The use of TPA in combination with alcohol in the treatment of the recurrent complex hydrocele.

A hydrocele is an abnormal collection of serous fluid in the space between the parietal and visceral layers of the tunica vaginalis. Hydrocele is the most common cause of painless scrotal swelling which affects about 1% of men. Generally, adult hydroceles are idiopathic in origin; however, inguinal surgery, varicocelectomy, infection, trauma and a patent processus vaginalis are each associated with the subsequent development of a hydrocele. Surgical removal of hydroceles is the gold standard of care. However, multiple cases have reported high success rates (ranging from 85% to 96%) using a combination of aspiration and sclerotherapy. We present a case of a patient with recurring complex hydrocele and effective treatment utilizing a combination of thrombolytic therapy, catheter drainage and subsequent alcohol ablation.

Long-term functional outcome and satisfaction of patients with hypospadias repaired in childhood.

INTRODUCTION: Potential long-term sequelae of hypospadias and its surgical correction include difficulties in voiding, sexual function, psychosexual adjustment and self-appraisal. These difficulties often evolve long after surgical repair as children grow to adulthood. Despite this, patient-driven data on long-term functional outcomes and satisfaction are limited, leaving the true success of hypospadias surgery essentially unknown. The aim of this study was to address these deficiencies. METHODS: We conducted a chart review for all patients operated on by a single urologist from 1981 to 1988. Extensive efforts were made to obtain accurate current address information for patients. A database of patient demographics and pathology, operative details and complications was created. A 22-item questionnaire was mailed to study subjects. Telephone follow-up by an independent research nurse bolstered response rates. Responses from returned questionnaires were pooled and analyzed. RESULTS: The chart review included 115 patients. Of 100 patients (with address information) who were sent questionnaires, 28 ultimately responded. The chart review group was comparable to groups in other published studies. Despite a slightly higher initial major complication rate (57.2%), respondents reported few long-term complications (11% fistula, 29% persistent chordee and 10% stricture) and excellent urinary and sexual functional results. The most common functional complaints were spraying and hesitancy during micturition. Overall, 86% of patients were satisfied with their surgical result, and 52% wished they had been provided longer follow-up. CONCLUSION: Long-term outcomes data are critical to an honest account of success rates for hypospadias surgery. Obtaining these data remains challenging. In this series, despite high initial complication rates, most patients reported excellent long-term functional results and were quite satisfied with their overall outcome.

Abstracts presented at the American Urological Association Annual Meeting: determinants of subsequent peer reviewed publication.

PURPOSE: Abstracts submitted to medical meetings do not undergo the same critical peer review process as published manuscripts. Despite this limited scrutiny presented abstracts often influence clinical thinking and practice. Consequently the peer reviewed publication rate of abstracts becomes critical in judging the quality of this research. We determined this publication rate and factors influencing it. MATERIALS AND METHODS: All 1,584 abstracts presented at the 2000 American Urological Association Annual Meeting were reviewed and assessed for subsequent publication with a fixed MEDLINE search protocol. We searched for publications from January 1, 1999 to May 31, 2005. Abstracts were deemed published if 1) at least 1 author of the presented abstract was a manuscript author and 2) at least 1 conclusion in the presented abstract was included in the final publication conclusions. Publication rates according to mode and topic of presentation, country or state of origin and time to publication were calculated. Journal impact factors for publications were compared according to these variables. RESULTS: Of presented abstracts from the 2000 American Urological Association meeting 55% went on to successful publication, including 59% of podium, 55% of poster, 55% of unmoderated poster and 42% of video presentations. Mean time from presentation to publication was 17 months. The average journal impact factor was 3.2. CONCLUSIONS: A significant proportion of presentations at the American Urological Association Annual Meeting is never subjected to or fails the critical peer review process. The overall journal impact factor for published manuscripts is modest. Meeting attendees should consider these observations when deciding whether to incorporate the findings of presentations into their clinical practice.