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Journal of Clinical Urology

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ISSN (Print) 2051-4158 - ISSN (Online) 2051-4166
Published by Sage Publications

[700 journals]

Editorial
- Pages: 139 - 139
  PubDate: 2013-05-08T07:17:51-07:00
  DOI: 10.1177/2051415813485197|hwp:resource-id:spuro;6/3/139
  Issue No: Vol. 6, No. 3 (2013)
Contemporary Management of recurrent UTI in adult females
- Authors: Christofides, A; Swallow, T, Parkinson, R.
  Pages: 140 - 147
  Abstract: The management of recurrent UTI is subject to significant variation and patients may fall under the care of a variety of specialties. We review the pathogenesis, investigation and management of this group of patients. Accurate diagnosis of UTI is the cornerstone of successful management, and careful interpretation of MSU results is needed. Although prophylactic antibiotic regimes are often successful, the emergence of antibiotic resistance mandates the cautious use of antibiotics and consideration of other initial therapies where possible.
  PubDate: 2013-05-08T07:17:51-07:00
  DOI: 10.1177/2051415812472433|hwp:master-id:spuro;2051415812472433
  Issue No: Vol. 6, No. 3 (2013)
Tumour multiplicity as a risk factor for the development of bladder tumours after primary upper urinary tract cancer
- Authors: Ito, H; Oyama, N, Tsuchiyama, K, Yokoyama, O.
  Pages: 148 - 152
  Abstract: Objective: To determine the independent risk factors for intravesical tumour recurrence in patients with primary urothelial cancer of the upper urinary tract. Patients and methods: Of the 60 patients who underwent nephroureterectomy for urothelial cancer of the upper urinary tract, the data from 49 patients were retrospectively reviewed. Patients with a previous history or concomitance of bladder cancer were excluded from the study. Multivariate analysis by Cox’s proportional hazards model was used to determine independent risk factors for intravesical tumour recurrence. Results: Of the 49 patients reviewed, 22 (44.9%) experienced subsequent intravesical tumour recurrence during a mean follow-up period of 26 months (range 3–103). On multivariate analysis, tumour multiplicity had a statistically significant impact on the risk of intravesical tumour recurrence (P < 0.01). Conclusion: Neither the pathology of the upper urinary tract cancers nor the method of treatment was associated with recurrent bladder cancers. Only tumour multiplicity had a significant impact on the incidence of intravesical tumour recurrence.
  PubDate: 2013-05-08T07:17:51-07:00
  DOI: 10.1016/j.bjmsu.2012.01.001|hwp:resource-id:spuro;6/3/148
  Issue No: Vol. 6, No. 3 (2013)
The evaluation of CT urography in the haematuria clinic
- Authors: Bromage, S. J; Liew, M, Moore, K, Raju, B, Shackley, D.
  Pages: 153 - 157
  Abstract: Objective: We set out to evaluate the diagnostic yield of a haematuria clinic that utilised CT Urography (CTU) as the primary imaging modality in order to provide some guidance on imaging in this setting. Patients and methods: Records of 1000 consecutive patients attending a haematuria clinic over a 2-year period were analysed. Patients aged over 40 years with either visible (VH) or non-visible haematuria (NVH) underwent CTU & cystoscopy unless contraindicated. Results: 560 males and 440 females (median age 62 years; range 17–98) were assessed. 130 malignancies related to the urinary tract were identified from the clinic; 17% for men and 8% for women. There were no upper tract urothelial tumours in patients under the age of 50 years, yet 4 were identified in patients over 50 years who presented with NVH. 28 patients who were found to have a positive MSU were diagnosed with an underlying malignancy, all over the age of 50 and 22 of these with VH. Conclusion: Our results aid in the development of an evidence-based protocol for the use of CTU in haematuria assessment. We also suggest full investigation of patients presenting with VH over the age of 50 and a positive MSU.
  PubDate: 2013-05-08T07:17:51-07:00
  DOI: 10.1016/j.bjmsu.2012.06.007|hwp:resource-id:spuro;6/3/153
  Issue No: Vol. 6, No. 3 (2013)
Importance of local data on occurrence and outcomes of renal cell cancer
- Authors: Veeratterapillay, R; Rakhra, S, El-Sherif, A, Robson, C, Johnson, M, Pickard, R, Soomro, N, Heer, R.
  Pages: 158 - 163
  Abstract: Background: In comparatively socioeconomically deprived areas male cancer mortality is often above the national average. Given this, we explored the pattern of presentation and outcomes of men with conventional clear cell renal cell carcinoma (CCRCC) undergoing nephrectomy at a North East of England regional tertiary referral centre. Patients and methods: A retrospective review of CCRCC patients treated with nephrectomy between 2004 and 2008 was performed. Risk of progression for men and women was calculated using Mayo, Memorial Sloan-Kettering (MSK) and Kattan prognostic scores. Outcomes of disease free progression and overall survival were measured. Results: 292 patients with complete local follow up were identified that had undergone radical nephrectomy for conventional clear cell histology. The median (range) follow up was 36 months (10–65 months), and men accounted for 64% of these cases. At presentation, 45% of cases presented with stage III–IV (>T2, N0/1, M0/1) disease compared with 32% nationally (BAUS cancer registry). At diagnosis men had more advanced tumours compared with women (54% vs. 22% for stage >T2, N0/1, M0/1; p < 0.001) and had higher risk of progression based on prognostic scores (p < 0.01) despite similar risk factors and clinical symptoms. Early outcome analysis comparing men to women revealed both lower disease-free survival (82% vs. 89%) and overall survival (87% vs. 93%) in men at 24 months (p < 0.01). However, stage for stage comparisons between men and women demonstrated no significant difference in survival. Discussion: Men in the North East of England presented later with more advanced CCRCC. The reason for this remained undefined in this study. This pattern is consistent with reports of adverse male cancer-related outcomes in deprived areas and highlights the importance of local data in planning local health care.
  PubDate: 2013-05-08T07:17:51-07:00
  DOI: 10.1016/j.bjmsu.2012.03.004|hwp:master-id:spuro;j.bjmsu.2012.03.004
  Issue No: Vol. 6, No. 3 (2013)
Post-operative care following primary optical urethrotomy: towards an evidence based approach
- Authors: Beckley, I; Garthwaite, M.
  Pages: 164 - 170
  Abstract: Introduction: Optical urethrotomy (OU) is the commonest procedure performed for primary bulbar urethral strictures. Recurrence rates of up to 50% are reported, but data is lacking on the influence of post-operative management regimes on patient’s outcomes. The aim of this study was to quantify the variation in treatment approaches within a region and determine from the literature what constitutes best practice. Methods: A survey regarding post-operative management following OU was sent to urologists in the Yorkshire Deanery. The questions related to post-operative catheter usage, intermittent self dilatation (ISD) regimes and follow-up investigations. A literature review regarding these aspects of post-operative care was subsequently performed. Results: Questionnaires were sent to 70 urologists, of which 42 urologists replied. All respondents insert a urethral catheter following OU. Two thirds of respondents advise patients to perform ISD but one third of those advise continuing for only 6 months. Uroflowmetry and post micturition residual estimation are the mainstay of follow up investigations. Conclusions: The practice in our region largely reflects the best available evidence. The literature suggests that catheter size/material has no effect on outcome. Catheter duration should be for less than 3 days due to increased risk of recurrence. ISD should be performed for at least one year as this is associated with significantly lower recurrence rates than 6 months treatment. Urethrography is more accurate than uroflowmetery for follow up but results must be correlated with patient symptoms.
  PubDate: 2013-05-08T07:17:51-07:00
  DOI: 10.1016/j.bjmsu.2012.04.006|hwp:resource-id:spuro;6/3/164
  Issue No: Vol. 6, No. 3 (2013)
Routine sperm banking for testicular cancer patients should be performed both before and after orchidectomy
- Authors: Tomlinson, M; Kohut, T, Hopkisson, J, Lemberger, R.
  Pages: 171 - 176
  Abstract: Background: Despite some groups recommending that sperm banking for testicular cancer patients prior to orchidectomy results in improved overall semen quality, it remains common practice for this to occur post operatively, prior to any chemotherapy. Having seen anecdotal evidence of patients being rendered azoospermic and thus sterile by unilateral orchidectomy, we investigated further. Methods: Forty men listed for orchidectomy banked a single sample before surgery and were then given the opportunity to bank further samples post operatively. Results: Post orchidectomy, overall sperm concentration (p = 0.01) and motility (p < 0.05) were lower compared to before surgery and two men had azoospermia. However, the overall picture was misleading as in 13 individuals their sperm output was increased (n = 13) after surgery. Both cases of post operative azoospermia were amongst the patients with seminoma although at least 50% of patients with teratoma had severe oligozoospermia post surgery. Conclusions: Despite the relatively high frequency of normal sperm counts amongst seminoma patients, there was no significant difference in total sperm output or sperm quality between these men and those with teratoma or mixed cell tumours. As overall sperm quality was lower after surgery and some patients had totally compromised fertility, our centre has changed its policy to encouraging sperm banking prior to surgery. However, we maintain that generalisation of this population is unwise and patients should also attend after surgery to optimise the quality of their samples in the sperm bank.
  PubDate: 2013-05-08T07:17:51-07:00
  DOI: 10.1016/j.bjmsu.2012.06.005|hwp:resource-id:spuro;6/3/171
  Issue No: Vol. 6, No. 3 (2013)
Effect of a suspension suture in addition to a total anatomical reconstruction in robot assisted laparoscopic prostatectomy: does it help early continence'
- Authors: Shah, T. T; Undre, S, Adshead, J.
  Pages: 177 - 182
  Abstract: Introduction: Continence post robotic assisted laparoscopic radical prostatectomy (RALP) is approximately 90% and many reconstructive techniques have been described to improve early continence. We assessed whether a peri-urethral suspension stitch in addition to a total anatomical repair (TAR) improved early continence. Materials and methods: We describe our procedure and assessed 68 consecutive RALP’s over a two-year period. Complete data were collected on continence rates and incontinence modular questionnaire (ICIQ) scores in 55 patients. Results: In the "no suspension stitch" (NoSS) group continence rates at 2 weeks, 6 weeks and 3 months were 11%, 48% and 81% respectively whilst in the "suspension stitch" (SS) group continence rates were 11%, 46% and 75% respectively (lowest p-value = 0.26 seen at 2 weeks). Average ICIQ scores in the NoSS group were 9.8, 6.6 and 4.3 and in the SS group were 9.4, 6.4 and 4.8 at each time frame (lowest p-value = 0.63 at 6 weeks). Conclusions: No significant difference in continence or ICIQ scores was seen between the two groups. Overall our continence rates were comparable to the published literature. The addition of a suspension stitch did not add any further benefit in improving early continence when performing a total anatomical reconstruction.
  PubDate: 2013-05-08T07:17:51-07:00
  DOI: 10.1016/j.bjmsu.2012.01.002|hwp:resource-id:spuro;6/3/177
  Issue No: Vol. 6, No. 3 (2013)
The legal framework surrounding expert witnesses
- Authors: Stowe; N.
  Pages: 183 - 185
  PubDate: 2013-05-08T07:17:51-07:00
  DOI: 10.1177/2051415813482687|hwp:resource-id:spuro;6/3/183
  Issue No: Vol. 6, No. 3 (2013)
Acute lower limb ischaemia following radical cystectomy
- Authors: Smith, T; Chetwood, A, Prasad, A, Franklin, I, Hrouda, D.
  Pages: 186 - 187
  PubDate: 2013-05-08T07:17:51-07:00
  DOI: 10.1016/j.bjmsu.2011.12.001|hwp:master-id:spuro;j.bjmsu.2011.12.001
  Issue No: Vol. 6, No. 3 (2013)
Urethral metastasis from renal cell carcinoma: an unusual cause of visible painless haematuria
- Authors: Bailie, J; Wood, E, Connolly, D, O'Rourke, D, Hagan, C.
  Pages: 188 - 190
  Abstract: Urethral metastasis from renal cell carcinoma (RCC) is rare, with only six previously described cases.1–6 The authors report a case which presented eight months post laparoscopic radical nephrectomy with painless, visible haematuria. The epidemiology, potential pathophysiological mechanisms and treatment options are explored.
  PubDate: 2013-05-08T07:17:51-07:00
  DOI: 10.1016/j.bjmsu.2012.04.002|hwp:resource-id:spuro;6/3/188
  Issue No: Vol. 6, No. 3 (2013)
Hyperammonaemic encephalopathy secondary to an infected perinephric urinoma
- Authors: Vasdev, N; Mafeld, S, Ali, A. S, Walton, J, Walton, K. E, Thomas, D, Pickard, R. S, Thorpe, A. C.
  Pages: 191 - 193
  PubDate: 2013-05-08T07:17:51-07:00
  DOI: 10.1016/j.bjmsu.2011.12.006|hwp:resource-id:spuro;6/3/191
  Issue No: Vol. 6, No. 3 (2013)
Penile strangulation by a substantial metal napkin ring: successful removal with medtronic midas rex(R) legend(R) stylus(R) drill system
- Authors: Roushias, S; Veeratterapillay, R, McCracken, S, Heer, R.
  Pages: 194 - 196
  Abstract: We report the case of a 34-year-old with penile constriction by a large solid steel ring napkin holder in whom attempts of removal by conventional techniques failed. Standard instruments available in urology and general surgical theatres proved too weak to sever the ring and those offered by the fire services were grossly oversized and dangerous to use around the genitalia. Orthopaedic staff offered an instrument not previously used within our urology department: the Medtronic Midas Rex© Legend EHS Stylus High-Speed Surgical Drill. This intricate electronic powered drill allowed quick, controlled and safe incision of the metal ring, relieving the constriction. In addition to this first report of a metal penile constriction device removed using the Medtronic Midas Rex® Legend® Drill System, we review the literature on penile constriction and management strategies.
  PubDate: 2013-05-08T07:17:51-07:00
  DOI: 10.1016/j.bjmsu.2012.03.002|hwp:resource-id:spuro;6/3/194
  Issue No: Vol. 6, No. 3 (2013)
BAUS Section of Endo-urology Meeting Abstracts
- Pages: 198 - 202
  PubDate: 2013-05-08T07:17:51-07:00
  DOI: 10.1177/2051415813485007|hwp:resource-id:spuro;6/3/198
  Issue No: Vol. 6, No. 3 (2013)