Computerised audit system in urology.
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Biomedical subjects
Publications and source records attributed to G N Rajkumar.
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An MS Office package has been developed to score IPSS, take a patient history, compare flows with nomograms and decide on interim management. This is based on these scores, residual volume and laboratory results. A clearly formatted GP letter is produced. The patient uses a touch screen to answer questions on the IPSS and other medical history. These questions and responses are stored in Excel spread sheets. Clinic staff then enter results of flow studies, urinalysis, U&E and PSA. Excel Visual Basic creates a detailed printout for the notes and the MS Office mail merge facility creates a summary printout, which also serves as a letter to the GP. Excel allows embedding of formulae and program code to implement the rules for management. Based on these rules, the program either generates a request for an urgent appointment in the clinic or recommends the use of either an alpha blocker (if not contraindicated by medical history) or 5 alpha reductase inhibitors in the interim period before they are reviewed in clinic. A total of 139 patients have been seen and the computer decisions compared with those of a consultant urologist. Agreement was found in 106, disagreement in 33. However, 21 of the 33 involved computer oversensitivity to flow results. We do not anticipate difficulty improving this and are investigating using an artificial neural network. Of the other 12 patients, the urologist departed from the fixed rules for IPSS, creatinine, PSA and residual urine when only one variable was slightly abnormal. To conclude, this novel user-friendly system shows great potential in the management of prostate outpatients. Some tuning is needed, with particular respect to uroflow results.
Primary lymphoma of the bladder is a rare non-epithelial bladder tumour. It is usually non-Hodgkin's lymphoma with mucosa-associated lymphoid tissue (MALT) lymphoma being its predominant subtype. Most of the literature has been limited to individual sporadic case reports. We present 2 cases of the MALT-type primary lymphoma of the urinary bladder which were treated in our unit. Both patients were females with a history of recurrent urinary tract infections. They were treated successfully with chemotherapy alone. We also present a review of the literature emphasising the clinical presentation, the morphological and immunophenotypic features and the various treatment modalities of this rarely seen bladder pathology.