The relationship between volume and outcome in urological surgery.
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Humans↗
Biomedical subjects
Mark Emberton
Publications and source records attributed to Mark Emberton.
Men's experiences of having lower urinary tract symptoms: factors relating to bother.
OBJECTIVE: To gain an understanding of men's experiences of having lower urinary tract symptoms (LUTS) and of bother, a principle determinant of whether a patient has an intervention for LUTS. PATIENTS AND METHODS: Data were collected on 75 patients with LUTS presenting to a urology outpatient clinic. Men completed a questionnaire asking about their symptoms, bother, mood and perceptions about LUTS. RESULTS: Most participants scored within the normal range for anxiety and depression, and expressed a moderate level of distress. They were to some extent bothered by their symptoms. Most men perceived LUTS as a long-term problem but felt unable to control their symptoms. The results suggest that bother reflects men's overall distress with having LUTS. Bother appears to be related to symptom severity, self perception, social limitation and the impact of LUTS. Embarrassment and social anxiety relate strongly to bother. CONCLUSION: Several psychological factors relate to bother; it may be possible to reduce bother using a brief psychological intervention.
Adult↗
Threshold volumes for urological cancer surgery: a survey of UK urologists.
OBJECTIVE: To determine minimum threshold levels of activity set by surgeons for urological cancer surgery, and to relate threshold levels to stated current procedural volume. METHODS: In all, 307 consultant urological surgeons were sent a questionnaire asking them to state for four urological cancer operations of different complexity their current procedural volume; whether minimum volume thresholds per surgeon should be implemented; and if so, the level of such thresholds; 212 (69%) replied. RESULTS: For all four procedures >/= 75% of surgeons advocated the setting of a minimum volume threshold. Overall, surgeons set the highest thresholds for radical prostatectomy and the lowest for radical cystectomy with continent diversion. There was no significant association between either the principle of supporting minimum volume thresholds or the level of such a threshold and the number of years worked as a consultant surgeon. The level of surgeon-derived minimum thresholds increased with increasing surgeon procedural volume. CONCLUSION: Most surgeons supported the principle of setting minimum volume thresholds. These thresholds appear to be influenced by current procedural volume and by procedural complexity. By setting thresholds greater than their current volume, some surgeons implicitly indicate that their current volume is insufficient to maintain their surgical competency.
Clinical Competence↗
A pilot randomized double-blind placebo-controlled trial on the use of antibiotics on urinary catheter removal to reduce the rate of urinary tract infection: the pitfalls of ciprofloxacin.
OBJECTIVE: To assess if a short course of antibiotics starting at the time of the removing a short-term urethral catheter decreases the incidence of subsequent urinary tract infection (UTI). PATIENTS AND METHODS: Patients across specialities with a urethral catheter in situ for >/= 48 h and </= 7 days were recruited at the time of catheter removal. Patients were excluded if they had had recent genitourinary surgery or were on antibiotics. Eligible patients were randomly assigned to a 48-h course of either ciprofloxacin or placebo tablets starting 2 h before catheter removal. A catheter specimen of urine was obtained before the start of the trial medication. The follow-up was at 7 and 14 days after catheter removal, with a questionnaire for UTI symptoms, and a mid-stream urine sample was taken. RESULTS: Forty-eight patients were recruited and had a complete follow-up (25 received ciprofloxacin and 23 placebo). Of the ciprofloxacin group, four patients (16%) had a UTI at the follow-up after catheter removal, and two were symptomatic. The UTI in two patients (including one of those symptomatic) was newly developed after catheter removal; the other two UTIs were a result of failure to resolve a catheter-associated UTI. All these UTIs in the ciprofloxacin group were resistant to ciprofloxacin. Of the placebo group, three patients (13%) had a UTI at the follow-up after removal, and one patient was symptomatic. The UTI, newly developed after catheter removal, was resistant to ciprofloxacin. The other two patients were asymptomatic; their UTIs were a result of failure to resolve a catheter-associated UTI, and one was resistant to ciprofloxacin. CONCLUSIONS: The risk of UTI (both symptomatic and asymptomatic) after removing a urethral catheter is real, even in absence of catheter-associated UTI before removal. UTIs occurring after removing a short-term urinary catheter had a high rate of resistance to ciprofloxacin. There was no detectable significant benefit in using prophylactic ciprofloxacin to reduce the UTI rate after catheter removal.
Adolescent↗
Men and chronic illness: a qualitative study of LUTS.
In order to determine how men react to and manage chronic conditions 16 men with Lower Urinary Tract Symptoms (LUTS) were interviewed to examine the relationship between detecting symptoms and seeking medical help, perceptions of symptoms and the impact of symptoms on daily life. Transcripts were analysed employing IPA and four major themes identified: Uncertainty/Trying to understand, Implications, Ways of coping and Self-concept/Identity. Uncertainty about the nature and origins of their condition and its gradual onset contributed to the delay in seeking medical advice. Men adopted a range of coping strategies to manage their symptoms. Implications for primary health care consultations are considered.
Adaptation, Psychological↗
[International comparison of guidelines for the management of benign prostatic hyperplasia: use of a validated generic tool].
INTRODUCTION: Many clinical practice guidelines (CPG) have been developed over the last decade for the management of benign prostatic hyperplasia (BPH) and associated lower urinary tract disorders. The purpose of this study was to analyse CPG published on the web until the end of 2001 and to compare their content and their methodology of development by using a validated evaluation tool. methodologies of development of CPG and their content using a validated tool. RESULTS: The methodology of elaboration and presentation of CPG was insufficient in the majority of CPGs. The type and number of diagnostic examinations recommended by each CPG were very variable. A consensus concerning treatment was reached at the cost of poorly defined criteria, apart from complications of BPH. CONCLUSION: The considerable number of men potentially eligible for management of voiding disorders related to BPH in the years to come will constitute a substantial medico-economic burden. Consensual rationalisation of this management by urologists in order to ensure practical application of the guidelines would limit expenditure without decreasing the quality of patient management. However, our study showed limited coherence between the various CPG, suggesting that rationalisation should first be applied to the method of development of CPG.
Humans↗
Behavioural approaches are helpful in overactive bladder.
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Behavior Therapy↗
Benign prostatic hyperplasia: a progressive disease of aging men.
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Adult↗
Sexual dysfunction in 1,274 European men suffering from lower urinary tract symptoms.
PURPOSE: We determine the prevalence and bothersomeness of erectile and ejaculatory dysfunction in men with lower urinary tract symptoms suggestive of bladder outlet obstruction in real life practice, and analyze predictors of sexual dysfunction in this population. MATERIALS AND METHODS: Sexual function of 1,274 European men with lower urinary tract symptoms was assessed by the DAN-PSSsex questionnaire. The relationship between sexual dysfunction and selected clinical characteristics was analyzed. RESULTS: The proportion of sexually active men decreased from 91% in those 60 years old or younger to 60% in those 70 years old or older. Erectile dysfunction, reduced ejaculation and pain/discomfort on ejaculation were reported by 62%, 63% and 23% of patients, respectively. Erectile dysfunction strongly related with age (40% younger than 60 years, 80% 70 years old or older), lower urinary tract symptom severity (55% mild, 70% severe) and body mass index, hypertension and concomitant treatment with calcium channel antagonists. Reduced ejaculation was significantly related to age (42% younger than 60 years, 82% 70 years old or older), lower urinary tract symptom severity (55% mild, 68% severe) and previous benign prostatic hyperplasia surgery. Pain/discomfort on ejaculation was only related to lower urinary tract symptom severity (7% mild, 31% severe). Erectile dysfunction, reduced ejaculation and pain/discomfort on ejaculation were considered a problem by 96%, 82% and 91% of patients younger than 60 years, respectively. These 3 sexual symptoms were still highly bothersome in patients 70 years old or older. CONCLUSIONS: Erectile dysfunction and reduced ejaculation are highly prevalent in men with lower urinary tract symptoms, and are strongly related to increasing age and lower urinary tract symptom severity. Both these aspects of sexual dysfunction are also highly bothersome, even in advanced age. Sexual function should be carefully assessed in the initial evaluation of patients with lower urinary tract symptoms and in deciding on treatment options, as it may have a negative impact on sex life.
Adult↗
Photodynamic therapy for prostate cancer recurrence after radiotherapy: a phase I study.
PURPOSE: Photodynamic therapy, using a photosensitizing drug activated by red light, can destroy localized areas of cancer with safe healing and without the cumulative toxicity associated with ionizing radiation. We used photodynamic therapy in a phase I-II study to treat patients with locally recurrent prostate cancer after radiotherapy. MATERIALS AND METHODS: Patients with an increasing prostate specific antigen (PSA) and biopsy proven local recurrence after radiotherapy were offered photodynamic therapy. Three days after intravenous administration of the photosensitizer meso-tetrahydroxyphenyl chlorin, light was applied using optical fibers inserted percutaneously through perineal needles positioned in the prostate with imaging guidance. Patients were followed with PSA measurements, prostate biopsies, computerized tomography or magnetic resonance imaging and questionnaires on urinary and sexual function. RESULTS: Photodynamic therapy was given to 14 men using high light doses in 13. Treatment was well tolerated. PSA decreased in 9 patients (to undetectable levels in 2) and 5 had no viable tumor on posttreatment biopsies. After photodynamic therapy, contrast enhanced computerized tomography or magnetic resonance imaging showed necrosis involving up to 91% of the prostate cross section. In 4 men stress incontinence developed (troublesome in 2 and mild in 2) which is slowly improving. Sexual potency was impaired in 4 of the 7 men able to have intercourse before photodynamic therapy, which did not improve. There were no rectal complications directly related to photodynamic therapy, but in 1 patient a urethrorectal fistula developed following an ill-advised rectal biopsy 1 month after therapy. CONCLUSIONS: Photodynamic therapy is a new option that could be suitable for organ confined prostate cancer recurrence after radiotherapy. With more precise light dosimetry, it may be possible to destroy essentially all glandular tissue within the prostate with few complications. These results suggest that photodynamic therapy merits further investigation.
Adenocarcinoma↗