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Urologists
Kinds of Urologists Selected AbstractsCURRENT OPINION AMONGST RADIOLOGISTS AND UROLOGISTS IN THE UK ON PERCUTANEOUS NEPHROSTOMY AND URETERIC STENT INSERTION FOR ACUTE RENAL OBSTRUCTION: RESULTS OF A POSTAL SURVEYBJU INTERNATIONAL, Issue 6 2007Deen P Sharma No abstract is available for this article. [source] HISTORY: Adrian Walton Zorgniotti (1925,1994): Renaissance UrologistTHE JOURNAL OF SEXUAL MEDICINE, Issue 2 2005Eli F. Lizza MD Abstract Adrian Zorgniotti was born on March 3, 1925 and died on July 6, 1994. During his 47 years as a physician, he brought innovation and imagination to the field of Urology, especially in the field of erectile dysfunction (ED). Biographical information was obtained from Dr. Zorgniotti's curriculum vitae, his published articles, and his eulogies. Several of his colleagues and peers were also interviewed by telephone. In addition, personal experiences of this author, from the 9 years we spent as associates, and of several other friends were recounted. Dr. Zorgniotti's involvement with the history of Urology began in 1970 when he published his first historical treatise on Rome's first doctor, Arcagathus. He continued his involvement when he served as moderator for the History Forum of the American Urological Association (AUA) from 1975 to 1988 and as Historian for the AUA from 1979 to 1988. This innovator brought vision to the field of ED when he introduced the combination of papaverine and phentolamine as an intracavernous injection for the treatment of ED. He also organized the first International Conference on Corpus Cavernolum Revascularization in 1978 at New York University and published long-term results with this therapy. Adrian Zorgniotti will probably be best remembered by the multitude of Urologists whose lives he has touched for his generosity of spirit and for his ability to help shape our careers with a kind gesture, suggestion, or phone call. I am proud to call him a mentor, a colleague, and a friend. [source] Jean Casimir Félix Guyon,Urologist and anatomistCLINICAL ANATOMY, Issue 1 2007Marios Loukas No abstract is available for this article. [source] Review Article: Economic evaluation of prostate cancer screening with prostate-specific antigenINTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2008Tomoaki Imamura Abstract: Economic issues cannot be ignored in conducting prostate cancer screening using prostate-specific antigen (PSA). Through an electronic search, we reviewed five descriptive cost studies and nine cost-effectiveness/cost-utility analyses concerning PSA screening. Most of the existing evidence was based on mathematical model analysis and the results are enormously disparate. The cost per quality-adjusted life years (QALY) gained was estimated to be $US 63.37 to $68.32, and $8400 to $23 100, respectively, or was dominated by no screening. Economic studies evaluating PSA screening are still far from sufficient. Urologists, epidemiologists and health economists must jointly conduct further studies on not only mortality but also quality of life assessment and economic evaluation, using randomized clinical trials, for a strict evaluation of the actual efficacy of PSA screening. At present, patients should be thoroughly informed of the limitations of PSA screening and, in consultation with urological specialists, make the personal decision of whether to receive it. [source] Report from the 1st Japanese Urological Association-Japanese Society of Medical Oncology joint conference, 2006: ,A step towards better collaboration between urologists and medical oncologists'INTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2007Hideyuki Akaza Abstract: The 1st Japanese Urological Association,Japanese Society of Medical Oncology Joint Conference, titled ,A step towards better collaboration between urologists and medical oncologists', was held to coincide with the 44th Meeting of the Japan Society of Clinical Oncology, Tokyo, in October 2006. The main theme of the conference addressed the need for a subspecialty of medical oncologist within urology to keep abreast of advances in medical oncology. Urologists should become more involved in the postoperative management of urologic cancer. Consensus on the optimal way to move forward in the treatment of urological cancer is needed. The conference featured eight lectures surveying the present status of uro-oncology in Europe, the USA, Korea, Singapore, and Japan; the relationship between surgical oncologists and medical oncologists; global trends and international clinical trials in uro-oncology; and the future of urologic oncology. These were followed by a general discussion titled ,Achieving better collaboration between the surgical oncologist and the medical oncologist.' This report presents a roundup of the 1st Japanese Urological Association,Japanese Society of Medical Oncology Joint Conference. [source] HISTORY: Adrian Walton Zorgniotti (1925,1994): Renaissance UrologistTHE JOURNAL OF SEXUAL MEDICINE, Issue 2 2005Eli F. Lizza MD Abstract Adrian Zorgniotti was born on March 3, 1925 and died on July 6, 1994. During his 47 years as a physician, he brought innovation and imagination to the field of Urology, especially in the field of erectile dysfunction (ED). Biographical information was obtained from Dr. Zorgniotti's curriculum vitae, his published articles, and his eulogies. Several of his colleagues and peers were also interviewed by telephone. In addition, personal experiences of this author, from the 9 years we spent as associates, and of several other friends were recounted. Dr. Zorgniotti's involvement with the history of Urology began in 1970 when he published his first historical treatise on Rome's first doctor, Arcagathus. He continued his involvement when he served as moderator for the History Forum of the American Urological Association (AUA) from 1975 to 1988 and as Historian for the AUA from 1979 to 1988. This innovator brought vision to the field of ED when he introduced the combination of papaverine and phentolamine as an intracavernous injection for the treatment of ED. He also organized the first International Conference on Corpus Cavernolum Revascularization in 1978 at New York University and published long-term results with this therapy. Adrian Zorgniotti will probably be best remembered by the multitude of Urologists whose lives he has touched for his generosity of spirit and for his ability to help shape our careers with a kind gesture, suggestion, or phone call. I am proud to call him a mentor, a colleague, and a friend. [source] Attitudes to evidence-based practice in urology: Results of a surveyANZ JOURNAL OF SURGERY, Issue 5 2001Alan M. F. Stapleton Background: The advantages of promoting evidence-based care through implementation of clinical guidelines are well established. Clinical practice guidelines have been developed for lower urinary tract symptoms (LUTS) and prostate cancer screening. Aspects of the delivery of care by urologists or specialist registrars relevant to the guidelines were assessed. Methods: A questionnaire was distributed at the 1999 meeting of the Urological Society of Australasia, which was attended by 187 Australasian and 33 foreign delegates. Questions addressed access to resources for evidence-based medicine; perceived need; preferred sources of information; and then presented four clinical scenarios. These were: (i) treatment recommendations in early stage prostate cancer; (ii) the same scenario if the respondent was the patient; (iii) treatment recommendations after radical prostatectomy when there was a positive resection margin; and (iv) clinical investigations for mild to moderate LUTS. Results: Of 220 possible responses, 132 were received, a response rate of 60%. Urologists overwhelmingly (100%) endorsed the need for access to evidence-based reviews, although 28% claimed such access was non-existent to poor. Clinical guidelines were the preferred source of evidence-based information. For early stage prostate cancer in a 55-year-old man, radical prostatectomy was recommended by 93.2% of respondents, but this dropped to 83% when the respondent was the patient (P < 0.05), and a wider range of treatments was recommended. Pelvic radiotherapy and hormone therapy were equally recommended for biochemical progression following radical prostatectomy where there was a positive surgical margin. Investigations for LUTS included serum prostate-specific antigen (PSA) testing (78.0%) and voided flow studies (77.3%). Conclusions: Urologists express a need for evidence-based practice resources, in particular clinical guidelines. Nevertheless their clinical approach is not necessarily consistent with existing guidelines, particularly for LUTS. An alteration in the recommendation when the respondent is the patient of interest and endorses the recommendation that patients with prostate cancer should be involved in treatment decisions. [source] 71 2005 Australia and New Zealand female urology survey: where are we and where are we going?BJU INTERNATIONAL, Issue 2006S. PILLAY Introduction:, Historically Urologists have had more training in the management of incontinence than prolapse, yet these conditions often coexist. As public hospitals perform less elective surgery there is an erosion of trainee exposure to female urology. Do Urological Society members see incontinence and prolapse as important areas for Urologists to continue managing? Methods:, A survey was sent to all Urologists and Trainees in Australia and New Zealand about training, current practice and interest in female urology. Results:, Sixty-nine per cent perform SUI surgery in current practice, and 94% of these had exposure to SUI surgery during their training. 50% of those performing SUI surgery would have liked more training, and 99% believe Urologists should be able to perform SUI surgery. 23% perform prolapse surgery in current practice, and 52% of these had exposure to prolapse surgery during their training. 55% of those performing prolapse surgery would have liked more training. 92% believe Urologists should be able to competently assess women for prolapse and 76% believe Urologists should be able to perform prolapse surgery. 51% have a chaperone present when performing vaginal examination and greater than 50% indicated an interest in attending workshops in female urology. 99% believed trainees should be trained in female urology, and 67% believed there should be a fellowship in female urology. Conclusions:, Most believe Urologists should manage incontinence and prolapse. Many wish they had more training in this area. Female urology fellowships are widely supported. There is sufficient interest to run workshops in this area. [source] The role of the adult urologist in the care of children: findings of a UK surveyBJU INTERNATIONAL, Issue 1 2001D.F.M. Thomas Objective To document the current role of adult urologists in the care of children in the UK and to consider the future provision of urological services for children within the context of published national guidelines. Methods A detailed postal questionnaire was sent to all 416 consultant urologists listed as full members of the British Association of Urological Surgeons and resident in the UK. The range of information sought from each urologist included details of personal paediatric training, scope of personal practice, and information about facilities and provision of urological services for children in their base National Health Service hospital. Results The response rate was 69%; most consultant urologists (87%) in District General Hospitals (DGHs) undertake paediatric urology, mainly routine procedures of minor or intermediate complexity. Of urologists in teaching hospitals, 32% treat children but their involvement is largely collaborative. Consultants appointed within the last 10 years are less willing to undertake procedures such as ureteric reimplantation or pyeloplasty than those in post for ,10 years. Currently, 18% of DGH urologists hold dedicated children's outpatient clinics and 34% have dedicated paediatric day-case operating lists. Almost all urologists practise in National Health Service hospitals which meet existing national guidelines on the provision of inpatient surgical care for children. Conclusion Urologists practising in DGHs will retain an important role as providers of routine urological services for children. However, the tendency for recently appointed consultants to limit their practice to the more routine aspects of children's urology is likely to increase. Training and intercollegiate assessment should focus on the practical management of the conditions most commonly encountered in DGH practice. The implementation of national guidelines may require greater paediatric subspecialization at DGH level to ensure that urologists treating children have a paediatric workload of sufficient volume to maintain a high degree of surgical competence. [source] Urology and the Internet: an evaluation of Internet use by urology patients and of information available on urological topicsBJU INTERNATIONAL, Issue 3 2000G.O. Hellawell Objective To determine the use of the Internet by urological patients for obtaining information about their disease, and to conduct an evaluation of urological websites to determine the quality of information available. Patients and methods Questionnaires about Internet use were completed by 180 patients attending a general urological outpatient clinic and by 143 patients attending a prostate cancer outpatient clinic. The Internet evaluation was conducted by reviewing 50 websites listed by the HotbotÔ search engine for two urological topics, prostate cancer and testicular cancer, and recording details such as authorship, information content, references and information scores. Results Of the patients actively seeking further information about their health, 19% of the general urological outpatient group and 24% of the prostate cancer group used the Internet to obtain this information. Most websites were either academic or biomedical (62%), provided conventional information (95%), and were not referenced (71%). The information score (range 10,100) was 44.3 for testicular cancer and 50.7 for prostate cancer; the difference in scores was not significant. Conclusion The use of the Internet by patients is increasing, with > 20% of urology patients using the Internet to obtain further information about their health. Most Internet websites for urological topics provide conventional and good quality information. Urologists should be aware of the need to familiarize themselves with urological websites. Patients can then be directed to high-quality sites to allow them to educate themselves and to help them avoid misleading or unconventional websites. [source] Safety of supracostal punctures for percutaneous renal surgeryINTERNATIONAL JOURNAL OF UROLOGY, Issue 10 2006RAJIV YADAV Aim: Supracostal superior calyceal access has been shown to be the most suitable approach for staghorn calculi, calculi in the upper ureter and complex inferior calyceal calculi, as well as for antegrade endopyelotomy. However, many urologists hesitate in using this approach because of the potential for chest complications. The aim of this study was to analyze one institution's data regarding the safety and efficacy of this approach for percutaneous renal surgery. Methods: A total of 890 renal units (762 patients) were treated with percutaneous renal surgery (849 percutaneous nephrolithotomy, 41 antegrade endopyelotomy) from July 1998 to July 2004. Supracostal access was obtained in 332 (37.3%) patients. The indications for a supracostal approach were ureteropelvic junction obstruction, staghorn and complex inferior calyceal calculi, and stones in the upper calyx or the upper ureter. All punctures were made by the urologist under C-arm fluoroscopic guidance in the prone position. Results: The interspace between 11th and 12th rib was used in all except four patients in whom the puncture was made above the 11th rib. Eleven patients (3.31%) had a pleural breach presenting with fluid in the chest. Insertion of a chest tube was required in seven patients, while other four were managed conservatively. No patient had injury to the lung or other viscera. Hospital stay was not significantly prolonged as a result of the pleural breach in any patient. Except for staghorn calculi where multiple tracts were a necessity for maximal clearance, a single supracostal superior or middle posterior calyceal access served the purpose in 86% (177/205) of patients who underwent percutaneous surgery for renal or upper ureteric calculi. Conclusions: The supracostal superior calyceal approach was found to be effective as well as safe, with an acceptably low risk of chest complications. [source] Joaquin Maria Albarran Y Dominguez: Microbiologist, histologist, and urologist,a lifetime from orphan in Cuba to Nobel nomineeINTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2006ROWAN G CASEY Abstract, Joaquin Albarran was an extraordinary late 19th century urologist. His early career was in the field of microbiology and histopathology in Paris at a time of great medical developments and innovations. His later contributions to urology included the Albarran lever, Albarrans sign, Albarran,Ormond syndrome and seminal works on testicular and renal tumors. He also wrote treatizes on the pathophysiology of acute urinary retention, nephritis and calculus ureteric obstruction. He died at the young age of 52 from the effects of tuberculosis and in this same year was nominated for the Nobel prize in medicine. [source] Foreskin development before adolescence in 2149 schoolboysINTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2006TENG-FU HSIEH Background:, We examined the external genitalia of 2149 elementary schoolboys in the suburban area of Taichung in Taiwan for an understanding of foreskin development before adolescence. Methods:, The study's subjects comprised 692 first-grade boys, 725 fourth-grade boys, and 732 seventh-grade boys. The foreskin's condition was classified as: type I (normal prepuce), type II (adhesion of prepuce), type III (partial phimosis), type IV (phimosis) and type V (circumcised foreskin). Other abnormalities of the genitalia also were recorded. All of the examinations were performed by the same urologist. Results:, The incidence of type I foreskin was 8.2% in first-grade boys, 21.0% in fourth-grade boys, and 58.1% in seventh-grade boys. The incidence of type IV foreskin was 17.1% in first-grade boys, 9.7% in fourth-grade boys, and 1.2% in seventh-grade boys. Only one boy had balanoposthitis. Other abnormalities included inguinal hernia (n = 2), hydrocele (n = 12), cryptorchitism (n = 8), varicocele (n = 22), and subcoronal-type hypospadia (n = 1). Conclusions:, Physiological phimosis declines with age. Most boys with phimosis in this study did not require treatment. [source] Comprehensive health assessments during de-institutionalization: an observational studyJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 10 2006N. Lennox Abstract Background People with intellectual disability (ID) leaving institutions pass through a transition stage that makes them vulnerable to inadequate health care. They enter into community care under general practitioners (GPs) who are often untrained and inexperienced in their needs. Specifically designed health reviews may be of assistance to both them and their new GPs as they go through that phase. Methods This research aimed to investigate the effectiveness of a specially designed health review, the comprehensive health assessment program (CHAP) health review, in a group of adults as they transitioned out of the care of the last institution for people with ID in Tasmania. There were 25 residents reviewed by their GPs. Results The CHAP reviews picked up a number of health conditions and stimulated health promotion activities. Some of the findings were: a high number of abnormal Body Mass Indexes (19/23), immunizations given (13/23), vision impairment reported (2/23), mental health issues recorded (4/23) and skin abnormalities described (17/23). There were 22 referrals made to other health professionals (Australian Hearing Service 4, dentists 3, optometrists 3, psychiatrists 2, neurologists 2, ophthalmologist 1, urologist 1, ultrasound 1, mammogram 1, family planning 1, physiotherapist 1, continence nurse 1 and respiratory physician 1). These were in addition to various requests for pathology. Conclusions The CHAP health review was effective in identifying a number of health issues in the population of people with ID as they transitioned out of institutional care into the general community. [source] Early Results of Photoselective Vaporization of the Prostate in Medical Control-failed PatientsLUTS, Issue 2 2009Shen Kuang CHANG Objectives: We present here our early results and learning curve for photoselective vaporization of the prostate (PVP) performed by an experienced urologist and we provide an analysis of the morbidity and early functional outcomes. Methods: Forty-four patients were selected, from May 2006 to January 2009, who had benign prostate hyperplasia (BPH) accompanied by lower urinary tract symptoms (LUTS). After undergoing PVP for BPH at our hospital, the patients were followed up for approximately 2 years. PVP was performed by the same experienced urologist using potassium-titanyl-phosphate (KTP) laser. Baseline characteristics, preoperative and perioperative data, and postoperative complications were evaluated. Regular outpatient department follow-up was conducted after patients were discharged from the hospital at 1, 4 and 12 weeks. Results: The mean age of the 44 patients was 71.6 years. The mean prostate volume was 47.52 mL. The mean PVP surgery time was 79.11 min. The mean urinary catheterization time was 23.41 h. Few complications arose after PVP, except that 47.7% of the patients developed pyuria after being discharged from hospital. The average hospital stay was 2.45 days. There were no significant differences in the efficiency of tissue vaporization among the patients. Conclusion: PVP for BPH has various advantages, including reducing postoperative complications. An experienced urologist can easily perform PVP. However, early results show no significant differences in the efficiency for the PVP technique. [source] ORIGINAL RESEARCH,PEYRONIE'S DISEASE: Predicting Delay in Presentation in Men with Peyronie's DiseaseTHE JOURNAL OF SEXUAL MEDICINE, Issue 6 2010John P. Mulhall MD ABSTRACT Introduction., Many men with Peyronie's disease (PD) delay presentation to a urologist. The reasons for this are unclear. Aim., To define the differences in men who present early compared to those presenting in a delayed fashion and to determine predictors of delayed presentation. Methods., A retrospective analysis of all patients presenting for the first medical evaluation of PD. All patients underwent a standard history and physical examination and had a standardized deformity assessment. Demographic and PD parameters were recorded. Main Outcome Measures., Statistical comparison was used to define factors that were different between early and delayed presenters and multivariable analysis was used to define predictors of presentation >12 months. Results., 482 patients were analyzed, 61% presenting ,12 months, 39% >12 months. Mean patient age was 52 ± 13 years and mean duration of PD was 17 ± 30 months. Mean measured curvature was 42° ± 19°. Multivariable analysis revealed that delayed presentation patients were significantly more likely to be older (odds ratio [OR] = 4.0), to be in long-term relationships (OR = 3.6), to have dorsal curvature (OR = 2.5), to have curvature <45° (OR = 3.3), to be heterosexual (OR = 2.0), and to have simple deformity (OR = 1.5). Conclusions., One-third of men with PD presented in a delayed fashion and they tended to be older, to be in long-term relationships, to have dorsal curvature, or to have simple deformity. Mulhall JP, Alex B, and Choi JM. Predicting delay in presentation in men with Peyronie's disease. J Sex Med 2010;7:2226,2230. [source] Civiale, stones and statistics: the dawn of evidence-based medicineBJU INTERNATIONAL, Issue 3 2009Harry W. Herr The statistical research on bladder stones conducted by Paris urologist Jean Civiale in the early 19th century provided historical roots for evidence-based medicine. Translations of original documents by Civiale describing his work on treating bladder stones, and the discussion by members of the Paris Academy of Sciences that commented on his results in 1835, were reviewed. By collecting statistical data on a wide scale throughout Europe, Civiale argued that his new transurethral procedure, called lithotripsy, was superior to the more widely used but highly morbid technique, lithotomy. The Paris Academy of Sciences commented on his research and chose the occasion to debate whether or not numerical reasoning and statistics had any place in medical and surgical practice. Civiale's insights and methods espoused similar concepts and ideas driving today's new paradigm of evidence-based medicine. [source] The proportion of cores with high-grade prostatic intraepithelial neoplasia on extended-pattern needle biopsy is significantly associated with prostate cancer on site-directed repeat biopsyBJU INTERNATIONAL, Issue 4 2007Ardavan Akhavan OBJECTIVE To determine whether the predictive value of isolated high-grade prostatic intraepithelial neoplasia (HGPIN) for an unsampled prostate cancer on an extended biopsy is lower due to more thorough prostate sampling, and whether the proportion of cores with HGPIN is associated with prostate cancer, as isolated HGPIN on sextant prostate biopsy is associated with a 27,57% risk of prostate cancer on repeat biopsy. PATIENTS AND METHODS All extended prostate biopsies taken by one urologist over 6 years were reviewed for patients with isolated HGPIN on initial biopsy. Biopsies were evaluated for histological features and the proportion of cores with HGPIN. The clinical characteristics and pathological findings from subsequent biopsies were determined. RESULTS Of 577 men having extended biopsies, 48 had isolated HGPIN, followed by one to four site-directed repeat biopsies. Although only 10 (21%) had cancer on the first repeat biopsy, overall 15 (31%) had cancer. Those with cancer on repeat biopsy had a significantly higher proportion of cores with HGPIN, i.e. 29% vs 15%, cancer vs no cancer, respectively (P = 0.04). CONCLUSIONS Isolated HGPIN on extended biopsy conferred a 31% risk of unsampled prostate cancer. The proportion of cores with HGPIN on initial biopsy was significantly associated with the risk of cancer. The same was not true for age, race, prostate-specific antigen level, or the findings on digital rectal examination. The significant association between the proportion of cores with HGPIN and the risk of cancer suggests that patients with unifocal HGPIN on extended biopsy be managed expectantly, whereas those with multifocal HGPIN be re-biopsied. [source] Recognizing the risk of erectile dysfunction in a urology clinic practiceBJU INTERNATIONAL, Issue 7 2005David L. Rowland OBJECTIVE To determine the utility of simple patient-reported information in signalling erectile dysfunction (ED), as a challenge for the clinical urologist or related specialist is to quickly recognize risk factors for sexual dysfunction within the time constraints of an office visit. PATIENTS AND METHODS In a sample of men visiting a urology clinic, we determined the utility of simple patient-reported information in signalling ED. RESULTS Information readily obtained through a patient's self-report (that typically obtained in the office setting) can be very useful in understanding and predicting the likelihood of ED. Risk factors identified largely paralleled those identified in men generally, and included age, specific urological and non-urological somatic conditions, and tobacco use. Furthermore, knowing about even moderate levels of patient-reported psychological or relationship stress was useful in assessing the risk of ED. CONCLUSION Understanding the relationship of such risk factors to ED among men visiting a urology clinic might be particularly useful in clinical situations where the patient, for whatever reason, is reluctant to disclose an erectile problem when scheduling an appointment or even during the consultation. [source] A preoperative clinical prognostic model for non-metastatic renal cell carcinomaBJU INTERNATIONAL, Issue 9 2003L. Cindolo Authors from Naples, Paris and Rennes describe their efforts to develop a model for the preoperative prediction of outcome for non-metastatic renal cancer. It is valuable to both urologist and patient to develop such a model, particularly so on preoperative criteria. The results of their study are interesting, leading to possibly helpful findings. In another article, authors from Iceland estimated the risk of developing prostate and other cancer among relatives of men from that country diagnosed with prostate cancer. They found that a family history is a risk factor for prostate cancer, with the risk potentially higher for relatives of patients who died from the disease. From the relative dearth of papers on quality of life after radical prostatectomy there are now several, and the authors from Bristol report on the effects of erectile dysfunction on quality of life after this type of treatment. They had a very high response rate (91%) to their questionnaire, and found that erectile dysfunction has a profound effect on quality of life. This finding is not a surprise, but do we need to examine our management of prostate cancer in the light of it? OBJECTIVE To develop a model to predict the outcome before surgery for non-metastatic renal cell carcinoma (RCC). PATIENTS AND METHODS The records of 660 patients with non-metastatic RCC, operated at three European medical institutes, were reviewed. Univariate and multivariate analyses were used to assess the clinical and pathological variables affecting disease-free survival. RESULTS The median (range) follow-up was 42 (2,180) months; the disease recurred in 110 patients (16%). The 2- and 5-year overall survival was 87% and 54%, respectively. Five variables were significant in the univariate analysis, i.e. clinical presentation, clinical and pathological size, tumour grade and stage (P < 0.05). The preoperative variables, e.g. clinical presentation and clinical tumour size, were retained from the multivariate model. A recurrence risk formula (RRF) was constructed from this model, as (1.28 × presentation (asymptomatic = 0; symptomatic = 1) + (0.13 × clinical size)). Using this equation, the 2- and 5-year disease-free survival was 96% and 93% for an RRF of ,,1.2 and 83% and 68% for an RRF of >,1.2. CONCLUSION A formula was developed which, independent of stage, can be used to predict the rate of treatment failure in patients who undergo nephrectomy for non-metastatic RCC. The RRF might be useful for more accurate sub-grouping of good-prognosis patients, and for counselling patients before surgery, their personalized follow-up or adjuvant treatment once available. [source] A preliminary report on a patient-preference study to compare treatment options in early prostate cancerBJU INTERNATIONAL, Issue 3 2002The North West Uro-oncology Group Objectives,To prospectively record prognostic factors, quality-of-life and outcome data in a patient-preference controlled study comparing radical prostatectomy with radical radiotherapy for the treatment of early prostate cancer. Patients and methods,All patients suitable for radical treatment of early prostate cancer were identified and provided with information from a urologist, oncologist and nurse to allow them to choose a treatment option. Prognostic and demographic data were recorded for all patients and patients followed up uniformly, with the additional collection of quality-of-life data. Results,In a 38-month period, 196 patients were recruited to the trial; of these, 81 chose surgery, 81 radiotherapy, 30 brachytherapy and four ,watchful waiting'. The distribution of acknowledged prognostic factors was similar between the groups. Conclusion,If patient preference continues to divide this population into roughly equal and comparable arms, it should be possible to answer the underlying questions on the treatment of early prostate cancer using this study design. [source] The role of the adult urologist in the care of children: findings of a UK surveyBJU INTERNATIONAL, Issue 1 2001D.F.M. Thomas Objective To document the current role of adult urologists in the care of children in the UK and to consider the future provision of urological services for children within the context of published national guidelines. Methods A detailed postal questionnaire was sent to all 416 consultant urologists listed as full members of the British Association of Urological Surgeons and resident in the UK. The range of information sought from each urologist included details of personal paediatric training, scope of personal practice, and information about facilities and provision of urological services for children in their base National Health Service hospital. Results The response rate was 69%; most consultant urologists (87%) in District General Hospitals (DGHs) undertake paediatric urology, mainly routine procedures of minor or intermediate complexity. Of urologists in teaching hospitals, 32% treat children but their involvement is largely collaborative. Consultants appointed within the last 10 years are less willing to undertake procedures such as ureteric reimplantation or pyeloplasty than those in post for ,10 years. Currently, 18% of DGH urologists hold dedicated children's outpatient clinics and 34% have dedicated paediatric day-case operating lists. Almost all urologists practise in National Health Service hospitals which meet existing national guidelines on the provision of inpatient surgical care for children. Conclusion Urologists practising in DGHs will retain an important role as providers of routine urological services for children. However, the tendency for recently appointed consultants to limit their practice to the more routine aspects of children's urology is likely to increase. Training and intercollegiate assessment should focus on the practical management of the conditions most commonly encountered in DGH practice. The implementation of national guidelines may require greater paediatric subspecialization at DGH level to ensure that urologists treating children have a paediatric workload of sufficient volume to maintain a high degree of surgical competence. [source] A prospective study of conservatively managed acute urinary retention: prostate size mattersBJU INTERNATIONAL, Issue 7 2000V. Kumar Objective To evaluate in a prospective study the medium- to long-term outcome of a policy of conservatively managing acute urinary retention (AUR), arising solely by bladder outlet obstruction caused by benign prostatic enlargement (BPE), and to identify the factors favouring a positive outcome of a trial without catheter (TWOC). Patients and methods All men admitted as an emergency with primary AUR caused by BPE (from August 1997 to March 2000) underwent a TWOC. The following variables were recorded; the nature and duration of any preceding lower urinary tract symptoms, previous episodes of retention, concomitant anticholinergic medication, coexisting constipation, alcohol as a precipitating cause of AUR, previous prostatectomy, confirmed urinary tract infection, residual urine drained on catheterization and prostate size, as determined by a digital rectal examination (DRE) carried out by one consultant urologist in all patients. Those voiding successfully were followed up prospectively using the International Prostate Symptom Score (IPSS), quality-of-life score, urinary flow rate measurement and ultrasonographic measurement of the postvoid residual (PVR). Results Of the 40 men with AUR, 22 (55%) voided spontaneously after removing the catheter and continued to do so with mean peak flow rates of 12.2 mL/s and mean PVRs of 69.6 mL over a follow-up of 8,24 months. These patients remained asymptomatic, with a mean IPSS of 5.2 and quality-of-life score of 0.9. These men had a mean prostatic size of 15.9 g and a mean catheterized residual volume of 814 mL, while in those who had an unsuccessful TWOC the mean prostate size was 27.5 g (P = 0.006) and a mean catheterized residual volume of 1062 mL (P = 0.09). Prostate size as assessed by the DRE was the most significant factor in predicting the outcome of a TWOC. Conclusion A TWOC is justified in the long-term for men presenting with AUR caused by BPE. Prostate size is the most important factor for predicting the outcome of such a trial. [source] Surveillance for bladder cancer: the management of 4.8 million peopleBJU INTERNATIONAL, Issue 4 2000M.P.J. Wright Objective To document the workload of bladder cancer surveillance on the British urologist. Methods Thirty-one consultant urologists serving a population of 4.8 million were sent postal questionnaires eliciting their views on the management of superficial bladder cancer. The number, type and outcome of cystoscopies performed over a 6-week period throughout the region was then assessed prospectively. Results One person in 1450 in the South-west region is undergoing follow-up for bladder cancer. Of the responding consultants, 36% would give a single dose of intravesical chemotherapy within 24 h of resection for a G1/2 pTa tumour and 84% would perform the first check cystoscopy at 3,4 months. Over the 6-week period of the study, 696 cystoscopies were performed; there was considerable variation among centres in the choice of cystoscopy type, with 3,80% being rigid cystoscopies. Overall, there was a positive finding in 31% of the assessments. Conclusion This study documents the practice of a significant number of UK urologists in the management of superficial bladder cancer. There are considerable variations among individuals in the type and timing of check cystoscopy. [source] Urologist Practice Patterns in the Management of Premature Ejaculation: A Nationwide SurveyTHE JOURNAL OF SEXUAL MEDICINE, Issue 1 2008Alan Shindel MD ABSTRACT Introduction., Contemporary U.S. urologist's "real world" practice patterns in treating premature ejaculation (PE) are unknown. Aim., To ascertain contemporary urologist practice patterns in the management of PE. Method., A randomly generated mailing list of 1,009 practicing urologists was generated from the American Urologic Association (AUA) member directory. A custom-designed survey was mailed to these urologists with a cover letter and a return-address envelope. Responses were compared with the AUA 2004 guidelines for the treatment of PE. Main Outcome Measures., The survey assessed several practice-related factors and asked questions of how the subject would handle various presentations of PE in their practice. Results., Responses from practicing urologists totaled 207 (21%). Eighty-four percent of the respondents were in private practice and 11% were in academics. Most urologists (73%) saw less than one PE patient per week. On-demand selective serotonin reuptake inhibitor (SSRI) therapy was the most commonly selected first line treatment (26%), with daily dosing a close second (22%). Combination SSRI therapy, the "stop/start" technique, the "squeeze" technique, and topical anesthetics were favored by 13, 18, 18, and 11% of the respondents, respectively. If primary treatment failed, changing dosing of SSRIs, topical anesthetics, and referral to psychiatry were increasingly popular options. Ten percent of urologists would treat PE before erectile dysfunction (ED) in a patient with both conditions, with the remainder of the respondents treating ED first, typically with a phosphodiesterase type 5 inhibitor (78% of total). Fifty-one percent of urologists report that they would inquire about the sexual partner, but only 8, 7, and 4% would evaluate, refer, or treat the partner, respectively. Conclusions., The majority of our respondents diagnose PE by patient complaint, and treat ED before PE, as per the 2004 PE guidelines. Very few urologists offer referral or treatment to sexual partners of men suffering from PE. Additional randomized studies in the treatment of PE are needed. Shindel A, Nelson C, and Brandes S. Urologist practice patterns in the management of premature ejaculation: A nationwide survey. J Sex Med 2008;5:199,205. [source] Morphological classification and definition of benign, preneoplastic and non-invasive neoplastic lesions of the urinary bladderHISTOPATHOLOGY, Issue 6 2008R Montironi The morphological classification used in this essay has been based on the most recent World Health Organization (WHO) classification of tumours of the urinary system (i.e. 2004 WHO classification). It includes epithelial abnormalities and metaplasias as well as dysplasias and carcinomas in situ. The lesions are broadly subdivided into two major groups: benign, preneoplastic and non-invasive neoplastic lesions of the urothelium; and benign, preneoplastic and non-invasive neoplastic bladder lesions other than urothelial. Each of these lesions is defined with strict morphological criteria to provide more accurate information to urologists and oncologists in managing patients. There is still debate in the literature as to whether the 2004 WHO system should be the only one to be used and whether the 1973 WHO system should be abandoned. [source] Medical treatment of benign prostatic hyperplasia: physician and patient preferences and satisfactionINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2010M. Emberton Summary Practice guidelines acknowledge the importance of patient preferences in determining the appropriate treatment of benign prostatic hyperplasia (BPH). Recent literature suggests that patient and physician perspectives and satisfaction with BPH treatment management may differ; this may have an impact on clinical outcomes and patient compliance. This review evaluates patients' and physicians' preferred treatment options for managing BPH and patient satisfaction with therapy. A Medline-based systematic review using the terms ,Benign prostatic hyperplasia' + ,Patient preference/perception/satisfaction' or ,Physician/urologist preference/perception' was performed. Patients prefer therapies affecting long-term disease progression over those that provide short-term symptom improvement, which contrasts with the beliefs of their physicians. The prescribing behaviour of urologists and primary care physicians can be very varied. Studies of patient satisfaction with specific treatments generally show a high level of overall satisfaction, but cross-study comparisons are limited because of heterogeneity in study design. The evidence to date suggests that patients' views and beliefs and those of their physician may not always be in agreement. Improved physician,patient communication will help determine the best treatment option for patients with BPH and may ensure greater compliance and treatment success. [source] Preoperative smoking cessation: a questionnaire studyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 12 2007D. Owen Summary Background:, Preoperative smoking cessation has been shown to improve postoperative outcomes. Methods:, A total of 120 anonymous questionnaires were distributed to non-vascular surgeons practising in four centres in the UK asking about their smoking cessation advice practices, and whether they appreciated both the benefits of preoperative smoking cessation, and the efficacy of smoking cessation interventions. Results:, Eighty-three questionnaires were returned (response rate 69%). Twenty-three gastrointestinal surgeons, 11 orthopaedic surgeons, 9 breast surgeons, 12 plastic surgeons, 13 neurosurgeons and 15 urologists took part in this study. Eighty-eight per cent of respondents had not referred any elective patients to smoking cessation services in the previous month. Most non-vascular surgeons underestimated both the benefits of preoperative smoking cessation on outcome, and the efficacy of smoking cessation interventions. Conclusions:, This survey demonstrates that non-vascular surgeons underestimate the fact that preoperative smoking cessation can improve postoperative outcome, and that smoking cessation interventions are successful in helping patients to quit smoking. They largely do not refer patients to smoking cessation services. In order for patients to benefit postoperatively from this intervention it would be necessary to educate surgeons about the scale of the benefit, and the efficacy of smoking cessation interventions or to set up systematic frameworks to offer smoking cessation advice to preoperative patients who smoke. [source] Hypospadias repair: an overviewINTERNATIONAL JOURNAL OF UROLOGICAL NURSING, Issue 1 2010Michael Pfeil Hypospadias is a birth defect in boys where the meatus is not placed at the tip of the glans of the penis. This article reviews the rapidly developing international literature surrounding hypospadias and hypospadias repairs paying specific attention to important aspects of nursing care, including preparing for surgery, use of dressings, stents and catheters as well as medication. It concludes by considering the long-term impact of hypospadias and its surgical correction on the patient's life. Hypospadias is treated surgically, normally during the second 6 months of the boy's life. Hospitalization periods vary from day case surgery to several days. The success of the hypospadias repair can be measured according to functional results and cosmetic appearance of the penis. The post-operative use of dressings as well as urinary catheters or stents is common but not uniform. Complication rates for hypospadias surgery vary from below 10% in boys with distal hypospadias to above 50% in children with a proximal meatus. The most common complications are urethral fistulas, strictures and stenoses. The continuing efforts by paediatric urologists focus on further optimizing the cosmetic and functional results. [source] Sedation with midazolam versus local anaesthesia with lignocaine for transrectal prostate biopsiesINTERNATIONAL JOURNAL OF UROLOGICAL NURSING, Issue 2 2008Ilana Golan Abstract Transrectal ultrasound-guided needle biopsy of the prostate is the only method for diagnosing prostate cancer. Although tolerated by most patients, 65,90% of patients complain of pain during the procedure. Most urologists utilize ultrasound-guided transrectal injection of lignocaine. Intravenous sedation with short-acting medications such as midazolam has been successfully used during many invasive ambulatory procedures, reducing discomfort and anxiety. The aim of this study was to compare the efficacy of pain and anxiety reduction using intravenous sedation with midazolam versus local anaesthesia with lignocaine during transrectal biopsies of the prostate in a cross-sectional study. Ninety consecutive candidates for transrectal prostate biopsy were divided into 2 groups. Group A received periprostatic block with 2% lignocaine and group B received sedation with intravenous injection of 4 mg midazolam prior to insertion of the probe. Side-effects and patient satisfaction were documented by questionnaires, which included a pain visual analogue scale (VAS). Significant differences were found between the two groups with respect to the patient's perceived intensity of pain. Pain level expressed by a VAS was 4·2 in group A and 1·9 in group B (P < 0·001). Eighty-seven per cent of the patients in group B stated that they would be willing to repeat the procedure if necessary compared with 55% in group A (P = 0·002). There were no complications or side-effects as a result of midazolam sedation. Midazolam is more effective in relieving pain and anxiety during transrectal prostate biopsies and as safe as a local injection of lignocaine. [source] | ||||||||||||||||||||||||||||