Pub Date : 2023-02-17DOI: 10.1177/20514158231155046
Farooq Hameed, Adeel Anwaar
Prostatitis is a common disorder affecting 10–14% of men. Chronic prostatitis is a bothersome disease affecting young, middle-aged and elderly men. Routine cultures often fail to localise the source of infection. Although the four-glass test is considered for evaluating chronic prostatitis, the three-glass urine test can also be performed. This test yields excellent results. Overall, 144 cases of Pakistani origin were enrolled. A three-glass test was performed, and the samples were labelled as VB1, VB2 and VB3+ expressed prostatic secretions (EPS). Qualitative culture and drug sensitivity test were performed for 16 antimicrobials. Samples from 127 patients ( Mage = 37 years) were analysed. Chronic bacterial prostatitis was identified in 81 (63.77%) patients. In more than half of the cases examined in this study, the bacteria were localised to the prostate. IIIb
{"title":"The three-glass test yields excellent results for diagnosis of chronic bacterial prostatitis: Study from a Pakistani tertiary care hospital","authors":"Farooq Hameed, Adeel Anwaar","doi":"10.1177/20514158231155046","DOIUrl":"https://doi.org/10.1177/20514158231155046","url":null,"abstract":"Prostatitis is a common disorder affecting 10–14% of men. Chronic prostatitis is a bothersome disease affecting young, middle-aged and elderly men. Routine cultures often fail to localise the source of infection. Although the four-glass test is considered for evaluating chronic prostatitis, the three-glass urine test can also be performed. This test yields excellent results. Overall, 144 cases of Pakistani origin were enrolled. A three-glass test was performed, and the samples were labelled as VB1, VB2 and VB3+ expressed prostatic secretions (EPS). Qualitative culture and drug sensitivity test were performed for 16 antimicrobials. Samples from 127 patients ( Mage = 37 years) were analysed. Chronic bacterial prostatitis was identified in 81 (63.77%) patients. In more than half of the cases examined in this study, the bacteria were localised to the prostate. IIIb","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46543683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-12DOI: 10.1177/20514158231153251
Joel Corkill, R. Hawthorne, J. Westera, N. Collin, J. Aning
The objective of this study was to evaluate the management and survival outcomes of patients referred to urology as an emergency with malignant upper urinary tract obstruction (MUUTO). Between 2019 and 2020, the outcomes of all emergency referrals with MUUTO to the Urology team at a single institution were prospectively analysed. In total, 119 patients, median age 77 years, were referred to the urology team with MUUTO. Of these, 59% (70/119) had bilateral and 41% (49/119) unilateral obstruction. The three commonest primary underlying malignancies were gladder (41% (49/119)), prostate (19% (23/119)), and colorectal (8% (10/119)) cancer. The commonest indication for referral was acute kidney injury (86% (103/119)), the remainder had sepsis (13% (15/119)), and pain (1% (1/119)). Median in-patient stay for the admission was 7 days. Median estimated glomerular filtration rate (eGFR/1.73 m2) measured on discharge improved irrespective of whether intervention for MUUTO was received. Overall survival of the cohort was 13% (16/119). Patients referred with MUUTO as an emergency have a poor prognosis. Renal function does not significantly deteriorate in the short term in this patient group with no intervention, and overall survival is not significantly improved after intervention unless further treatment is received. Multidisciplinary team discussion, including patients and oncologists, should be best practice before intervention in this challenging situation. 2b
{"title":"Malignant upper urinary tract obstruction: A prospective evaluation of patients presenting as an emergency to urology and their long-term real-life outcomes","authors":"Joel Corkill, R. Hawthorne, J. Westera, N. Collin, J. Aning","doi":"10.1177/20514158231153251","DOIUrl":"https://doi.org/10.1177/20514158231153251","url":null,"abstract":"The objective of this study was to evaluate the management and survival outcomes of patients referred to urology as an emergency with malignant upper urinary tract obstruction (MUUTO). Between 2019 and 2020, the outcomes of all emergency referrals with MUUTO to the Urology team at a single institution were prospectively analysed. In total, 119 patients, median age 77 years, were referred to the urology team with MUUTO. Of these, 59% (70/119) had bilateral and 41% (49/119) unilateral obstruction. The three commonest primary underlying malignancies were gladder (41% (49/119)), prostate (19% (23/119)), and colorectal (8% (10/119)) cancer. The commonest indication for referral was acute kidney injury (86% (103/119)), the remainder had sepsis (13% (15/119)), and pain (1% (1/119)). Median in-patient stay for the admission was 7 days. Median estimated glomerular filtration rate (eGFR/1.73 m2) measured on discharge improved irrespective of whether intervention for MUUTO was received. Overall survival of the cohort was 13% (16/119). Patients referred with MUUTO as an emergency have a poor prognosis. Renal function does not significantly deteriorate in the short term in this patient group with no intervention, and overall survival is not significantly improved after intervention unless further treatment is received. Multidisciplinary team discussion, including patients and oncologists, should be best practice before intervention in this challenging situation. 2b","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46864383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-17DOI: 10.1177/20514158221144344
A. Olaitan, T. Tien, S. Russ, Josephine Tapper, E. Herrington, J. Green, S. Chaudhri
The aim of this article is to summarise core quality improvement (QI) methodologies and concepts to assist urology teams in conducting well-designed improvement projects. We provide an introduction to the methodological foundations of QI, including the model for improvement, plan-do-study-act, lean and six sigma and present some useful QI tools such as process modelling and pareto charts with examples of how they might be applied to urological care. We also introduce the concept of measurement for QI and describe how this differs from the more traditional measurement approaches used in research. The key to successful QI work undoubtedly lies in the careful planning and appropriate selection of the available QI tools and methods, alongside pragmatic approaches to measurement that yield enough data to spot meaningful variation in outcomes. To support these core methods, QI leadership and stakeholder engagement will be critical to embedding QI into urological care and ensuring that improvements can be sustained once QI projects come to an end. Not applicable.
{"title":"Quality improvement in urological care: Core methodological principles","authors":"A. Olaitan, T. Tien, S. Russ, Josephine Tapper, E. Herrington, J. Green, S. Chaudhri","doi":"10.1177/20514158221144344","DOIUrl":"https://doi.org/10.1177/20514158221144344","url":null,"abstract":"The aim of this article is to summarise core quality improvement (QI) methodologies and concepts to assist urology teams in conducting well-designed improvement projects. We provide an introduction to the methodological foundations of QI, including the model for improvement, plan-do-study-act, lean and six sigma and present some useful QI tools such as process modelling and pareto charts with examples of how they might be applied to urological care. We also introduce the concept of measurement for QI and describe how this differs from the more traditional measurement approaches used in research. The key to successful QI work undoubtedly lies in the careful planning and appropriate selection of the available QI tools and methods, alongside pragmatic approaches to measurement that yield enough data to spot meaningful variation in outcomes. To support these core methods, QI leadership and stakeholder engagement will be critical to embedding QI into urological care and ensuring that improvements can be sustained once QI projects come to an end. Not applicable.","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43647492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-12DOI: 10.1177/20514158221145775
Z. Panayi, S. Srirangam
Rates of prostate cancer (PC) vary considerably between ethnic groups worldwide, and migratory studies have demonstrated the importance of both inherent and environmental influences. Healthcare systems also differ significantly worldwide, and comparisons of PC data between the United Kingdom and America have previously shown contradictory conclusions among ethnic groups. The South Asian population (SA) is the most predominant UK ethnic minority group. To systematically explore and critically analyse the available UK-based evidence regarding PC among SA men. Specifically, to review research that assesses the following factors: PC incidence, disease characteristics, treatment and survival outcomes. The existing evidence suggests that UK SA men have a lower PC incidence and younger age at diagnosis, in comparison with White men in the United Kingdom. Contrasting evidence is presented in studies that separately analyse men originating from India, Pakistan and Bangladesh. There is insufficient and contradictory evidence regarding whether SA men show altered PC disease characteristics or have differential survival rates. The evidence is limited regarding PC treatment; however, this indicates that SA men are less frequently treated surgically compared to White men Further high-quality research is required focusing on accurate ethnicity allocation, analysis of separate SA origin countries, socio-economic adjustment, subgroup analysis of treatment in low-risk PC and identifying the support needs of SA minorities with PC. This will help to ensure that ethnic minorities with PC are appropriately diagnosed, counselled and treated 3
{"title":"Prostate cancer among South Asian men in the United Kingdom: A systematic review","authors":"Z. Panayi, S. Srirangam","doi":"10.1177/20514158221145775","DOIUrl":"https://doi.org/10.1177/20514158221145775","url":null,"abstract":"Rates of prostate cancer (PC) vary considerably between ethnic groups worldwide, and migratory studies have demonstrated the importance of both inherent and environmental influences. Healthcare systems also differ significantly worldwide, and comparisons of PC data between the United Kingdom and America have previously shown contradictory conclusions among ethnic groups. The South Asian population (SA) is the most predominant UK ethnic minority group. To systematically explore and critically analyse the available UK-based evidence regarding PC among SA men. Specifically, to review research that assesses the following factors: PC incidence, disease characteristics, treatment and survival outcomes. The existing evidence suggests that UK SA men have a lower PC incidence and younger age at diagnosis, in comparison with White men in the United Kingdom. Contrasting evidence is presented in studies that separately analyse men originating from India, Pakistan and Bangladesh. There is insufficient and contradictory evidence regarding whether SA men show altered PC disease characteristics or have differential survival rates. The evidence is limited regarding PC treatment; however, this indicates that SA men are less frequently treated surgically compared to White men Further high-quality research is required focusing on accurate ethnicity allocation, analysis of separate SA origin countries, socio-economic adjustment, subgroup analysis of treatment in low-risk PC and identifying the support needs of SA minorities with PC. This will help to ensure that ethnic minorities with PC are appropriately diagnosed, counselled and treated 3","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65475624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-27DOI: 10.1177/20514158221142683
T. R. Terry
In the absence of published quantitative data on resilience and mental health in the UK urology trainees, this paper analyses the 2018 and 2021 General Medical Council National Training Surveys with regard to the outcomes of seven work-related questions for all trainees and at all stages of training. The answers to these questions are used as a proxy for burnout levels in urology trainees and also to understand the effect of coronavirus disease 2019 (COVID-19) on training. In addition, the extrinsic and intrinsic factors that may influence a urological trainee’s performance are reviewed as these can act as negative drivers on personal and professional performance. The use of a trainee’s reflective practice and emotional intelligence are promoted to allow early diagnosis of burnout and prompt institution of viable treatment options. Level of evidence: 2b
{"title":"Resilience and mental health in UK urology trainees","authors":"T. R. Terry","doi":"10.1177/20514158221142683","DOIUrl":"https://doi.org/10.1177/20514158221142683","url":null,"abstract":"In the absence of published quantitative data on resilience and mental health in the UK urology trainees, this paper analyses the 2018 and 2021 General Medical Council National Training Surveys with regard to the outcomes of seven work-related questions for all trainees and at all stages of training. The answers to these questions are used as a proxy for burnout levels in urology trainees and also to understand the effect of coronavirus disease 2019 (COVID-19) on training. In addition, the extrinsic and intrinsic factors that may influence a urological trainee’s performance are reviewed as these can act as negative drivers on personal and professional performance. The use of a trainee’s reflective practice and emotional intelligence are promoted to allow early diagnosis of burnout and prompt institution of viable treatment options. Level of evidence: 2b","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49020527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-27DOI: 10.1177/20514158221135683
Bharti Arora, E. Chung
This study evaluates the evolving surgical management of renal stones in Australia over the past 15 years. The National Australian Medicare and Australian Institute of Health and Welfare (AIWH) data were used to obtain the annual number of hospital presentations for urolithiasis and surgical procedures for upper urinary tract stones from 2005 to 2020. The four treatment modalities observed included nephrolithotomy, shockwave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL) and endoscopic lithotripsy. The total number of renal colic presentations in Australian hospitals and urology procedures claimed by Medicare has increased during the past 15 years. A total of 218,999 urological procedures were claimed by Medicare for renal stones over 15 years. There has been a dramatic rise in endoscopic lithotripsy surgery for stones. In 2005–2006, endoscopic lithotripsy comprised 56.6% of total stonework claimed by Medicare, and this proportion jumped to 88.9% in 2019–2020. All other modalities saw a decline in absolute and relative numbers. Endoscopic management of upper renal tract stones predominates in the current management of renal stone disease in Australia. Epidemiology audits such as this study can provide insight into national disease trends and guide future healthcare policies and resource planning. 2b
本研究评估了过去15年来澳大利亚肾结石手术治疗的发展。澳大利亚国家医疗保险和澳大利亚健康与福利研究所(AIWH)的数据用于获得2005年至2020年每年尿石症住院和上尿路结石手术的数量。观察到四种治疗方式:肾镜取石术、冲击波取石术、经皮肾镜取石术和内镜取石术。在过去的15年里，澳大利亚医院和泌尿外科手术中肾绞痛的总人数有所增加。在过去的15年里，共有218,999例泌尿外科手术被医疗保险报销。内窥镜碎石术治疗结石的病例急剧增加。2005-2006年，内镜下碎石术占医疗保险索赔的56.6%，这一比例在2019-2020年跃升至88.9%。所有其他方式的绝对数量和相对数量都有所下降。上肾结石的内镜治疗在目前澳大利亚肾结石疾病的治疗中占主导地位。像本研究这样的流行病学审计可以洞察国家疾病趋势，并指导未来的医疗保健政策和资源规划。2 b
{"title":"A 15-year longitudinal analysis of the trends in the surgical management of renal and ureteric stones in Australia","authors":"Bharti Arora, E. Chung","doi":"10.1177/20514158221135683","DOIUrl":"https://doi.org/10.1177/20514158221135683","url":null,"abstract":"This study evaluates the evolving surgical management of renal stones in Australia over the past 15 years. The National Australian Medicare and Australian Institute of Health and Welfare (AIWH) data were used to obtain the annual number of hospital presentations for urolithiasis and surgical procedures for upper urinary tract stones from 2005 to 2020. The four treatment modalities observed included nephrolithotomy, shockwave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL) and endoscopic lithotripsy. The total number of renal colic presentations in Australian hospitals and urology procedures claimed by Medicare has increased during the past 15 years. A total of 218,999 urological procedures were claimed by Medicare for renal stones over 15 years. There has been a dramatic rise in endoscopic lithotripsy surgery for stones. In 2005–2006, endoscopic lithotripsy comprised 56.6% of total stonework claimed by Medicare, and this proportion jumped to 88.9% in 2019–2020. All other modalities saw a decline in absolute and relative numbers. Endoscopic management of upper renal tract stones predominates in the current management of renal stone disease in Australia. Epidemiology audits such as this study can provide insight into national disease trends and guide future healthcare policies and resource planning. 2b","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44789275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-23DOI: 10.1177/20514158221138845
G. Rutherford, Lieo Jiun Tan, O. Aboumarzouk, J. de Souza, R. Khan, B. Somani, T. Amer
Recurrent urinary tract infections (rUTIs) have a significant effect on a patient’s quality of life and frequent use of antibiotics increases multi-drug resistance. Previous research on intravesical antibiotics suggests that this has a local effect on bacteria with reduced systemic absorption and associated side effects. We conducted a systematic review to assess the effectiveness and adverse effects of intravesical gentamicin treatment. Systematic review of all English published articles from January 2001 to October 2021 according to the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. A total of 139 studies were identified, 20 full-text articles were screened and 6 subsequently included totalling 166 patients. All studies reported a decrease in the mean number of urinary tract infections (UTIs) with a significant reduction ( p = 0.0025 and p < 0.004) in two studies. When the number of breakthrough UTIs on prophylactic gentamicin installations was assessed, 65% ( n = 86/133) remained UTI free. Throughout treatment, 99% of serum gentamicin levels were <0.3 ng/dL, and reported instances of increased creatinine were low (2%). A decrease in the growth of multi-drug-resistant bacteria was reported in two papers ( p = 0.065 and p = 0.04). Intravesical gentamicin seems to be an effective treatment in patients with symptomatic rUTIs. The evidence suggests it also reduces UTIs caused by multi-drug-resistant bacteria with no systemic absorption and minimal renal toxicity. 2a
{"title":"Intravesical gentamicin treatment for recurrent urinary tract infections: A systematic review over the last two decades","authors":"G. Rutherford, Lieo Jiun Tan, O. Aboumarzouk, J. de Souza, R. Khan, B. Somani, T. Amer","doi":"10.1177/20514158221138845","DOIUrl":"https://doi.org/10.1177/20514158221138845","url":null,"abstract":"Recurrent urinary tract infections (rUTIs) have a significant effect on a patient’s quality of life and frequent use of antibiotics increases multi-drug resistance. Previous research on intravesical antibiotics suggests that this has a local effect on bacteria with reduced systemic absorption and associated side effects. We conducted a systematic review to assess the effectiveness and adverse effects of intravesical gentamicin treatment. Systematic review of all English published articles from January 2001 to October 2021 according to the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. A total of 139 studies were identified, 20 full-text articles were screened and 6 subsequently included totalling 166 patients. All studies reported a decrease in the mean number of urinary tract infections (UTIs) with a significant reduction ( p = 0.0025 and p < 0.004) in two studies. When the number of breakthrough UTIs on prophylactic gentamicin installations was assessed, 65% ( n = 86/133) remained UTI free. Throughout treatment, 99% of serum gentamicin levels were <0.3 ng/dL, and reported instances of increased creatinine were low (2%). A decrease in the growth of multi-drug-resistant bacteria was reported in two papers ( p = 0.065 and p = 0.04). Intravesical gentamicin seems to be an effective treatment in patients with symptomatic rUTIs. The evidence suggests it also reduces UTIs caused by multi-drug-resistant bacteria with no systemic absorption and minimal renal toxicity. 2a","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43241179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-22DOI: 10.1177/20514158221143248
S. Sinha, Sirish Bharadwaj
To examine the urodynamic characteristics of men with mixed detrusor overactivity with detrusor underactivity (DODU) across the entire adult-age spectrum. Data included all adult men who underwent urodynamics for refractory non-neurogenic lower tract symptoms between 2011 and 2019. DODU was defined as the concomitant presence of detrusor overactivity (DO) during storage with underactivity (bladder contractility index, BCI < 100) during voiding. Nonparametric tests with multiple hypothesis correction were used (SPSS 25.0). DODU was noted in 199/1596 men (12.5%; median, 62 years). Men with DODU were older than men with detrusor underactivity (DU) or DO alone (median, 62, 48 and 56 years, respectively). DODU was commoner in older men but was noted across all age groups. As compared to men with isolated DU, men with DODU were more likely to be obstructed (38.7% versus 23.6%) and had better contractility (median BCI 81 versus 75). Peak detrusor contraction pressure during overactivity was lower in men with DODU than men with isolated DO. DODU should not be regarded as an exclusively geriatric disease. Differences in urodynamic characteristics suggest that this condition might not just be the coincidental occurrence of DO and underactivity in the same individual. III
{"title":"Urodynamic characteristics of adult men with mixed detrusor overactivity with detrusor underactivity: A database analysis","authors":"S. Sinha, Sirish Bharadwaj","doi":"10.1177/20514158221143248","DOIUrl":"https://doi.org/10.1177/20514158221143248","url":null,"abstract":"To examine the urodynamic characteristics of men with mixed detrusor overactivity with detrusor underactivity (DODU) across the entire adult-age spectrum. Data included all adult men who underwent urodynamics for refractory non-neurogenic lower tract symptoms between 2011 and 2019. DODU was defined as the concomitant presence of detrusor overactivity (DO) during storage with underactivity (bladder contractility index, BCI < 100) during voiding. Nonparametric tests with multiple hypothesis correction were used (SPSS 25.0). DODU was noted in 199/1596 men (12.5%; median, 62 years). Men with DODU were older than men with detrusor underactivity (DU) or DO alone (median, 62, 48 and 56 years, respectively). DODU was commoner in older men but was noted across all age groups. As compared to men with isolated DU, men with DODU were more likely to be obstructed (38.7% versus 23.6%) and had better contractility (median BCI 81 versus 75). Peak detrusor contraction pressure during overactivity was lower in men with DODU than men with isolated DO. DODU should not be regarded as an exclusively geriatric disease. Differences in urodynamic characteristics suggest that this condition might not just be the coincidental occurrence of DO and underactivity in the same individual. III","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47177419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-09DOI: 10.1177/20514158221139897
J. K. Raja Thinagaran, P. James, S. Agrawal
Intravesical Bacillus Calmette–Guérin (BCG) instillation is an established form of immunotherapy for intermediate and high-risk bladder cancers. Mandatory cystoscopic surveillance is commonly performed under general anaesthesia (GA) to facilitate biopsy or other procedures. However, it is resource-intensive with unclear clinical benefit. We performed a two-cycle audit, before and after changing post-BCG surveillance policy, from GA cystoscopy to local anaesthetic flexible cystoscopy (LAFC) on trans urethral laser ablation (TULA) lists, where patients may undergo a tumour biopsy or laser ablation. In the first cycle, we audited 53 patients undergoing 114 post-BCG rigid cystoscopies from January 2018 to December 2019. In the second cycle, there were 56 patients undergoing 99 post-BCG LAFCs on TULA lists in 2020. In the first audit cycle cohort, the mean patient age was 72.29 ± 8.98 years and 48 were men; malignant histology was identified only on five occasions (three grade progressions). Fourteen patients required overnight admission. In the second audit cycle cohort, the mean patient age was 70.44 ± 9.17 years and 47 were men. Four had a grade progression, while another a stage progression. Out of 99 LAFCs, 47 confirmed normal bladder appearance. A biopsy was taken during other 52 cystoscopies: 17 (33%) confirmed malignancy. Fifteen patients showed findings that were labelled as recurrence, but only two required a further GA procedure to deal with recurrence. One patient was admitted for post-procedure bleeding, which settled with irrigation. Local anaesthetic TULA procedure is a safe and effective alternative for a GA rigid cystoscopy to survey bladders of patients on intravesical BCG therapy. 3
{"title":"Efficacy of outpatient surveillance in post-intravesical BCG management of high-risk bladder cancer","authors":"J. K. Raja Thinagaran, P. James, S. Agrawal","doi":"10.1177/20514158221139897","DOIUrl":"https://doi.org/10.1177/20514158221139897","url":null,"abstract":"Intravesical Bacillus Calmette–Guérin (BCG) instillation is an established form of immunotherapy for intermediate and high-risk bladder cancers. Mandatory cystoscopic surveillance is commonly performed under general anaesthesia (GA) to facilitate biopsy or other procedures. However, it is resource-intensive with unclear clinical benefit. We performed a two-cycle audit, before and after changing post-BCG surveillance policy, from GA cystoscopy to local anaesthetic flexible cystoscopy (LAFC) on trans urethral laser ablation (TULA) lists, where patients may undergo a tumour biopsy or laser ablation. In the first cycle, we audited 53 patients undergoing 114 post-BCG rigid cystoscopies from January 2018 to December 2019. In the second cycle, there were 56 patients undergoing 99 post-BCG LAFCs on TULA lists in 2020. In the first audit cycle cohort, the mean patient age was 72.29 ± 8.98 years and 48 were men; malignant histology was identified only on five occasions (three grade progressions). Fourteen patients required overnight admission. In the second audit cycle cohort, the mean patient age was 70.44 ± 9.17 years and 47 were men. Four had a grade progression, while another a stage progression. Out of 99 LAFCs, 47 confirmed normal bladder appearance. A biopsy was taken during other 52 cystoscopies: 17 (33%) confirmed malignancy. Fifteen patients showed findings that were labelled as recurrence, but only two required a further GA procedure to deal with recurrence. One patient was admitted for post-procedure bleeding, which settled with irrigation. Local anaesthetic TULA procedure is a safe and effective alternative for a GA rigid cystoscopy to survey bladders of patients on intravesical BCG therapy. 3","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44179737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-24DOI: 10.1177/20514158221136340
C. Yepes, M. Bandini, P. Joshi, Ahmed A Alrefaey, S. Bhadranavar, S. Bafna, S. Kulkarni
The aim of this article is to present our experience of pedicled dorsal penile skin tube as neourethra after radical penectomy due to invasive primary male carcinoma of anterior urethra. This is an observational descriptive study including seven men with primary urethral carcinoma who underwent radical penectomy between 2018 and 2021. Instead of urinary derivation with suprapubic catheter, perineal urethrostomy, or bladder orthotopic/heterotopic reconstruction, patients underwent reconstruction of the anterior urethra with a pedicled dorsal penile skin tube. In brief, before corpora amputation and radical urethrectomy, the dorsal penile skin is preserved to reconstruct the neourethra. The distal end of the skin is anastomosed with the proximal urethral stump (usually membranous urethra) to assure continuity of the urinary tract, without jeopardising urinary continence. Finally, the flap is tubularized with two layers of watertight running sutures. Median age was 50 (35–70) years. Histology revealed squamous cell carcinoma in all patients. Almost 100% of patients presented locally advanced (pT3–4, G3) disease and received perioperative chemotherapy (MVAC). The median follow-up was 10 (5–24) months. Median operative time was 230 min (190–315). There were not severe (Clavien–Dindo III–IV) perioperative complications. All patients were able to void in standing position through the reconstructed neourethra. No patients reported post-operative incontinence. Two patients died after 8 and 11 months from surgery. This new technique of using the dartos-based dorsal penile skin tube urethroplasty offers the possibility to void in standing position after radical penectomy with no need of urinary derivations. Not applicable.
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