoposide and cisplatin (BEP), the serum markers had normalized but a large retroperitoneal mass predominantly on the left side encasing the large vessels including the left renal hilum persisted. A thoraco-abdominal approach was taken and the supraceliac aorta was defined, and the large mass encasing the left renal hilum was excised along with a left nephrectomy. The preaortic mass was divided applying the "split and roll" technique and subsequently removed. The interaortocaval and the precaval regions were also subsequently cleared. The aorta and the IVC were preserved and cleared completely of the tumor mass. Post-chemotherapy large residual lymph nodes present a difficult challenge in managing testicular malignancies especially if they encase major vessels that need to be preserved. Careful approach to tumor resection and standard surgical principles for lymph node dissection need to be followed to ensure a successful outcome.
      PubDate: 2014-06-18T06:10:27-07:00
      DOI: 10.1177/2051415813505563|hwp:master-id:spuro;2051415813505563
      Issue No: Vol. 7, No. 4 (2014)
  • Compartment syndrome of the testicle: a case report and review of the
    • Authors: Sharifi, L; Patten, D, Thomas, R, Alchikhali, T, Vig, S.
      Pages: 299 - 302
      Abstract: In this case report we describe a patient presenting with symptoms of right sided testicular torsion who, upon surgical exploration, was noted to no longer have a torsion of the spermatic cord but persisted in having an ischaemic testicle refractory to reperfusion. A testicular compartment syndrome was suspected and the patient underwent fasciotomy of the tunica albuginea, leading to full reperfusion and good clinical outcome at three weeks and 10 months. This case raises the question of the value of performing such fasciotomies in patients who would otherwise undergo orchidectomy. Following a review of the literature, we feel the technique may well have a place in the management of torsion, pending further study. Databases searched were Medline, Embase, Cochrane, Trip and NHS Evidence. Search criteria included ‘compartment’, ‘testicle’, ‘testicular’, ‘syndrome’, ‘compartment syndrome’ and testis’ and combinations of these key words.
      PubDate: 2014-06-18T06:10:27-07:00
      DOI: 10.1177/2051415813505561|hwp:master-id:spuro;2051415813505561
      Issue No: Vol. 7, No. 4 (2014)
  • Penile ulceration: a rare complication of nicorandil therapy
    • Authors: Patrick, N; Iskander, M, Ellison, J, McCabe, J. E.
      Pages: 303 - 304
      PubDate: 2014-06-18T06:10:27-07:00
      DOI: 10.1177/2051415813505562|hwp:master-id:spuro;2051415813505562
      Issue No: Vol. 7, No. 4 (2014)
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