'I Did No Harm': Compliance with GMC Guidelines for the Use of a Chaperone in Urology Outpatient Clinic.

OBJECTIVE: To assess the performance of our urology team against GMC guidelines for using chaperone during intimate clinical examination. BACKGROUND DATA: intimate physical examination is an integral part of our urological practice. There is a paucity of literature regarding the use of chaperones among urologists. Given the importance of this topic for both patient safety and providing support for the urologist, we decided to assess our performance as per the GMC guidelines for good medical practice. METHODS: We completed an audit loop to evaluate the performance of 12 members in our urology team as regards compliance with GMC guidance for the documentation of chaperone use in urology clinic. Based on our scoring system, we objectively assessed both overall team performance as well as individual scores for documenting chaperone use. RESULTS: There was a significant improvement in the overall documentation rate in both clinical notes (+9.85%) and clinic letters (+36.65%). Raising awareness among team members managed to increase the individual performance scores as well. CONCLUSION: This is the first report using a scoring system for objective assessment of a pertinent topic such as the use of chaperone and its documentation. This managed to achieve a significant improvement in our practice.

Isolated scalp nodule in patient with undiagnosed RCC.

An unexpected diagnosis of metastatic RCC after excision biopsy of a skin nodule can bring uncertainty. A case of isolated scalp metastasis from undiagnosed RCC was noted and a review of the literature was undertaken to aid management. RCCs often present with distant disease involving multiple organ systems. Single metastasis to the scalp region without other organ involvement is uncommon. Cytoreductive nephrectomy and limited metastectomy offer survival advantage in physically fit patients with RCC.

Metastatic malignant melanoma of the urinary bladder: Case report and literature review.

Metastatic malignant melanoma of the urinary bladder is a rare clinical finding suggestive of advanced disease. Only 17 cases have been described in the English literature. We present a case of an 84-year-old male who was referred to the urology department with the incidental finding of bladder metastases on computed tomography (CT) one year following the diagnosis of malignant melanoma of the skin. Herein, we will discuss epidemiology, prognosis, and management options of metastatic malignant melanoma based on literature review.

Transurethral prostate resection and bleeding: a randomized, placebo controlled trial of role of finasteride for decreasing operative blood loss.

PURPOSE: Bleeding associated with transurethral prostate resection can often be significant and lead to increased morbidity and occasionally mortality. It has been shown that finasteride decreases bleeding in patients with hematuria of prostatic origin. We hypothesized that bleeding in patients undergoing transurethral prostate resection could be decreased by giving finasteride for 2 weeks before surgery. MATERIALS AND METHODS: A total 70 patients scheduled to undergo elective transurethral prostate resection were randomized to receive 5 mg. finasteride daily or placebo for 2 weeks before surgery. Serum hemoglobin was measured before and after surgery, and the following day. The volume of irrigation fluid used and its hemoglobin concentration as well as resected prostate weight were recorded. RESULTS: Of the 68 patients who underwent transurethral prostate resection 2 were withdrawn before surgery, and so 32 received finasteride and 36 received placebo. There was significantly less mean blood loss in irrigation fluid in the finasteride group than in the control group (43.6 versus 69.3 gm. hemoglobin, p = 0.011). The mean difference was more significant when blood loss per gm. resected prostate was calculated (2.65 versus 4.65 gm. hemoglobin per gm. prostate, p < 0.01). CONCLUSIONS: This study shows that finasteride given for 2 weeks preoperatively decreases bleeding in patients undergoing transurethral prostate resection. Further study is required to determine the optimal timing and dose duration to minimize blood loss and identify how relevant such a decrease in bleeding is in clinical practice.