Testicular Sperm Extraction and Intracytoplasmic Sperm Injection: Outcomes in a specialist fertility centre.

Assisted reproduction with testicular sperm extraction (TESE) and intra-cytoplasmic sperm injection (ICSI) are fertility treatment options for couples with severe oligospermia or azoospermia. A retrospective review was performed of 146 TESE procedures in a specialist fertility centre in Ireland. The indication for TESE was obstructive azoospermia (OA) in 59% (n = 80) and non-obstructive azoospermia (NOA) in 41% (n = 56). Sperm retrieval rates after TESE were determined and the pregnancy rates per ICSI cycle number were evaluated. Sperm retrieval rates were 99% (n = 79/80) and 32% (n = 18/56) for OA and NOA men respectively. Fifty-eight couples proceeded to ICSI. Overall 114 ICSI cycles were performed and 33 cycles resulted in fertilisation (29%). Our sperm retrieval and pregnancy rates are consistent with international studies and support the ongoing role for TESE and ICSI as successful assisted reproductive techniques for male factor infertility in Ireland.

A rare case of recurrent urachal adenocarcinoma of the bladder.

Urachal carcinoma is a rare, aggressive malignancy accounting for less than 1% of bladder neoplasms. These tumours are usually adenocarcinomas and occur at the dome or anterior wall of the bladder. They often escape early clinical detection, growing for prolonged periods prior to diagnosis, resulting in local invasion and systemic spread before therapeutic intervention is initiated. We present the case of a recurrent urachal carcinoma in a young female.

Ureteric angioplasty balloon placement to increase localised dosage of BCG for renal pelvis TCC.

Endoscopic percutaneous resection of a renal pelvis transitional cell carcinoma (TCC) is a viable treatment option in those who would be rendered dialysis dependent following a nephroureterectomy. We report endoscopic percutaneous resection of an upper tract TCC recurrence in a single functioning kidney followed by antegrade renal pelvis BCG instillation with novel placement of inflated angioplasty balloon in the ureter to help localise its effect.

External validation of the 2007 and 2001 Partin tables in Irish prostate cancer patients.

INTRODUCTION: External validation of predictive prostate cancer nomograms is of critical importance within distinct geographical locations, prior to their institution into routine clinical practice. We performed external validation of the 2007 and 2001 Partin tables in a cohort of Irish prostate cancer patients. PATIENTS AND METHODS: Men enrolled in the Irish Prostate Cancer Research Consortium (n = 175) and who had undergone radical prostatectomy between 2004 and 2008 were used to externally validate the 2007 and 2001 Partin tables. A comparative analysis of the clinical and pathological parameters of the Irish and Partin patient cohorts was performed. The reported receiver operating characteristic (ROC) curve derived area under the curve (AUC) values were used to assess for variations in predictive accuracy. Statistical analyses were calculated with R software. RESULTS: AUC values assigned to the differentiation of extra-prostatic extension and seminal vesicle invasion using the 2007 tables are 22 and 3%, respectively. The 2007 Partin tables showed superior accuracy for all parameters, excluding seminal vesicle invasion. CONCLUSION: Cumulatively the Partin tables showed poor discriminate ability for prediction of post-radical prostatectomy pathological outcomes in Irish men, necessitating caution in their clinical utilisation.

Neo-adjuvant chemoradiotherapy in advanced rectal carcinoma: a note of caution.

Rectal cancer remains a major source of morbidity and mortality with its prognosis relating directly to the initial stage of the disease at presentation. This report highlights the potentially serious morbidity and mortality, which may be associated with neo-adjuvant chemoradiotherapy in advanced rectal cancer, emphasising the need for thorough discussion with patients on the risks and benefits of such treatment.

Perforation of a retrocaecal appendix presenting clinically as a right lumbar abscess.

Presentations of acute appendicitis represent an ongoing challenge to surgeons. This case of retrocaecal perforated appendicitis presented clinically as a right lumbar abscess, with the concomitant new diagnosis of type 2 diabetes mellitus in a 66-year-old male. This case emphasises the importance of an abdominal CT scan in any patient presenting with unusual sepsis near the abdomen.

Trends and attitudes towards paediatric circumcision in the South of Ireland.

BACKGROUND: Paediatric circumcision is one of the oldest surgical procedures performed worldwide. Traditionally performed by general surgeons, paediatric surgeons and urologists, there is a falling trend in the rate of paediatric circumcision being performed by adult and paediatric general surgeons. There is currently no corresponding contemporary data pertaining to trends and attitudes of general surgeons to paediatric circumcision in Ireland. AIM: The aim of this study was to assess the trends and attitudes of consultant general surgeons, and to assess its potential impact on the specialist delivery of paediatric urological care. METHODS: A questionnaire was mailed to all practicing general surgeons in whom we identified as having a potential role in the management of paediatric circumcision. Data pertaining to population demographics within the south of Ireland were accessed through the Central Statistics Office. RESULTS: There was an 89 % response rate to the questionnaire survey. Seventy-seven percent of those under 50 were trained in adult circumcision compared with 100 % of those respondents over 50 years. There was a significant difference in paediatric circumcision with only 24 % those under 50 performing this procedure compared with 68 % above 50 years. Eighty-six percent respondents under 45 years (35 % over 45 years) felt that this procedure should be carried out by urology. CONCLUSION: In a region with an expanding paediatric population, it is crucial to maintain paediatric urological services. Given present trends and attitudes of newer appointed general surgeons, it is essential that further specialist appointments are made, and funding directed towards demand in order to keep pace.

A rare case of minimal deviation adenocarcinoma of the uterine cervix in a renal transplant recipient.

INTRODUCTION: We report the first described case of minimal deviation adenocarcinoma of the uterine cervix in the setting of a female renal cadaveric transplant recipient. MATERIALS AND METHODS: A retrospective review of this clinical case was performed. CONCLUSION: This rare cancer represents only about 1% of all cervical adenocarcinoma.

An unusual case of cancer of the urachal remnant following repair of bladder exstrophy.

INTRODUCTION: We report the first case of cancer of the urachal remnant following repair of bladder exstrophy, in a renal transplant recipient. METHOD: A retrospective review of this clinical case and the associated literature were performed. CONCLUSION: This unusual case highlights two very rare entities. Bladder exstrophy has an incidence of 1 in 50,000 newborns, whereas urachal cancer accounts for less than 1% of all bladder tumours.

Perioperative management of chronic anticoagulation therapy in urological patients: a cross-sectional survey of practice.

BACKGROUND: There has been a significant increase in the volume of urological patients on daily anticoagulation therapy requiring invasive elective urological procedures. AIMS: We sought to assess whether urologists are familiar with appropriate perioperative management strategies in this patient cohort. METHODS: Urologists completed a questionnaire on their current management strategy for warfarin during the perioperative period in patients undergoing elective urological surgery. Eleven urological procedures graded as minor, endoscopic and major were assessed in the study. In addition, respondents were also asked whether they administered bridging therapy with heparin when warfarin was discontinued perioperatively. RESULTS: The response rate was 52.5% (210/400). Procedure grade did not influence the duration warfarin was discontinued preoperatively with respondents discontinuing the agent 4.71 ± 1.52 days (range 2-10 days) prior to minor procedures, 4.74 ± 1.43 days (range 2-10 days) prior to endoscopic procedures and 4.88 ± 1.34 days (range 2-10 days) prior to major procedures (p > 0.05). Postoperatively, procedure grade significantly affected the day to recommencement with respondents recommencing warfarin 2.41 ± 2.31 days (range 1-14 days) after minor procedures, 3.07 ± 3.52 days (range 1-28 days) after endoscopic procedures and 4.38 ± 3.53 days (range 1-14 days) after major procedures (p < 0.0001). In total, 60 ± 0.52% of the respondents who discontinued warfarin routinely administered bridging therapy with heparin perioperatively. CONCLUSIONS: Our study demonstrates variations in perioperative management practices for patients on chronic anticoagulation therapy undergoing urological procedures. Urologists should familiarise themselves with standardised guidelines if this patient subgroup are to receive optimal perioperative management.

Preliminary analysis of demographics and learning attributes of graduate entry medical students.

INTRODUCTION: Students entering university are empowered to move towards self-directed professional learning and beyond didactic tuition. Graduate entry medical (GEM) students have prior experience of this transition from pedagogical to androgogical learning. We aimed to assess the demographics and learning attributes of GEM students. METHODS: Ethical exemption was awarded. The short version of the approaches and study skills inventory for students and the learning style questionnaire were distributed to GEM students during semester 1, 2008. RESULTS: Response rate was 84% (n = 32). Fifty percent of responders had graduated in 2008 (22%) or 2007 (28%). Seventy-five percent had a background in basic science (56%) or an allied health profession (19%). The predominant learning approach is a combination of deep and strategic. The predominant learning style is reflective. CONCLUSIONS: Our preliminary analysis reveals GEM students to exhibit a mature approach to learning and the requisite learning style to achieve academic and clinical success.

Novel predictive tools for Irish radical prostatectomy pathological outcomes: development and validation.

AIMS: We developed and validated prostate cancer predictive models for Irish patients, allowing individualised predictions of radical prostatectomy pathological outcomes. METHODS: Retrospective review of the Irish Prostate Cancer Research Consortium database from 2003 to 2008 was performed. Two predictive models were formulated: a replica of the Partin tables (n = 169) and a look-up table based on PSA and biopsy Gleason Score (n = 253). Clinico-pathological parameters were compared to the Partin data set. Internal validation was performed. RESULTS: In total, 70% of patients were at clinical stage T1c. 5.8% had a PSA less than 4.1 ng/ml, whereas 25% of the Partin patients had a PSA in this range. Maximal predictive accuracy was seen for seminal vesicle invasion (area under the curve = 72%). Prediction of extra-prostatic extension and lymph node involvement was only equivalent to that of a chance phenomenon. CONCLUSIONS: Our current results do not support the introduction of the formulated predictive models into routine clinical practice.

Takayasu's arteritis: a challenging diagnosis.

The practices of medicine and surgery are inherently and irrevocably entwined. This case report highlights the need for an integrated, multi-disciplinary approach to care of the modern patient. Our patient fulfils the traditional Ishikawa's criteria and the modified Ishikawa's criteria for the clinical diagnosis of Takayasu's disease. Her case underpins the need for co-ordinated care and careful periodic review of the symptomatology and signs of the multiple clinic attendees.

Perforated retrocaecal appendix presenting as right lumbar abscess.

BACKGROUND: Acute appendicitis is common in older patients, however, the presentation may differ from the younger population and it is often complicated by coexistent disease and delays in presentation. AIMS: This case report describes an unusual presentation of acute appendicitis in an elderly patient and also demonstrates a unique anatomical pathway of disease extension. In addition, this case report highlights the advantages of CT in preoperative evaluation and subsequent management of these protean presentations of acute appendicitis. METHODS: This report describes a case of an asymptomatic retrocaecal perforated appendicitis which presented clinically as a right lumbar abscess with surrounding cellulitis, and was further complicated by a concomitant new diagnosis of type 2 diabetes mellitus in a 66-year-old male. CONCLUSION: Elderly or immunocompromised patients presenting with cellulitis or a cutaneous abscess of the abdominal wall or lumbar region may benefit from an abdominal CT to demonstrate an intraperitoneal source of sepsis.

The mortality of coke workers in Britain.

Two studies of coke workers in Britain, comprising 6,767 men, gave similar results. The proportion of lung cancer deaths was about 20% higher than in manual workers generally. The excess occurred primarily among younger men. The ratio of lung cancers to all other cancers was also higher than expected, with limited data showing no evidence of excessive tobacco consumption. Death rates from other causes were generally favorable. Overall the lung cancer death rates in oven workers were similar to those in non-oven men, but in both studies some indications of a job-specific excess were noted. These findings are compared with results from earlier studies in the United States and Canada where a much higher excess lung cancer mortality was found in oven men, particularly those with longer exposure times. We discuss possible reasons for the differences, and conclude that the results reported now contribute further evidence that exposure to coal carbonization fumes can cause lung cancer.