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S Alan McNeill

Publications and source records attributed to S Alan McNeill.

8 recordsLinked to original sources
PubMed2006

Prostatic infarction involving the urinary sphincter, an association with pyoderma gangrenosum.

A 70-year-old man presented with haematuria and restrictive urinary symptoms 7 years after a transurethral prostatectomy (TURP). Onset of symptoms coincided with development of a large skin ulcer on his back. A diagnosis of pyoderma gangrenosum was made based on clinical signs and histopathology. On repeated cystoscopy the urethral sphincter was obliterated by necrotic tissue, suspicious for malignancy. Histopathology revealed only necrotic tissue consistent with infarction of the prostate and sphincter. This clinical presentation with infarction of the prostate and sphincter, concurrent with development of skin ulcers, was consistent with pyoderma gangrenosum affecting the prostatic urothelium and sphincter. Previous prostatic surgery may have predisposed our patient to development of pyoderma gangrenosum in the area of the prostate.

Aged↗
PubMed2006

Is frenuloplasty worthwhile? A 12-year experience.

INTRODUCTION: Frenuloplasty is commonly performed. Its outcome has never been reported. PATIENTS AND METHODS: We have performed 213 frenuloplasties since 1992. Patients were sent a questionnaire regarding indication, treatment advised on presentation, anaesthetic, outcome (linear analogue satisfaction score), and further intervention required. RESULTS: Overall, 48 of 209 (23%) patients replied (median age of series, 27 years; range 16-78 years: and of respondents, 27 years; range, 17-78 years). Indications included tearing/bleeding of the foreskin (n = 32), balanitis (n = 3), pain on intercourse (n = 26), phimosis (n = 4), ejaculatory (n = 1) and hygiene (n = 1) problems. Twenty-five patients received general anaesthesia. Median satisfaction score was 8 (range, 1-10). Thirty-four patients would recommend frenuloplasty to another with similar symptoms. Three of nine patients initially advised to undergo circumcision later underwent circumcision (frenuloplasty satisfaction score, 1-3), 1 awaits circumcision (score, 5), 1 has a tight foreskin (score, 3), and 4 are satisfied (scores 6,9,10,10). In total, 23 of 209 patients (11%; median age, 27 years) underwent circumcision following frenuloplasty. Median time to circumcision was 11 months (range, 5-52 months). CONCLUSIONS: This is the only reported series of frenuloplasty. The response rate reflects a young mobile population. Most men are satisfied with the outcome, including some initially advised to undergo circumcision. The overall rate of circumcision following frenuloplasty is likely to be 15-20%.

Adolescent↗
PubMed2005

Trends in reporting Gleason score 1991 to 2001: changes in the pathologist's practice.

OBJECTIVE: The prostate specific antigen (PSA) era has been associated with a grade migration towards moderately-differentiated (Gleason 5-7) prostate cancer. We investigated whether changes in interpretation of the Gleason system could be a contributing factor by reviewing the Gleason scores for prostate cancer in our region. PATIENTS AND METHODS: Records of patients with prostate cancer assigned a Gleason score between 1991-2001 were retrospectively reviewed. We analysed trends in Gleason score, method of diagnosis and age at diagnosis. Following this, 50 cases from the dataset were randomly selected (stratified to contain half Gleason 2-4 reports) and reviewed in a blinded manner by an uropathologist and given a new Gleason score. RESULTS: 2737 patients were diagnosed and given a Gleason score; 1484 by prostate biopsy (PB) and 1172 by transurethral resection of prostate (TURP). 273 radical prostatectomy (RP) specimens were received, although the results of pre-operative biopsies were available in only 192 of these patients. Over time, there was an increase in the proportion of patients with Gleason 5-7, and a significant decrease in reporting of Gleason 2-4 cancer (r2 = 0.81, p < 0.0001). In 1991, 24% of cancers were Gleason 2-4; in 2001 this had decreased to 2.4%. TURP was associated with more Gleason 2-4 reports (23%) compared with PB (13.2%) and RP (9.2%). On blinded review, all Gleason 2-4 reports were upgraded to Gleason 5-7 cancer (p < 0.001). CONCLUSION: Over time, the proportion of Gleason 2-4 prostate cancer reported has significantly decreased. Our study suggests that a change in practice by the pathologist is a significant factor in this grade migration.

Adult↗
PubMed2005

A comparison of the pathology of transitional cell carcinoma of the bladder and upper urinary tract.

OBJECTIVE: To clarify the histopathological patterns of upper and lower urinary tract transitional cell carcinomas (TCCs), as previous reports suggest that upper urinary tract TCCs have a greater tendency towards high-grade disease than bladder TCCs, of which most are low-grade and low-stage tumours. PATIENTS AND METHODS: All patients presenting with TCC of bladder or upper urinary tract between February 1991 and December 2001 at one institution were identified. Further patient information was obtained from the hospital database and case-note review. RESULTS: In all, 164 patients with upper urinary tract TCC and 2197 with bladder TCC were identified. There was a correlation between grade and stage of both upper urinary tract and bladder TCCs. 35% of the upper tract TCCs were classified as grade 2 and 44% as grade 3, while for bladder TCCs, 31% of lesions were classified as grade 2 and 35% as grade 3 (P = 0.003). Of the upper urinary tract lesions 33% were stage pT2-T4, compared with only 20% of bladder TCCs (P = 0.001). CONCLUSIONS: Upper urinary tract TCC is a higher grade and stage disease than bladder cancer, a finding that emphasizes the need for aggressive treatment of upper urinary tract TCC. If endourological management of upper urinary tract TCC is considered, histopathological determination of tumour grade before treatment is essential.

Aged↗
PubMed2004

The role of alpha-blockers in the management of acute urinary retention caused by benign prostatic obstruction.

OBJECTIVES: To consider theories concerning the etiology of acute urinary retention (AUR), which may influence the outcome of a trial without catheter (TWOC), and to discuss evidence regarding the use of medical therapy in the management and secondary prevention of AUR. METHODS AND MATERIALS: A search of the literature discussing measurable parameters that may identify patients at risk for AUR and who require further intervention after initial treatment was undertaken. Studies of the effect of medical interventions for benign prostatic hyperplasia (BPH) and AUR were also identified. RESULTS: The etiology of acute urinary retention remains unknown in many cases, which are often described as spontaneous, but catheterization remains standard management followed by a TWOC and bladder outlet surgery in those who do not void satisfactorily. Alpha-blockers (alpha(1)-adrenoreceptor antagonists) effectively reduce the symptoms associated with BPH and improve the urodynamic parameters of obstruction, without the sexual adverse events associated with the 5alpha-reductase inhibitors. They may diminish the incidence of AUR and the need for surgical intervention in symptomatic men. There is now good evidence that alfuzosin, in particular, improves the success rate of a TWOC, although other uroselective alpha-blockers have also been shown to improve the success rates of TWOC. CONCLUSIONS: The proven effects of alpha-blockers support the hypothesis that they will increase the chances of a successful TWOC following AUR, which has now been proven in several well-designed and conducted studies. However, it is not yet clear whether these or other medical therapies have a role to play in the secondary prevention of further AUR or the need for further surgery. It is clear that certain measurable parameters may be used to identify patients at highest risk of a further episode of AUR following a successful TWOC; these patients may then be offered urgent surgical intervention.

Acute Disease↗
PubMed2004

Oncological control following laparoscopic nephroureterectomy: 7-year outcome.

PURPOSE: Proof of the oncological safety of laparoscopic nephroureterectomy (LNU) relies on truly long-term outcome being at least equivalent to that of open surgery. We compared the long-term oncological outcome of laparoscopic versus open nephroureterectomy (ONU) in patients with upper tract transitional cell carcinoma (TCC). MATERIALS AND METHODS: Between April 1992 and January 1999, 26 LNUs and 42 ONUs were performed at our hospital for suspected upper tract TCC. Hospital medical records were retrospectively reviewed to assess preoperative staging, pathology and followup. RESULTS: There were 4 patients excluded from study (1 who underwent LNU and 3 ONU) since the histological diagnosis was other than TCC. Median followup for the laparoscopic and open groups was 101 and 96 months, respectively. There was local recurrence in 2 patients (8%) after LNU and in 6 patients (15.4%, p = 0.3) after ONU. TCC recurred in the contralateral kidney or ureter in 2 LNU cases (8%) and 1 ONU case (2.6%, p = 0.3). There was bladder recurrence in 7 patients (28%) following LNU compared with 15 patients (42%, p = 0.2) after open nephroureterectomy. The 1 and 5-year metastasis-free survival rates were 80% and 72% for LNU compared with 87.2% and 82.1% for ONU (p = 0.33 and 0.26). Upper tract tumor grade and stage influenced the incidence of metastatic and contralateral disease, but not the incidence of local or bladder recurrence. CONCLUSIONS: In the surgical management of upper tract TCC, the laparoscopic approach does not affect long-term oncological control. Tumor stage and grade are important prognostic factors in the development of metastases and cancer specific mortality.

Adult↗