Advanced Chronic Kidney Disease Units in Spain: a national survey on standards of structure, resources, results and patient safety. / Unidades de Enfermedad Renal Crónica Avanzada en España: una encuesta nacional sobre los estándares de estructura, recursos, resultados y seguridad del paciente.

BACKGROUND AND OBJECTIVE: Recently, the Advanced Chronic Kidney Disease Units (UERCA, in Spanish) have been developed in Spain to offer a better quality of life to patients with advanced chronic kidney disease (ACKD), improving their survival and reducing morbidity in this phase of the disease. Nowadays, there is not much evidence in the Spanish and international literature regarding the structure and how to achieve these objectives in the UERCA. From the ERCA working group of the Spanish Society of Nephrology (SEN), this project is promoted to improve care for ERCA patients through the definition of quality standards for the operation of the UERCA. MATERIAL AND METHODS: An initial proposal for quality standards concerning the operation of the UERCA was configured through consultation with the main sources of references and the advice of an expert working group through face-to-face and telematic meetings. Base on this initial proposal of standards, a survey was conducted and sent it via email to 121 nephrology specialist and nursing professionals with experience in Spanish UERCA to find out, among others, the suitability of each standards, that is, its mandatory nature or recommendation as standards. The access to the survey was allowed between July 16th, 2018, until September 26th, 2018. RESULTS: A total of 95 (78.5%) professionals participated out of the 121 who were invited to participate. Of these, 80 of the participants were nephrology specialists and 15 nursing professionals, obtaining a varied representation of professionals from the Spanish geography. After analyzing the opinions of these participants, the standards were defined to a total of 68, 37 of them (54.4%) mandatory and 31 of them (45.5%) recommended. Besides, it was observed that the volume of patients attended in the UERCA is usually above 100 patients, and the referral criteria is generally below 25-29 mL/min/1.73 m2 of glomerular filtration. CONCLUSIONS: This work constitutes a first proposal of quality standards for the operation of UERCA in Spain. The definition of these standards has made it possible to establish the bases for the standardization of the organization of UERCA, and to subsequently work on the configuration of a standards manual for the accreditation of ERCA Units.

Urological surgery during SARS-CoV-2 pandemic. Descriptive analysis of the experience in a Urology Department across the pandemic phases. / Cirugía urológica durante la pandemia por SARS-CoV-2. Análisis descriptivo de la experiencia en un Servicio de Urología durante distintas fases epidemiológicas.

INTRODUCTION: The SARS-CoV-2 pandemic has changed the urological practice around the world. Our objective is to describe the outcomes presented by patients undergoing surgery in the urology department of a tertiary hospital, across the pandemic phases. METHODS: Observational, cohort study including all patients undergoing surgery from March 1 to May 14. According to the hospital organization, we identified three periods: there were no changes during the first two weeks (1st. period), the following seven weeks, when only urgent interventions were carried out after performance of nasopharyngeal swab test (2nd. period), and finally, elective surgery was resumed on May 4, after the implementation of a multidisciplinary screening protocol (3rd. period). Demographic, baseline, surgical and perioperative variables, as well as postoperative outcomes, were obtained in a retrospective (periods 1 and 2) and prospective (period 3) manner. Telephone follow-up was initiated at least 3 weeks after hospital discharge. RESULTS: 103 urological surgeries were performed, and 11 patients were diagnosed with COVID-19, 8 of them within the 1st. PERIOD: The diagnosis was already known in 1 patient, while the other 10 developed the disease in an average of 25 days after the intervention and 16,6 days after discharge. Of seven transplant patients, four got the infection. Three deaths were recorded due to the disease: a 69-year-old woman transplanted and two men over 80 with comorbidities and high anesthetic risk who underwent drainage of retroperitoneal abscess and retrograde intrarenal surgery, respectively. CONCLUSIONS: SARS-CoV-2 infection mainly affected renal transplant recipients or elderly patients with high anesthetic risk, during the first 2 weeks of the pandemic. After implementing preoperative PCR tests and a comprehensive screening protocol, cases were substantially reduced, and safe surgical procedures were achieved.

[COVID-19 Pandemic: Impact and rapid reaction of Urology]. / Pandemia COVID-19: impacto y reacción rápida de la Urología.

The COVID-19 pandemic caused by the SARS-CoV-2 virus has caused tens of thousands of deaths in Spain and has managed to breakdown the healthcare system hospitals in the Community of Madrid, largely due to its tendency to cause severe pneumonia, requiring ventilatory support. This fact has caused our center to collapse, with 130% of its beds occupied by COVID-19 patients, thus causing the absolute cessation of activity of the urology service, the practical disappearance of resident training programs, and the incorporation of a good part of the urology staff into the group of medical personnel attending these patients. In order to recover from this extraordinary level of suspended activity, we will be obliged to prioritize pathologies based on purely clinical criteria, for which tables including the relevance of each pathology within each area of urology are being proposed. Technology tools such as online training courses or surgical simulators may be convenient for the necessary reestablishment of resident education.

Supportive Care Network: Evaluation of Its Impact on the Performance of a Urology Department.

INTRODUCTION: Hospitals are dealing with patients who may have clinical discharge but cannot return to their home due to non-medical issues. MATERIAL AND METHODS: Cross-sectional analysis of all the cases referred to the Integrated Care Network during the year 2016. Evaluation of waiting times, typology, reason for referral and clinical parameters. IBM SPSS 24.0 software was used for all statisticalanalyses. RESULTS: In the evaluated period, 2294 patients were discharged from our department. Of these, 55 were referred to Integrated Care Network. The mean length of hospitalization of the patients referred to the network was 20.6 ± 11.4 days, and the mean overall length of hospital stay in the period analyzed was 4.8 ± 0.9 days. The mean time between hospitalization and referral for continuing care was 10.7 ± 7.2 days. The time between referral and discharge of the hospital was 10.0 ± 8.7 days. Thirty-nine (70.9%) patients were hospitalized for oncological diseases. The most common referral was to Palliative Care units (n = 16; 29.1%). Patients referred to Palliative Care units showed the largest waiting times between the referral for the network and the hospital discharge, 12.2 ± 10.51 days. We observed 289 hospitalization days with patients who had no need of specialized urological care. DISCUSSION: In order to reduce time between referral to the network and hospital discharge, there is a need for enhanced cooperation and coordination among doctors, nurses and social workers. CONCLUSION: Early identification by physicians and nurses of patients who will require care after discharge will provide a better response from social workers and increased hospital performance.

Introdução: Os hospitais deparam-se cada vez mais com doentes que, tendo alta clínica, não têm condições de ordem não clínica para regressar imediatamente ao domicílio. Material e Métodos: Estudo transversal dos casos referenciados para a Rede Nacional de Cuidados Continuados Integrados durante o ano de 2016 no nosso Serviço de Urologia. Foram avaliados os tempos de espera, tipologia, motivo de referenciação e os parâmetros clínicos. Análise estatística realizada com recurso ao software IBM SPSS 24.0. Resultados: No período analisado, 2294 pacientes tiveram alta hospitalar no nosso serviço. Destes, 55 foram referenciados para a Rede Nacional de Cuidados Continuados Integrados. O tempo médio de internamento dos pacientes referenciados foi de 20,6 ± 11,4 dias enquanto o tempo médio global de internamento foi de 4,8 ± 0,9 dias. O tempo médio entre o internamento e a referenciação para a Rede Nacional de Cuidados Continuados Integrados foi de 10,7 ± 7,2 dias. O tempo entre a referenciação e a alta hospitalar foi de 10,0 ± 8,7 dias. Trinta e nove (70,9%) pacientes foram internados por patologias oncológicas. A referenciação mais frequente foi para unidades de cuidados paliativos (n = 16; 29,1%). Os pacientes referenciados para cuidados paliativos foram os que apresentaram os maiores tempos de espera entre a referenciação e a alta hospitalar efetiva, 12,2 ± 10,51 dias. Foram despendidos 289 dias de hospitalização com pacientes que não precisavam de cuidados urológicos especializados. Discussão: Para que o tempo entre a referenciação para a Rede Nacional de Cuidados Continuados Integrados e a alta hospitalar sejam diminuídos, é necessário que haja uma otimização da cooperação e coordenação entre médicos, enfermeiros e assistentes sociais. Conclusão: A identificação precoce dos doentes que necessitarão de apoio após a alta clínica permitirá uma resposta mais atempada por parte dos assistentes sociais e uma consequente melhoria do desempenho dos serviços hospitalares e satisfação dos doentes.

A novel rapid access testicular cancer clinic: prospective evaluation after one year.

BACKGROUND: Our institution has recently developed a rapid access outpatient clinic to investigate men with testicular lumps and/or pain suspicious for testicular cancer (TCa). AIMS: To present our experience after 12 months. METHODS: All referrals to the rapid access testicular clinic (RATC) clinic were prospectively analysed from 01/01/2013 to 01/01/2014. The primary outcome variable was incidence of TCa in the referred patient cohort. Secondary outcome variables were waiting times prior to clinical review and waiting times prior to radical orchidectomy in patients diagnosed with TCa. RESULTS: Seventy-four new patients were referred to the RATC during the 1-year period and the mean age was 34 (range 15-81 years). TCa was the most common diagnosis and was found in 18 (25 %) patients. Patients diagnosed with TCa underwent radical orchidectomy, a median of 3 (range 1-5) days after their initial GP referral. Patients requiring surgical intervention for benign scrotal pathology underwent their procedure a median of 32 (range 3-61) days after their initial referral. Of the 18 patients diagnosed with TCa, 9 (50 %) were diagnosed with a seminomatous germ cell tumour on histopathology. CONCLUSION: The RATC is a new initiative in Ireland that provides expedient and definitive treatment of patients with newly diagnosed TCa. Early treatment will ultimately improve long-term prognosis in this patient cohort.

[Quality of life, psychological distress, and social outcomes after radical prostatectomy. Results from a urology competence center for rehabilitation]. / Lebensqualität, psychische Belastung und sozialmedizinisches Outcome nach radikaler Prostatektomie : Ergebnisse aus dem Urologischen Kompetenzzentrum für die Rehabilitation.

BACKGROUND: Quality of life is an important parameter for quality assurance of the results. After radical prostatectomy, quality of life is often limited. The degree of urinary incontinence correlates significantly with quality of life. RESULTS: Oncological and functional results are significantly decreased with the age of the patients. On the other hand, the psychological distress of younger patients is significantly greater than in the elderly. In the relative short period of 3-4 weeks of an inpatient rehabilitation in our urology competence center for rehabilitation, the mean decrease of urinary loss (24-h pad test) was 44.4 %. Psychological distress also decreased significantly as measured by the questionnaire on psychological distress FBK-R10 (p < 0.001). CONCLUSIONS: With this, quality of life significantly increased in all function and symptom scales of the QLQ-C30. Thus, this makes reintegration into social life easier. The return to work rate of employed persons after our specific urological rehabilitation program following radical prostatectomy was 87 %.

Evolution of primary care referrals to urology. Impact of a protocol on prostate disease and continuing education.

OBJECTIVE: To analyze the evolution of primary care referrals to the Urology Department after the implementation of a joint protocol on prostate disease and a continuing education program in our healthcare area. MATERIAL AND METHODS: In January 2011, we launched an action protocol on prostate disease, which was complemented by training sessions and an e-mail-based consultation system. We analyzed primary care referrals to the Urology Department between 2011 and 2013 and determined the reasons for the consultations and the compliance with the established criteria on prostate disease. We obtained data from the "Request for Appointment in Specialized Care" program of the Community of Madrid. We calculated the sample size with a 95% confidence level and a 50% heterogeneity. RESULTS: A total of 19,048 referrals were conducted. The most common reason for the referrals was lower urinary tract symptoms associated with benign prostate hyperplasia, with a 27% reduction and a compliance that went from 46% at 67%. Although prostate-specific antigen consultations increased by 40%, they improved their appropriateness (from 55% to 72%). This was the main type of consultation for suspicion of malignancy (30%). Also worth mentioning were female incontinence, which doubled in number, and a 41% reduction in erectile dysfunction, which could be due to the primary care training. CONCLUSIONS: The collaboration between the Department of Urology and primary care succeeded in improving the appropriateness of prostate disease referrals and modified the tendency to refer the rest of the diseases included in the project.

[Causes and factors associated with reconciliation errors in medical and surgical services]. / Causas y factores asociados a los errores de conciliación en servicios médicos y quirúrgicos.

OBJECTIVE: The objective of this study was to determine the main causes of errors of medication reconciliation at hospital admission in medical and surgical department and establish factors associated with medication reconciliation errors. MATERIAL AND METHOD: Cross-sectional study. We included all patients admitted to two services and two surgical for a month. To determine the presence of error reconciliation, the pharmacist compared the medication history interview by the order physician. The factors associated with errors were identified by multivariate logistic regression analysis. RESULTS: 221 patients were included, of which 58.4% had at least one error reconciliation. We detected 629 discrepancies, 339 (53.9%) reconciliation errors. The incidence of errors in medical services was 24.3% and in the surgical services 43.0% (p <0.001) in both groups being most prevalent error of omission (46.2% and 50.8%). Regarding factors associated, the equation determines that patients older than 65 years, polymedicated and taking oral antidiabetic are more likely to have an error with a sensibility of 75.2% and a specificity of 68.5%. CONCLUSION: There is a high rate of error reconciliation in medical and surgical patients, which confirms the need to implement a strategy to reduce these errors. Given the difficulty of applying the process to all patients, the strategy must be directed to patients who are at increased risk of error.

Objetivo: Determinar las principales causas de errores de conciliacion de la medicacion al ingreso hospitalario tanto en los servicios medicos, como en los quirurgicos y que factores se asocian a dichos errores de conciliacion. Material y método: Estudio observacional transversal. Se incluyeron todos los pacientes que ingresaron en dos servicios medicos y dos quirurgicos durante un mes. Para determinar la presencia de error de conciliacion se cotejo la historia realizada por el farmaceutico con la del medico prescriptor. Los factores asociados a los errores se identificaron mediante un analisis de regresion logistica multivariante. Resultados: Se incluyeron 221 pacientes, de los cuales el 58.4% presentaron al menos un error de conciliacion. Se detectaron un total de 629 discrepancias, 339 (53.9%) errores de conciliacion. La incidencia de errores en los servicios medicos fue del 24.3% y en los quirurgicos del 43.0% (p.

Health care service utilization among patients with bladder pain syndrome/interstitial cystitis in a single payer healthcare system.

BACKGROUND: This study aims to investigate the differences in the utilization of healthcare services between patients with bladder pain syndrome/interstitial cystitis (BPS/IC) and patients without using a population-based database in Taiwan. METHODS: This study comprised of 350 patients with BPS/IC and 1,750 age-matched controls. Healthcare resource utilization was evaluated in the one-year follow-up period as follows: number of outpatient visits and inpatient days, and the mean costs of outpatient and inpatient treatment. A multivariate regression analysis was used to evaluate the relationship between BPS/IC and total costs of health care services. RESULTS: For urological services, patients with BPS/IC had a significantly higher number of outpatient visits (2.5 vs. 0.2, p<0.001) as well as significantly higher outpatient costs ($US166 vs. $US6.8, p<0.001) than the controls. For non-urologic services, patients with BPS/IC had a significantly high number of outpatient visits (35.0 vs. 21.3, p<0.001) as well as significantly higher outpatient cots ($US912 vs. $US675, p<0.001) as compared to the controls. Overall, patients with BPS/IC had 174% more outpatient visits and 150% higher total costs than the controls. Multiple-regression-analyses also showed that the patients with BPS/IC had significantly higher total costs for all healthcare services than the controls. CONCLUSIONS: This study found that patients with BPS/IC have a significantly higher number of healthcare related visits, and have significantly higher healthcare related costs than age-matched controls. The high level of healthcare services utilization accrued with BPS/IC was not necessarily exclusive for BPS/IC, but may have also been associated with medical co-morbidities.

Evolución histórica del tratamiento de la litiasis urinaria a propósito de una experiencia de 33 años del Servicio de Urología del Hospital Militar de Santiago / Historical evolution of urinary lithiasis treatment after a 33-year experience at the Urology Department of the Santiago Military Hospital

Introducción: La litiasis urinaria es una patología que acompaña al ser humano desde sus inicios. Para el tratamiento de esta enfermedad se han desarrollado diversas técnicas que han evolucionado con la tecnología de cada época. Así hemos visto que el método de elección ha variado cíclicamente, según la efectividad y cuan invasivo sea éste. Método: Se revisaron los libros de pabellón y la base de datos de litotricias extracorpóreas (LEC) del Servicio de Urología del Hospital Militar de Santiago considerando todos los procedimientos urológicos destinados al tratamiento de la urolitiasis, durante el periodo comprendido entre julio de 1978 y diciembre de 2011.Resultados: Se obtuvo un total de 5.762 pacientes tratados por urolitiasis, marcándose en la década de 1970 una preferencia por las técnicas abiertas y posteriormente, en 1986 con la llegada de un ureteroscópio rígido 11 Fr., una preferencia por las técnicas endoscópicas. Con la llegada del primer litotritor en 1990, la litotricia extracorpórea se convierte en el tratamiento más utilizado hasta la fecha. Conclusión: Los recursos son siempre escasos, especialmente en el contexto nacional. La Litotricia extracorpórea (LEC) es un método efectivo para la gran mayoría de los cálculos urinarios, esta disponible prácticamente en cualquier lado y requiere de pocos recursos en comparación a los otros métodos. Si se dispone de todos los medios, el tratamiento más adecuado es el que el médico tratante maneja mejor, el de más fácil acceso y aquél con el cual el paciente se siente mejor servido.

Introduction: Urolithiasis is a disease that has afected humans since the beginning of time. Diferent methods have been developed to treat this a iction, which have evolved depending on the technology of the time. Thus, it has been noticed that the preferred technique has changed in a cyclic manner depending on the e¬ ectiveness and invasiveness of the procedure. Methods: Surgery records as well as the Extracorporeal Shock Wave Lithotripsy data were analyzed at the Urology department at the Santiago Military Hospital. These included all urological procedures for the treatment of urolithiasis from July 1978 through December 2011.Results: A total of 5,762 patients were treated for urolithiasis. In the 1970s open techniques were the most practiced. Later, in 1986 an 11-Fr. rigid ureteroscope arrived at the urology department, and the endoscopic methods became the most practiced for this pathology. Along with the arrival of the first lithotripter in 1990, the extracorporeal shock wave lithotripsy becomes the most popular treatment for urinary calculi up to date. Conclusion: Economic resources are always limited, especially in Chile. Ergo, the extracorporeal shock wave lithotripsy is an efective therapy for most urinary calculi, it is easily available and is less expensive compared to other therapies. If all means are available, then the best treatment for urolithiasis will always be the one that the urologist has more experience, the best access, and the one which the patient feels more comfortable.

The burden of specialist urologic care in abuja, federal capital city, Nigeria: a single surgeons 4-year case load.

BACKGROUND: Urologic surgery is believed to form a major part of the surgical workload in many centers but this volume of clinical workload has not been extensively reported. Abuja is Nigeria's capital with a population of about 4 million residents. There are a total of fourteen public general and specialist hospitals with 6 consultant Urologists working in only three of these hospital serving the population. It is not known what proportion of the total surgical workload in Abuja is urological. OBJECTIVE: To report a single Urologist case load in three hospitals in Abuja, Nigeria over a 4 year period. METHODS: The out-patient clinic register, the Medical Records Department register, the surgical wards register and all retrievable patients' case notes of the Urologic Surgery service of the three hospitals were reviewed for extraction of patient's demographic data and clinical records RESULTS: 2167 urological presentations were recorded within the study period. Of these there were 1903 (87.8%) adult males, 140 (6.5%) adult females,122 pediatric males (5.6%) and 2 pediatric females(0.1%) (with an age range of 18-72 years, 22-55 years, 1 month - 12 years and 11-12 years respectively). Mean ages for the adult male and female patients were 44.4 and 33.4 respectively. The mean ages for male children less than 1 year old was 6.9 months and 3.1 years for those older while the mean age the only 2 female children seen was 11 years. The commonest urologic condition seen were male factor infertility in adult males, possibly renal/ureteric calculi in adult females and communicating hydrocele in male children. CONCLUSION: A total of 2167 cases seen during the period under review by a single urologist is suggestive of a significant urology case load in Abuja. Further study is required to determine if this result is a reflection of the burden of specialist urology care in all the tertiary referral health facilities in Abuja, Nigeria's Federal Capital Territory.

[Experience of open renal trauma in a urology service]. / Experiencia de traumatismo renal abierto en un servicio de urología.

INTRODUCTION: Opened renal trauma in urban areas reaches 15 to 20% of all renal traumas. It is mainly caused by gunshot wounds or knifes. Gunshot wounds are classified as high energy trauma and are usually associated to other organ injuries. We present our experience in opened renal trauma in the last 24 months. MATERIAL AND METHODS: Retrospective study: patients with thoracic, abdominal and thoraco-abdominal trauma admitted to the emergency room between July 2009 and June 2011 were studied. Fourteen patients were identified with opened renal trauma, with diagnostic confirmation by imaging study or during surgery. RESULTS: Ages ranged from 16 to 37 years, with a mean age of 24.5 years. Thirteen patients were males. The mechanism of injury was produced by gunshot in 71% (10/14) and by knife in 29% (4/14). The opened renal traumas were classified according to the American Association for the Surgery of Trauma. Of these, 3/14 (21%) belonged to grade II, 4/14 (29%) to grade III, 4/14 (29%) to grade IV and 3/14 to grade V (21%). Fall in hematocrit ranged from 1% to 27%, with an average of 13.9%. Expectant management was done in six patients, however, this management did not take into account those surgeries performed due to non-urologic organ injuries. Six patients (42%) required nephrectomy. Thoraco-abdominal injuries were associated in 11 patients (79%). CONCLUSIONS: Despite the low incidence of opened renal trauma, many patients are observed when other national reports are considered, probably due to the socio-cultural characteristics of this hospital.

[Pelvic organ prolapse and lower urinary tract symptoms: experience from a high-volume uro-gynecologic center]. / Prolasso degli organi pelvici e sintomi del basso tratto urinario: esperienza di un centro uro-ginecologico ad alto volume.

BACKGROUND: Female pelvic organ prolapse (POP) is a common condition that often leads to lower urinary tract symptoms (LUTS) and may require surgical intervention to alleviate those symptoms. However, the relationship between LUTS and pelvic organ descent however, remains unclear. The aim of this paper is to determine the correlation between LUTS and POP and changes after POP repair. METHODS: We retrospectively review female patients who attended our tertiary high- volume centre center for LUTS and POP, and underwent integral pelvic floor reconstruction. RESULTS: An overall of 256 patients presented with POP and LUTS and underwent POP repair. Most of 50% of patients reported two or more symptoms and only 4.2% were asymptomatic for LUTS. 189/256 (73.8%) patients had voiding symptoms and 39 a urodynamic detrusor overactivity. Thirteen suffered from hydronephrosis. 148/256 (57.8%) showed a stress urinary incontinence. All the patients underwent POP repair with or without contemporary anti- incontinence procedure. CONCLUSIONS: Urologists and gynaecologists should recognisebe aware of the high frequency of the POP and LUTS association of POP and LUTS. POP repair my restore a normal situation but symptoms may last after the surgery or develop "de novo."

The one-stop clinic as the standard of out-patient care in a hospital urology department

PURPOSE: To evaluate the performance of a 'one-stop' clinic in terms of proportion of discharges or inclusion in surgical waiting lists. MATERIALS AND METHODS: All patients were referred from primary care facilities (population 220.646) and from different departments in the hospital. Eight senior urologists, two registered nurses and two nurse attendants participated in the experience. Prior to the start of the project, referral protocols had been agreed with the primary care physicians involved. Compliance with the protocols was periodically tested. Eventually 5537 first visits (January-December 2009) where evaluable. RESULTS: Overall, the 'one-stop' format proved feasible in 74.2 percent of the patients (4108/5537). Patients, who successfully used the 'one-stop' format, were significantly younger than those who required additional consultations (43 vs 50 years old, respectively, Student's t test < 0.001). For obvious reasons the 'one-stop' format was universally possible in male sterilization and penile phimosis patients. Similarly, the 'one-stop' policy was applied in most consultations due to male sexual dysfunction (75 percent) and urinary tract infection (73 percent). Other health problems, such as haematuria (62 percent) and renal colic (46 percent), required more than one visit so that care of the patient reverted to the traditional, outpatient care model. CONCLUSION: A 'one-stop' philosophy is feasible for a number of procedures in a urological outpatient clinic. The costs to implement such an approach would be limited to managerial expenditure.

[Fourteen-year attitude survey on cancer disclosure to new outpatients of urology department].

PURPOSE: To investigate if timing of first visit, ages, sex, family history of cancer, and smoking history would cause any differences in patients' attitude toward cancer disclosure. SUBJECTS AND METHODS: Subjects were 10,552 patients who first visited Urology Department of Nihonkai Hospital between 1993 and 2007, and were asked to fill in the questionnaire. The questionnaire contents are as follows: "If you were diagnosed as having cancer, would you like to be informed about the diagnosis of your disease?", and "If your families were diagnosed as having cancer, would you like to inform them about the diagnosis of their disease?". The subjects were asked to select their answers from the following options: (1) "fully informed", (2) "informed only when it is curable", (3) "not informed", and (4) "can not decide now". The relation of patients' attitude toward cancer disclosure with the timing of first visit, ages, sex, family history of cancer, and smoking history was investigated. RESULTS: The response rate was approximately 80%. If the subjects would have cancer, 71.5% preferred to be informed ("fully informed" or "informed if it is curable"), and 9.2% did not. If the subjects' family would have cancer, 55.5% preferred their family to be informed ("fully informed" or "informed if it is curable"), and 14.9% did not. As it became more recent, both the rate of subjects who did not prefer to be informed (11.5% in 1993-1995, and 8.0% in 2005-2007) and the rate of those who did not prefer their family to be informed (18.6% in 1993-1995, and 11.0% in 2005-2007) decreased. Young subjects, men, and smokers more preferred to be informed. The subjects who had family history of cancer more preferred to inform them, but less to inform their family. CONCLUSIONS: As it became more recent, both the subjects who did not prefer to be informed and those who did not prefer their family to be informed decreased. The idea that cancer disclosure was necessary to select the treatment methods based on each patient's preference and decision had been pervasive.

[The current state of the art of chemotherapy of penile cancer: results of a nationwide survey of German clinics]. / Die aktuelle Situation der Chemotherapie des Peniskarzinoms : Ergebnisse einer deutschlandweiten Klinikumfrage.

INTRODUCTION: The prognosis for advanced penile carcinomas is extremely poor. Due to the low response rates and relevant side effects of current chemotherapy regimens, several attempts have been made to improve chemotherapy in recent years. In a retrospective survey the current state of the art of chemotherapy for penile carcinoma in Germany was analysed. METHODS: The study took the form of a retrospective survey among all urological departments in Germany. The questionnaire contained seven questions concerning indications and modalities for chemotherapy of penile carcinoma in addition to general questions. RESULTS: Out of 280 departments 129 (46%) returned an answered questionnaire. Chemotherapy was reported to be carried out by 91 of the answering departments and overall 18 different chemotherapy regimens were used. The regimens cisplatin/methotrexate/bleomycin, vinblastin/methotrexate/bleomycin and cisplatin/5FU were the most frequently reported. Chemotherapy was carried out on average 2.3 times per year per department. The majority of the departments reported response rates under 30%. Finally 101 of the answering departments confirmed the necessity of new chemotherapy regimens. CONCLUSIONS: The current state of the art for chemotherapy of penile carcinoma showed a very large variation in Germany. The response rates were disappointing. A nationwide study with new chemotherapy approaches is urgently needed (information under www.uni-rostock.de/peniskarzinom).

Assessing the feasibility of a one-stop approach to diagnosis for urological patients.

INTRODUCTION: Conventional publicly funded out-patient services in many specialties are characterised by delays, fragmented diagnostic processes, and overloaded clinics. This is bad for patients as it is clinically dangerous; bad for managers who spend hours managing the failure; bad for doctors who respond by overloading clinics; and bad for purchasers who have to fund the multiple out-patient visits needed. Sound clinical and financial reasons exist for introducing more efficient diagnostic processes. PATIENTS AND METHODS: A total of 330 consecutive patients referred to the urology department of Guy's and St Thomas' NHS Foundation Trust were invited to attend one of nine one-stop clinics staffed by consultant urologists with specialist registrars, nurses, and clerical staff. Pre-clinic blood and urine tests were ordered based on the referral letter. Clinics had facilities to perform cystoscopy, ultrasound, and urinary flow studies. Correspondence was generated in real time, and a copy given to the patient. RESULTS: Overall, 257 patients attended the clinics. Twenty-three patients cancelled appointments and 50 patients did not attend. Pre-clinic tests were requested in 133 patients and were completed by 86% of the patients who attended. Of patients, 42% were diagnosed and discharged; 28% were listed for surgery, extracorporeal shock wave lithotripsy (ESWL), or referred to another specialty. About 30% of patients needed further out-patient review; in approximately two-thirds to complete a diagnosis and one-third to review the results of therapy initiated. An estimated 350 appointments and 550 patient visits to hospital were saved. CONCLUSIONS: A one-stop method of consultation is efficient across a range of urological presenting complaints, and dramatically reduces the need for follow-up consultations. It has potential to: (i) reduce delays to being seen in out-patients; (ii) lead to more cost-effective care; and (iii) increase safety and patient satisfaction. It should become the standard of care in urology, and is probably applicable in many other disciplines.

An audit of urology two-week wait referrals in a large teaching hospital in England.

INTRODUCTION: Two week wait referral guidelines have been published by the UK Department of Health for suspected urological cancers. Concordance to these guidelines is variable. Our objectives were to assess the incidence of urological malignancy and the proportion of inappropriate referrals in the two-week wait pathway. PATIENTS AND METHODS: Retrospective audit of all two-week wait referrals to the urology department over 6 months. Inappropriate referrals were those not satisfying the referral criteria, but referred under the two-week wait system. Detection rates were calculated for each referral criterion based on diagnosis obtained from histology, imaging reports and clinic letters. RESULTS: Incidence of cancer was 90 of 400 two-week wait referrals (23%). The cancer-detection rate based on reasons for referral ranged from 50 of 122 (41%) for elevated prostate-specific antigen levels to 2 of 56 (4%) for scrotal lumps; 42 (11%) referrals were inappropriate. CONCLUSIONS: The overall cancer-detection rate is acceptable. Most inappropriate referrals were for long-standing symptoms and non-specific testicular/scrotal symptoms. The testicular cancer detection rate raises questions about the two-week wait guidelines. Providing general practitioners with fast-track scrotal ultrasound and revising the guideline may reduce the disproportionately high number of patients referred with suspected testicular cancer. Other inappropriate referrals are a cause for concern as they add to the workload of the 'urgent-referral' pathway.