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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  [759 journals]
  • Editorial
    • Authors: Pearce; I.
      Pages: 3 - 3
      PubDate: 2015-01-14T02:51:26-08:00
      DOI: 10.1177/2051415814564135
      Issue No: Vol. 8, No. 1 (2015)
  • Criteria used for the active surveillance of localised prostate cancer in
           the UK
    • Authors: Hawizy, A; Salji, M, Kelker, A, Gujral, S, Van As, N.
      Pages: 4 - 8
      Abstract: Introduction: Active surveillance (AS) is a valid option for localised prostate cancer and should be offered to patients who are suitable for radical treatment in conjunction with current NICE guidelines. The aim of this study was to evaluate the consensus on AS selection and follow-up criteria in the United Kingdom (UK). Method: An electronic survey (Appendix 1) was emailed to 500 British Association of Urological Surgeons (BAUS) members to determine their local criteria for active surveillance in prostate cancer. Results: Of the 134 (26.8%) BAUS members who responded, PSA ≤ 10 ng/ml, Gleason score ≤ 6 and clinical stage ≤ T1c were the preferred selection criteria used in the UK. However, only 51.5% will perform MRI for disease staging. Most urologists (65.6%) preferred three-monthly PSA follow-up visits for the first year then six-monthly thereafter. A digital rectal examination (DRE) is not performed by 57.1%. Increased Gleason score and PSA doubling time were the two main criteria that would trigger intervention. Conclusion: There is a lack of consensus on criteria used for selection, follow-up and repeat biopsy for prostate cancer patients on active surveillance in the UK.
      PubDate: 2015-01-14T02:51:26-08:00
      DOI: 10.1177/2051415814534233
      Issue No: Vol. 8, No. 1 (2015)
  • Intraoperative ureteric injuries and litigation in the NHS
    • Authors: Nachiappan, S; Currie, A, Askari, A, Faiz, O.
      Pages: 9 - 13
      Abstract: Objectives: The objective of this article is to analyse medicolegal claims arising from intraoperative ureteric injuries across all surgical specialties and the consequent financial costs to the National Health Service (NHS) in the United Kingdom. Materials and methods: We conducted a retrospective review of medicolegal claims reported to the NHS Legal Authority between April 2007 and March 2013. Results: A total of 191 claims were reported with 122 claims being resolved at the time of data collation. Of these, 97 were successful with a total of £9.66 million paid by the NHS in indemnity, averaging £99,611 per successful claim. There was an increasing number of claims filed over the study years and a slight decrease in the average pay-out per successful claim. Gynaecology and obstetrics accounted for over two-thirds of successful claims, with the remainder being divided equally among urology and colorectal surgery. However, claims arising from colorectal surgery had higher indemnity pay-outs on average. Conclusion: This is the first study analysing medicolegal claims and cost burden pertaining to ureteric injuries across different specialties. The findings concur with clinical studies which indicate gynaecological procedures and other pelvic (e.g. colorectal) procedures are at increased risk of causing ureteric injury.
      PubDate: 2015-01-14T02:51:26-08:00
      DOI: 10.1177/2051415814537822
      Issue No: Vol. 8, No. 1 (2015)
  • Cystolithotripsy using the Holmium laser: Evolving uses for the laser
    • Authors: Mains, E. A; Carrera, A, Ramsay, A, Halsall, A, Nalagatla, S. K.
      Pages: 14 - 18
      Abstract: Objective: The optimal management of bladder stones remains unclear, with a range of approaches described. We aim to describe our results using Holmium:YAG laser lithotripsy for the management of bladder stones. Patients and methods: Data were collected prospectively on 20 (19 male, one female) patients undergoing laser lithotripsy for bladder calculi at a single centre from February 2013 to February 2014. The mean patient age was 69.75 years (range 51–87). Patient demographics, stone size, operative details and post-operative events and hospital stay were recorded. A 365 or 550 micron Holmium:YAG laser fibre, with a power setting of 1.0J and a frequency of 10Hz was used in all cases. Results: The mean stone size was 2.2cm (1–4cm). The mean operative time was 32.85 min (15–70 min). Operative time correlated positively with stone size (r=0.74). Three patients underwent laser stone fragmentation followed by transurethral resection of the prostate (TURP) during the same anaesthetic. Visibility remained clear in all these patients during lithotripsy, allowing complete fragmentation and stone clearance. Intra-operative bleeding was noted during the TURP procedure as expected. There were two episodes of self-limiting post-operative pyrexia but no reported cases of post-operative sepsis. Apart from the three patients undergoing TURP, there were no cases of post-operative bleeding and no cases required blood transfusion. Stone clearance was complete after a single procedure in 100% of cases. The mean hospital stay was 2.5 days (1–7 days), with a mean post-operative stay of 1.8 days. Conclusion: Laser lithotripsy offers a safe and effective management option for bladder stones, including those which are large and hard. It offers the key benefit of lithotripsy under direct vision, with no recorded mucosal injury in our series and thus no intra-operative or post-operative haematuria (outside of the TURP group).
      PubDate: 2015-01-14T02:51:26-08:00
      DOI: 10.1177/2051415814538018
      Issue No: Vol. 8, No. 1 (2015)
  • UK single centre experience of rare and atypical variant of
           castrate-resistant prostate cancer: Poorly differentiated neuroendocrine
           small-cell carcinoma
    • Authors: Hingorani, M; Morgan, R, Robertson, A, Khafagy, R, Hawkyard, S.
      Pages: 19 - 29
      Abstract: Background: We report on the emergence of a rare and atypical variant of castrate-resistant prostate cancer (CRPC) that is characterised by transformation into poorly differentiated neuroendocrine small-cell carcinoma (NSCC). The existence of this variant was previously described in isolated case reports and small case-studies, but as yet there has been no UK series reported in the literature. Methods: Between January 2010 and January 2014, eight cases were presented in our local multi-disciplinary team meeting having a diagnosis of NSCC arising on a background of prostate cancer treated with androgen deprivation therapy. We performed a retrospective review of the clinical records of these patients, to identify the mode of presentation, diagnostic investigations, pathological characteristics, and subsequent treatment and survival outcomes. Results: The median patient age was 77 years (range, 68 – 84), with a median time interval of 25 months (range, 7 – 83) between the original diagnosis and subsequent transformation to NSCC. The median prostate-specific antigen (PSA) was 4 ng/ml, at presentation. Most patients presented with local progression, combined with high-volume and atypical sites of metastasis (e.g. brain, pancreas and penis). Patients developed a good initial response to platinum-based chemotherapy, but responses were short-lived and prognosis poor, with a median overall survival (OS) of 8 months. Conclusion: Prostate NSCC represents an atypical variant of CRPC with significant therapeutic and prognostic implications. Based on our observations, we have proposed a clinical algorithm for early diagnosis and appropriate management of these patients.
      PubDate: 2015-01-14T02:51:26-08:00
      DOI: 10.1177/2051415814534234
      Issue No: Vol. 8, No. 1 (2015)
  • A clinico-pathological review of non-haematological metastases to the
    • Authors: D'Arcy, F. T; Raheem, O, Dunne, B, Grainger, R.
      Pages: 30 - 32
      Abstract: Objective: Metastatic disease within the testicle is rare and the bulk of the literature relating to this is limited to individual case reports. In this study we retrospectively review all orchidectomy specimens in a single university-affiliated institution over a 20-year period and report on the incidence of non-haematological, histologically proven metastatic disease within this series, discussing clinical outcome. Patients and methods: In total 739 orchidectomy cases were reviewed. No autopsy cases were considered. Histological reports were supplemented with clinical notes in cases of interest. Results: Five cases of non-haematological, secondary tumours were identified in the testes (2% of all tumours). Of these, two were of prostatic origin, two were carcinoid lesions of the gastrointestinal tract and one a malignant melanoma. Survival in this group ranged from one to 48 months with one of the patients still alive 15 years later. Conclusion: Secondary testicular spread is a rare phenomenon generally associated with poor overall survival. Outside prostate cancer, this is a condition seen in younger men. Little is known about this interesting condition.
      PubDate: 2015-01-14T02:51:26-08:00
      DOI: 10.1177/2051415814539681
      Issue No: Vol. 8, No. 1 (2015)
  • Reconstruction of perineo-scrotal defects from Fournier's gangrene with
           the adipofascial anterolateral thigh flap
    • Authors: Onyekwelu, O; Reid, A, McGrouther, D.
      Pages: 33 - 37
      Abstract: Objective: To present a small case series of a novel solution, using pedicled adipofascial anterolateral thigh (ALT) flaps for skin grafting, for the reconstruction of perineo-scrotal defects following Fournier’s gangrene (a complex surgical problem). Many options are described. We believe that this procedure overcomes the contracture complications of skin grafting alone and that it is a more supple reconstruction in the Western population. Patients: We performed pedicled adipofascial ALT flaps on three patients, for the reconstruction of complex perineo-scrotal wounds with exposed testes, following Fournier’s gangrene. Patients were of male gender, aged 38 – 56 years old and otherwise healthy. The adipofascial ALT flap was raised based on the lateral circumflex femoral artery and was inset with split-thickness skin graft coverage. Results: Study outcomes were time-to-healing and complications. Follow-up was between 6 months to 4 years. At routine outpatient follow-up, all three patients had healed wounds; and at long-term follow-up, all three patients were satisfied with their wound reconstruction. There were no surgical complications. Conclusion: This study demonstrated that the pedicled adipofascial ALT flap is a reliable flap that is straightforward to raise, of an appropriate bulk, and has pliability for the neo-scrotum. The authors recommend this procedure as a good treatment option for reconstructing complex perineo-scrotal wounds following Fournier’s gangrene.
      PubDate: 2015-01-14T02:51:26-08:00
      DOI: 10.1177/2051415814537821
      Issue No: Vol. 8, No. 1 (2015)
  • Should a 31/62-day target be applicable to urinary stone patients with
           indwelling stents'
    • Authors: Smith, T; Gruber, M, Simoes, A, Krishnan, R, Shrotri, N.
      Pages: 38 - 41
      Abstract: Objective: Patients with urinary stone disease languish on waiting lists. They are often young and suffer morbidity and unemployment. Stone disease leads to sepsis, loss of renal units and even death. We aimed to assess the readmission rates and associated morbidity for patients with ureteric stents in situ secondary to stone disease. Patients and methods: Over 12 months 692 patients totalling 1114 admissions were admitted to our unit with a coded diagnosis of renal colic. Of the 692 individuals, 378 first presented as an emergency. The rest had elective first admissions. Results: Of the 378 emergency presentations, 78 were admitted between two and eight times. The total number of admissions for this group of 78 patients was 248. The average time interval was calculated from first emergency presentation to date of first elective treatment (52.3 days (range 2–281)) and from date of first emergency presentation to date of last treatment (63.6 days (range 2–281)). A total of 401 working days were lost. Conclusion: The management of patients with urinary stone disease needs serious reconsideration. We propose that patients with indwelling stents have a 31/62-day target similar to cancer patients due to the increased morbidity associated with loss of working days and the increased cost of readmissions to an overburdened health service.
      PubDate: 2015-01-14T02:51:26-08:00
      DOI: 10.1177/2051415814542866
      Issue No: Vol. 8, No. 1 (2015)
  • Integrated clinical coding in urology - a novel way of working
    • Authors: Misra, S; Chetwood, A, Dixon, G, Coker, C, Thomas, P.
      Pages: 42 - 45
      Abstract: Objectives: The objective of this article is to report a completed cycle of audit of coding co-morbidities for bladder outlet surgery. We also present a novel way of working to achieve better accuracy in capturing admitted patient care data and coding in urology. Materials and methods: We undertook a retrospective case note and coding review of all bladder outlet surgeries performed in a single month. After initiating several measures to improve data recording and capture, we re-audited our results prospectively and analysed the results. Results: The initial accuracy of coding co-morbidities was 73%. This improved to 100% at re-audit. However, we found that procedure coding errors remained. We have devised a novel working model to improve all coding issues related to urology. Conclusion: It is possible to improve accuracy of coding by educating clinicians working alongside our integrated model of a team of a clinician with an interest in coding with coding and finance personnel.
      PubDate: 2015-01-14T02:51:26-08:00
      DOI: 10.1177/2051415814540639
      Issue No: Vol. 8, No. 1 (2015)
  • Tined lead versus percutaneous nerve evaluation for sacral nerve
           stimulator assessment
    • Authors: Kass-Iliyya, A; Jenks, J, Moore, C, Hamid, R, Shah, J, Greenwell, T, Ockrim, J.
      Pages: 46 - 51
      Abstract: Purpose: We compared the outcomes of percutaneous nerve evaluation (PNE) with first-stage tined lead placement (FSTLP) for the testing phase of sacral nerve neuromodulation (SNM), and we assessed the outcomes of these two techniques following implantation of a (second-stage) permanent sacral nerve stimulator (SNS). Methods: Seventy consecutive patients had either PNE (n = 35) or FSTLP (n = 35) evaluation, and conversion to a permanent SNS implant according to response. Primary outcomes were assessed using frequency-volume charts, pad testing, ICIQ/EQ5D questionnaires and global health perception visual analogue scale (VAS). Success was considered if they achieved greater than 50% improvement in their urinary symptoms. Success and failure rates were compared during the test phase and after implantation of the SNS. Results: Mean follow-up for the FSTLP group was 14 months (nine to 20) and for the PNE group was 22 months (eight to 27). Sixteen (46%) of the PNE tests and 20 (57%) of the FSTLP patients were converted to permanent implant. A significant correlation was noted between patients’ general health (VAS score) and a successful test phase (r = 0.297, p = 0.013). Eighteen of 19 (95%) of tined lead patients have successful SNS implants, whereas five of 16 (31%) of PNE evaluations failed to convert test efficacy to the permanent SNS implant (p = 0.042). Furthermore, two of PNE-SNS patients were successfully salvaged by the implantation of a second tined lead. Conclusions: FSTLP-SNS has a significantly higher success rate than PNE-SNS in converting the test phase to SNS implantation. This may be due in part to difficulties retaining accurate lead placement with the two-lead (PNE-SNS) approach. These findings have important cost and logistical implications for SNS services.
      PubDate: 2015-01-14T02:51:26-08:00
      DOI: 10.1177/2051415814541651
      Issue No: Vol. 8, No. 1 (2015)
  • Group forum counselling for vasectomy: A consistent and cost-effective
           improvement in patient care
    • Authors: Roushias, S; Jones, P, Rajkumar, V, Pandit, A, Bailey, D.
      Pages: 52 - 62
      Abstract: Objective: The objective of this article is to improve patient care pathways for vasectomy referrals by offering a group forum pre-operative education and consent process. This should prove more consistent and efficient than traditional outpatient appointments, resulting in a high standard of information provision, reduction in waiting times and cost savings. Subjects/patients and methods: All vasectomy referrals were offered a group counselling seminar with subsequent individual examination instead of a routine outpatient appointment. Patient satisfaction questionnaires were completed and analysed at the forum conclusion. Results: During the pilot, 38/40 patients opted for group-based counselling. Subsequent forums had provision to counsel, examine and consent 45 patients within one hour. Patient satisfaction survey scores were consistently high and 100% gave scores >8/10 in overall satisfaction. The wait from GP referral to consultation dropped by 61% from 23 to 9 weeks. Conclusions: There has been a significant reduction in waiting times to consultation and improved efficiency of care provision. Standardised quality information should minimise dissatisfaction and litigation based on poor pre-operative counselling. Satisfaction surveys indicate that there have been no detrimental effects to patient care. One-hour group clinical sessions are adaptable to flexible working hours which may feature increasingly within the NHS.
      PubDate: 2015-01-14T02:51:26-08:00
      DOI: 10.1177/2051415814542497
      Issue No: Vol. 8, No. 1 (2015)
  • Day-case monopolar and bipolar transurethral resection of the prostate
    • Authors: Bright, E; Stocker, M, Koupparis, A, MacDermott, S.
      Pages: 63 - 67
      Abstract: Objective: The objective of this article is to investigate the safety and efficacy of both monopolar and bipolar transurethral resection of the prostate (TURP) performed on a day-case basis. Materials and methods: Data were collected prospectively for two cohorts of consecutive patients undergoing a day-case monopolar TURP (mTURP) by surgeon 1 in centre 1 (Group M) and a day case bipolar TURP (bTURP) by surgeon 2 in centre 2 (Group B). All were scheduled to be discharged on the day of surgery, with an indwelling catheter to be removed on an outpatient basis. Results: Fifty men underwent a day-case mTURP (Group M) and 27 men underwent a day-case bTURP (Group B) in centre 1 and 2, respectively. Patient age (p = 0.71) and resection weight (p = 0.35) were comparable between the two groups. No statistically significant difference in the number of admissions (p = 1.00) or re-admissions (p = 0.55) between the two groups was observed, with an identical day case discharge rate of 92%. Conclusions: Day-case TURP can be provided safely and effectively to patients regardless of the diathermy method employed, with successful discharge rates and low risk of admission or re-admission.
      PubDate: 2015-01-14T02:51:26-08:00
      DOI: 10.1177/2051415814548475
      Issue No: Vol. 8, No. 1 (2015)
  • Panton-Valentine leukocidin producing methicillin-sensitive Staphylococcus
           Aureus causing prostatic abscess
    • Authors: Goodall, P; Walton, T.
      Pages: 68 - 69
      PubDate: 2015-01-14T02:51:26-08:00
      DOI: 10.1177/2051415813509095
      Issue No: Vol. 8, No. 1 (2015)
  • Castleman's disease presenting as a penile cutaneous horn
    • Authors: Jefferies, M. T; Brown, G.
      Pages: 70 - 72
      PubDate: 2015-01-14T02:51:26-08:00
      DOI: 10.1177/2051415813512648
      Issue No: Vol. 8, No. 1 (2015)
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