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Biomedical subjects

S R Keoghane

Publications and source records attributed to S R Keoghane.

At least 19 recordsLinked to original sources
PubMed2006

A key cause of paraphimosis.

A 90-year-old man on hormonal treatment for invasive (T4) adenocarcinoma of the prostate presented as an emergency with a paraphimosis secondary to placement of four circumferential key rings around his penis. He had experienced referred penile pain from his prostate cancer, and to overcome this, had attempted to 'gate out' his pain by constricting his penis and thus stimulating the pudendal nerve. His treatment in our unit consisted of a penile local anaesthetic block, removal of the key rings with a ring cutter and manual reduction of the paraphimosis.

Adenocarcinoma↗
PubMed2006

A 4-year review of balloon dilation of ureteral strictures in renal allografts.

BACKGROUND: Ureteral obstruction necessitating intervention occurs in 2% to 7.5% of all renal allograft recipients. Conventional management includes open surgical repair, although more recently, percutaneous ureteral dilation has been performed. PATIENTS AND METHODS: The management and outcome of all seven allograft ureteral strictures treated with balloon dilation in our unit over a 4-year period were reviewed. Half (55%) of these strictures occurred in the proximal ureter. RESULTS: Four strictures were dilated successfully with a requirement for five dilations in total. These patients have stable graft function with no evidence of obstruction. Five strictures persisted despite 11 dilations. There were no significant complications from balloon dilation. CONCLUSION: Definitive surgical management should be considered if obstruction persists after one attempt at ureteral dilation, as multiple dilations have a low success rate (25%).

Catheterization↗
PubMed2001

Percutaneous retrograde varicocele embolisation using tungsten embolisation coils: a five year audit.

OBJECTIVE: To assess the efficacy of percutaneous retrograde varicocele embolisation using Spirale tungsten coils over a period of five years. PATIENTS AND METHODS: Fifty consecutive patients underwent local anaesthetic day case varicocele embolisation via a right femoral approach. Venous anatomy was identified and classified. Morbidity and recurrence were recorded at three month clinical follow up. RESULTS: The procedurewas technically successful in 94% of the patients. The varicocele recurred in 16%, the majority of whom had complex venous anatomy. 8% of the patients complained of discomfort at follow up. CONCLUSIONS: Although the coils used in this study have been withdrawn, a high technical success rate is described with failure being predominantly due to complex venous anatomy.

Adolescent↗
PubMed2000

A double-blind randomized controlled trial and economic evaluation of transurethral resection vs contact laser vaporization for benign prostatic enlargement: a 3-year follow-up.

OBJECTIVE: To evaluate the effect of contact laser prostate surgery in the treatment of benign prostatic hyperplasia. PATIENTS AND METHODS: A prospective double-blind randomized controlled trial of transurethral resection of the prostate (TURP) and contact laser prostatectomy was conducted, with an economic evaluation of both procedures. The primary outcome measure was the change in the American Urologic Association symptom score, with secondary outcome measures being the peak urinary flow rate, treatment-related complications, re-operation rate and health service costs. RESULTS: The perioperative blood loss and transfusion requirements were statistically significantly lower for laser prostatectomy than for TURP. There was no clinically significant difference between TURP and contact laser prostatectomy in the mean change in symptom scores and flow rates. There were distinct perioperative advantages in favour of the contact laser treatment, but some disadvantages in terms of re-catheterization and re-operation rates. CONCLUSIONS: Contact laser prostatectomy is a valid treatment for benign prostatic hypertrophy. The performance of contact laser prostatectomy as day-case surgery would have cost advantages to the National Health Service.

Aged↗
PubMed2000

Five-year data from the Oxford Laser Prostatectomy Trial.

OBJECTIVE: To evaluate the natural history of a group of patients who underwent contact laser prostatectomy or transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Patients were followed up at 5 years after enrolling in a prospective double-blind randomized controlled trial of TURP vs contact laser prostatectomy. RESULTS: Of the initial trial patients, 11.5% had died (seven in the laser and 10 in the TURP arm) and eight (5.4%) were too incapacitated by coexistent medical disease to respond to the questionnaires. Thirty-eight patients were not available for follow-up, despite numerous invitations. Thirteen of the laser patients (18%) and 11 of the TURP patients (14.5%) had undergone re-operation. Two patients from each arm had received alpha-blockers for worsening symptoms. CONCLUSIONS: Five years after prostatic surgery, a significant number of patients were dead or disabled by coexistent medical disease. The re-operation rate after TURP and contact laser prostatectomy were similar.

Double-Blind Method↗
PubMed1999

An audit of positive findings in flexible and rigid check cystoscopy.

Both flexible and rigid cysto-urethroscopy are routinely used in the surveillance of transitional cell bladder tumours. This study addressed the issue of patient selection for either rigid or flexible cystoscopy. What proportion of positive findings at flexible cystoscopy and negative findings at rigid cystoscopy are acceptable? Standards were set of 10% for the former and 50% for the latter and our practice was then audited. A retrospective analysis of 800 patients undergoing check cystoscopy revealed a positive finding rate of 8.3% using the flexible instrument and 48.1% using the rigid instrument.

Carcinoma, Transitional Cell↗
PubMed1996

The Oxford Laser Prostate Trial: sensitivity to change of three measures of outcome.

OBJECTIVES: To evaluate the sensitivity to change of outcome measures in a double-blind randomized controlled trial of transurethral resection of the prostate (TURP) and contact laser prostatectomy. METHODS: A total of 152 patients were randomized to TURP or contact laser prostatectomy using the Surgical Laser Technology (SLT) system. Preoperative data were obtained using a self-administered questionnaire containing the American Urological Association (AUA-7) symptom score, the bothersome score (benign prostatic hyperplasia impact index), and the Short Form-36 health status questionnaire (SF-36). Follow-up was at 1 and 3 months. Effect size scores were calculated to indicate the extent of change from baseline to follow-up. RESULTS: Data were available on 148 patients: 72 received laser therapy and 76 received TURP. Mean change in AUA-7 score at 3 months was 7.3 in the laser arm, compared with 11.9 in the TURP arm (P < 0.05). Furthermore, substantial change was detected in both groups on the bothersome score. However, very few significant differences in SF-36 dimension scores from baseline to 3 months were detected. CONCLUSIONS: The SF-36 at both baseline and follow-up indicated a similar level of health status as that reported in the general population. Subsequently, the measure did not improve on any dimensions. Our data support the claim of some researchers that shorter disease-specific indices are vital to the evaluation of treatment regimens in clinical trials, especially when the general health of the patients is similar to that of the population.

Double-Blind Method↗
PubMed1996

The Oxford Laser Prostate Trial: economic issues surrounding contact laser prostatectomy.

OBJECTIVE: To compare the economic implications of transurethral resection of the prostate (TURP) and contact-laser vaporization of the prostate (with the SLT system) using data obtained from a randomized controlled trial. METHODS: All aspects of management before, during and after surgery on 102 patients, followed up for 3 months, were costed and analysed. Based on the data from the trial, the mean costs were calculated. A sensitivity analysis was then performed to examine the effect of changes in some of the relevant variables. The mean difference in cost between laser treatment and TURP was plotted against the cost of laser consumables, assuming a 5% re-operation rate for both operations at 5 years and a 5% discount rate. A range of laser re-operation rates was compared with the mean difference in costs, assuming a hospital stay of one night and two district-nurse visits. Other assumptions on discounts and re-operation rates, based on collected data, were also tested. RESULTS: TURP will remain more economical until the cost of laser consumables is reduced to 20% of the current list price, or a hospital stay of one night is introduced. CONCLUSIONS: The costs of contact-laser vaporization of the prostate are likely to exceed the costs of TURP unless laser treatment is accompanied by a more active approach to post-operative management, including a hospital stay of one night and, if necessary, the removal of the patient's catheter at home by a district nurse.

Costs and Cost Analysis↗
PubMed1996

The Oxford Laser Prostate Trial: a double-blind randomized controlled trial of contact vaporization of the prostate against transurethral resection; preliminary results.

OBJECTIVE: To compare the results of contact laser vaporization and transurethral resection of the prostate (TURP) in a double-blind randomized controlled clinical trial. PATIENTS AND METHODS: The study comprised 148 patients with clinical benign prostatic hypertrophy (BPH) who were recruited and allocated randomly to undergo either TURP (72 patients) or laser ablation of the prostate (76 patients). The outcome was assessed using the American Urological Association (AUA -7) symptom score after 1 and 3 months as the primary measure and by urinary flow rates, haematological factors and the duration of hospital stay and length of catheterization. RESULTS: With 90% statistical power, the results at 3 months showed no clinical or statistical difference between the treatments in change in AUA symptom score. A lower blood loss, hospital stay and duration of catheterization significantly favoured the laser treatment, although the failure rate of trial without catheter and the rate of re-operation were higher after laser treatment. CONCLUSIONS: These early data are encouraging for this technique, although the outcome after one year requires evaluation before advocating the widespread uptake of this method.

Aged↗