British Association of Urological Surgeons' suprapubic catheter practice guidelines.

UNLABELLED: What's known on the subject? and What does the study add? The suprapubic catheter (SPC) is a useful and widely used tool in urological practice. However, complications can arise from its insertion or ongoing care. Currently there are no guidelines relating to SPC usage. This study has reviewed the available clinical evidence relating to SPC usage. Where this is lacking, expert opinion has been sought. Guidelines are suggested to help maximise safety and ensure best practice in relation to SPC usage. OBJECTIVE: To report the British Association of Urological Surgeons' guidelines on the indications for, safe insertion of, and subsequent care for suprapubic catheters. METHODS: A comprehensive literature search was conducted to identify the evidence base. This was reviewed by a guideline development group (GDG), who then drew up the recommendations. Where there was no supporting evidence expert opinion of the GDG and a wider body of consultees was used. RESULTS: Suprapubic catheterisation is widely used, and generally considered a safe procedure. There is however a small risk of serious complications. Whilst the evidence base is small, the GDG has produced a consensus statement on SPC use with the aim of minimising risks and establishing best practice (Table 1). It should be of relevance to all those involved in the insertion and care of suprapubic catheters. Given the paucity of evidence, areas for future research and development are also highlighted. This review has been commissioned and approved by BAUS and the Section of Female, Neurological and Urodynamic Urology. [Table: see text] CONCLUSIONS: It is hoped that these guidelines will assist in minimising morbidity associated with SPC usage.

Differences in side-effect duration and related bother levels between phosphodiesterase type 5 inhibitors.

OBJECTIVE: To assess whether the longer half-life of tadalafil is associated with longer lasting or more severe side-effects than the other phosphodiesterase type 5 inhibitors (PDE-5Is), as clinical trials have shown that the efficacy and safety of the three available are similar, but tadalafil has a half-life four times longer than the other two drugs. PATIENTS AND METHODS: Treatment-naive men beginning PDE5-I therapy were recruited from a specialist clinic. Data on the type and duration of drug-associated side-effects were collected prospectively. Levels of bother were assessed with a visual analogue scale (VAS). Differences in type, duration and bother of side-effect were compared between drugs. RESULTS: In all, 409 men provided data; there were no differences between drugs in the proportion of men responding, or the overall prevalence of side-effects. The mean duration of side-effects with tadalafil was 14.9 h, compared to 3.9 and 7.7 h for sildenafil and vardenafil. Of men taking tadalafil, 30% had side-effects lasting >12 h. There were no differences in mean VAS scores between the drugs. Individual side-effects caused similar levels of bother, except for facial flushing, which was less bothersome. CONCLUSIONS: Men taking tadalafil are at risk of prolonged side-effects, although levels of bother associated with these side-effects are not significantly greater than those seen with short-acting PDE5-Is.

Extracorporeal shockwave therapy for Peyronie's disease: who benefits?

BACKGROUND AND PURPOSE: Extracorporeal shockwave therapy (ESWT) has been reported to improve the symptoms of Peyronie's disease. However, the response rates to this treatment appear to be variable. This study aimed to determine whether any patient or plaque characteristics are associated with a better outcome. PATIENTS AND METHODS: A series of 36 patients with Peyronie's disease received ESWT as a primary treatment. Subjective response rates were compared on the basis of patient age, degree of pretreatment penile curvature, predisposing medical factors, duration of disease, and extent of plaque calcification. RESULTS: Ten men (27.8%) reported subjective improvements in curvature after ESWT. Of the factors considered, only age and pretreatment curvature influenced outcomes: 50% of the men below the mean age reported improvement compared with 5.6% of older men and 62.5% of men with mild curvature reported improvement compared with 8.3% of those with severe curvature. CONCLUSION: The response to EWST is not the same for all men with Peyronie's disease. Younger men and those with milder curvature have the best outcomes.

Laparoscopic nephrectomy for renal-cell carcinoma during pregnancy.

Renal-cell carcinoma (RCC) during pregnancy is rare. Laparoscopic nephrectomy has been used effectively and safely in nonpregnant patients with RCC. We report a case of a 34-year-old pregnant woman with RCC, which we believe to be the first such case to be managed by laparoscopic nephrectomy.

The pattern and progression of lower urinary tract symptoms after transurethral prostatectomy compared with those seen in the general population.

OBJECTIVES: Men undergoing transurethral prostatectomy (TURP) often have some level of residual symptoms after this operation. Reliance on symptom scores to assess outcomes means there is relatively little information on the exact pattern of such symptoms. The aim of this study was to describe the pattern, progression, and associated bother of lower urinary tract symptoms after TURP. METHODS: Detailed information on urinary symptoms, prostatectomy status, and associated bother was obtained from a randomly selected sample of community-dwelling men by using a postal questionnaire. Rates of individual urinary symptoms in the postprostatectomy population were calculated, and compared with those in the background population and those in secondary care. RESULTS: Of 7640 men who responded, 422 had undergone prostatectomy. Symptom levels remained significantly higher in the postoperative group than the background population, with 19.4% experiencing four or more symptoms on a weekly basis. The pattern of symptoms was similar to that seen in the general population. Men in the post-TURP group experienced greater levels of bother when symptom level (odds ratio: 2.69; 95%CI, 1.80-4.01) was controlled. Both symptom and bother, however, were significantly lower than those in people referred for secondary care treatment of their symptoms. CONCLUSIONS: Men with a previous prostatectomy still report high levels of urinary symptoms and appear to experience greater levels of bother from these symptoms than men in the general population.

Lower urinary tract symptoms and related help-seeking behaviour in South Asian men living in the UK.

OBJECTIVE: To describe the pattern and prevalence of lower urinary tract symptoms (LUTS) and related help-seeking behaviour in men of South Asian origin living in the UK, and to compare this to the white population. SUBJECTS AND METHODS: Data were obtained as part of the Leicestershire MRC Incontinence Study. Community-dwelling men aged >40 years were sent a postal questionnaire addressing urinary symptoms, bother and help-seeking. Prevalence rates of self-reported LUTS were compared on the basis of the Office of Population Censuses and Surveys ethnic classifications. Logistic regression was used to estimate the relative risk of symptoms between groups. Data from 7810 men were included in the analysis. RESULTS: In all, 409 (5.3%) of the population sample described themselves as Asian; 36.5% of these men described at least one significant LUTS, vs 29.0% of white men. The overall prevalence rates for all storage symptoms were significantly higher in Asian men. Straining to void was the only voiding symptom to show a difference in prevalence between the groups. However, when controlling for age, Asian men were at greater risk for all symptoms except a weak urinary stream. Reported levels of bother and felt need were the same in both population groups, but actual help-seeking was significantly less in the Asian group. Only 25.0% of Asian men had actively sought help, compared to 53.1% of white men. CONCLUSION: South Asian men in the UK have a higher risk of experiencing LUTS than white men from the same population. This increase in risk is greatest for storage symptoms. Although levels of bother are the same, South Asian men are less likely to seek help for their symptoms.