British Journal of Medical & Surgical Urology

Editorial Board

2012-05-01

Bipolar transurethral resection of prostate: Current status in the management of bladder outflow obstruction

M. Bolgeri, S. Naji, A. Sahai, F. Anjum, S. Madaan, S. Sriprasad, I. Dickinson — 2011-07-21

Summary: Monopolar transurethral resection of prostate has been the preferred surgical treatment of benign prostatic hyperplasia. Even in modern series there are significant risks such as haemorrhage requiring transfusion and TUR syndrome, although their incidence is lower than previously. Over the last decade or so newer technologies have emerged that have proven to be at least equivalent to monopolar TURP. Bipolar transurethral resection of the prostate in normal saline is a potentially safer option to monopolar resection but with equivalent efficacy in the medium term. This is supported by 2 recent meta-analyses. This review describes the technology, efficacy and safety profile of bipolar transurethral resection of the prostate.

Standing on the shoulders of giants: 3. John Wickham based on an interview 7/11/2009

Dominic Hodgson — 2011-09-28

John Wickham is British Urology's great innovator, whose desire to make surgery less invasive was a constant throughout his working life and crossed specialty boundaries.

Relationship between chronic inflammation at prostate biopsy and transition zone prostate volume enlargement in a prospectively UK screened population

Samarth Chopra, Edward Rowe, Marc Laniado, Marjorie Walker — 2011-11-07

Summary: Objective: The aim of this study was to evaluate the relationship between histological prostatic inflammation and prostate volume at the time of prostate biopsy.Patients and methods: From a prospective prostate cancer screening study, 137 men aged 50–65 years, underwent prostate biopsies negative for cancer, forming the study population. Biopsy criteria were prostate specific antigen (PSA) >4ng/ml (n=40), or between 1.1 and 4ng/ml with a percent free PSA (%fPSA) <25% (n=97). Total gland (TG) and transition zone (TZ) volumes were measured prior to TRUS guided biopsy. Histological classification included chronic inflammation (CI-lymphocyte predominant), active inflammation (AI-neutrophil predominant), and benign prostatic tissue (BPT-no inflammatory cells). A logistic regression analysis was performed using age, TPSA, %fPSA, histology, TZ and TG volume, TZ/TG ratio, PSA density, and transition zone PSA density as continuous variables. We also mailed validated self-administered symptom scores to men in the three histological subgroups (men without cancer) at a median of follow up of 6.5 years (range 5.9–7.1 years) after screening and biopsy.Results: Histological chronic inflammation (n=78, 57%) at biopsy was associated with a larger mean TG volume (30.8cc) than active inflammation (n=7, 22.7cc) and benign prostatic tissue (n=52, 25.9cc). On bivariate analysis, chronic inflammation was associated with greater TZ volume (p=0.0015) and TZ/TG ratio (p=0.0008). On multivariate analysis, chronic inflammation was the only independent variable associated with a greater ratio of the TZ to TG volume (odds ratio 478, p=0.005). IPPS symptoms scores were completed and returned by 88 men (66% compliance). In men with chronic inflammation (49), active inflammation (5), and benign tissue (30), the mean IPSS scores were 10.9, 7.2, and 8.7, respectively. These differences did not reach statistical significance p>0.05.Conclusions: In this younger screened population, chronic inflammation was associated with greater prostate gland volume secondary to transition zone volume enlargement. Further research is needed to establish a causally related link for this observation.

A simplified WHO checklist improves compliance and time efficiency for urological surgery

John Henderson, Timothy Fung, Jaimin Bhatt, Amarjit Bdesha — 2011-09-19

Abstract: Objective: A surgical safety checklist has been introduced throughout the UK in response to evidence that its use decreases surgical morbidity and mortality. The adaptation of this has resulted in a lengthy checklist which may be used improperly. We audited the existing and a new simplified checklist with regards to compliance, time-efficiency and relevant safety outcomes.Materials and methods: One hundred operations were observed. Fifty of these cases used the existing 14-question Briefing/Debriefing (BD) and 31-question Sign-in, Time-out and Sign-Out (STS) checklist. The subsequent 50 used a simplified 10-question BD and STS checklist. Percentage compliance, median time taken and relevant safety outcomes were recorded.Results: The median time for the BD questions decreased from 150 to 90s and the STS questions from 88 to 49s (p<0.05). The compliance improved from 68% to 73% (p=0.49) for BD questions and 53% to 92% (p<0.05) for STS questions. A clearer phrasing of the antibiotic check question in the revised checklist resulted in no administration of incorrect antibiotics.Conclusion: The nuclear and airline industries have used checklists for many years and observed that long and exhaustive checklists were often used improperly or disregarded completely. We demonstrate that a redesigned, simplified checklist improves time-efficiency and compliance with improved safety outcomes.

Patient selection for prostate biopsy: Risk-based or PSA-based?

2011-10-17

Summary: Aim: The AUA Best Practice Statement on PSA advocates a risk-based approach to selecting men for biopsy, based not on a PSA threshold, but on the risk of finding cancer on biopsy. We have therefore studied the association between candidate risk factors and prostate biopsy results.Method: All patients who underwent a prostate biopsy within the Epsom and St Helier NHS Trust between July 2005 and July 2007 were identified. Those with a serum PSA value of <15.0ng/ml were selected for inclusion. Univariate and multivariate logistic regression analysis was done to analyse risk factors for the presence of cancer, and of significant cancer, on biopsy. Significant prostate cancer on biopsy was arbitrarily defined as either a Gleason score of 7 or more, or the presence of cancer in 50% or more of the cores.Results: Of 400 cases, 153 (38%) were found to have prostate cancer on biopsy, of which 93 were classed as significant. On multivariate analysis, smaller prostate volume, abnormal DRE, PSA level and absence of previous negative biopsy were independent predictors of significant prostate cancer. The multivariate logistic regression results were used to create a predictive nomogram for significant cancer.Conclusion: The PSA level is merely one of several factors that predict biopsy results. A risk-based, rather than a PSA-based, approach to selecting men for prostate biopsy has the potential to both reduce the number of men undergoing biopsy, and increase the detection of significant cancers.

Emphysematous prostatitis

J.L. Douglas-Moore, L.J. Turnbull, M. Moazzam, A.T.F. Lee, A.M. Peracha — 2011-07-13

Few cases of emphysematous prostatitis with associated prostatic abscess have been reported in the literature. These have occurred exclusively in diabetic or immunocompromised patients .

Benign Schwannoma of seminal vesicle presenting as haematospermia

2011-07-21

Schwannomas (also known as neurilemmomas) are benign tumours arising from nerve sheath cells (Schwann cells) found along peripheral nerves . Schwannoma of the seminal vesicles are extremely rare and to our knowledge only three cases have been reported in the literature. We report on a further case of this condition.

Poster Abstracts

2012-05-01

Paper Abstracts

2012-05-01

Acute loin pain: Stones, scopes, shocks and stents

Daron Smith — 2012-03-14

Stone disease represents a significant part of a urology department's workload, particularly within an urgent or emergency setting. This article reviews some of the considerations in the diagnosis and early decision making in the management of these patients, including the need for ureteroscopic intervention and some issues associated with JJ stent drainage.