HIITing the brain with exercise: mechanisms, consequences and practical recommendations.

The increasing number of older adults has seen a corresponding growth in those affected by neurovascular diseases, including stroke and dementia. Since cures are currently unavailable, major efforts in improving brain health need to focus on prevention, with emphasis on modifiable risk factors such as promoting physical activity. Moderate-intensity continuous training (MICT) paradigms have been shown to confer vascular benefits translating into improved musculoskeletal, cardiopulmonary and cerebrovascular function. However, the time commitment associated with MICT is a potential barrier to participation, and high-intensity interval training (HIIT) has since emerged as a more time-efficient mode of exercise that can promote similar if not indeed superior improvements in cardiorespiratory fitness for a given training volume and further promote vascular adaptation. However, randomised controlled trials (RCTs) investigating the impact of HIIT on the brain are surprisingly limited. The present review outlines how the HIIT paradigm has evolved from a historical perspective and describes the established physiological changes including its mechanistic bases. Given the dearth of RCTs, the vascular benefits of MICT are discussed with a focus on the translational neuroprotective benefits including their mechanistic bases that could be further potentiated through HIIT. Safety implications are highlighted and components of an optimal HIIT intervention are discussed including practical recommendations. Finally, statistical effect sizes have been calculated to allow prospective research to be appropriately powered and optimise the potential for detecting treatment effects. Future RCTs that focus on the potential clinical benefits of HIIT are encouraged given the prevalence of cognitive decline in an ever-ageing population.

Emergency Management of Priapism in the United Kingdom: A Survey of Current Practice.

BACKGROUND: Despite its importance, current practice in the emergency management of priapism in the United Kingdom is unknown. AIM: To evaluate current practice in the emergency management of priapism in the United Kingdom. METHODS: All "full," "associate urological specialist," and "trainee" members of the British Association of Urological Surgeons (BAUS; leading membership-based organization for practitioners of urologic surgery in the United Kingdom) were invited to participate in an online survey. Questions related to the emergency management of priapism, access to tertiary andrology services, and use of guidelines. OUTCOMES: Key outcome measures included frequency of encountered cases, access to specialist andrology support, confidence in key management steps, and use of current guidelines. RESULTS: 213 of 1,304 (16.3%) eligible members completed the survey. Most reported managing 1 case annually (median = 1, range = 0->10). Only 7.0% transferred patients to a tertiary center and 87.8% believed they could access specialist andrology advice if required. Respondents were less confident in performing intracavernosal phenylephrine instillation (88.7%) compared with corporal aspiration (98.1%), with confidence lowest among trainee members. Only 68.5% reported performing the distal shunt procedure. Of the 212 respondents that chose to answer questions relating to guidelines, only 155 (73.1%) were aware of their existence, with those published by the European Association of Urology being most popular (53.8%). 205 (96.2%) respondents expressed an interest in the development of a UK-specific guideline, with 162 of 212 (76.4%) stating they would use this in practice. CLINICAL IMPLICATIONS: Urologists in the United Kingdom support the development of UK-specific guidance on the emergency management of priapism for use within the context of the National Health Service. STRENGTHS AND LIMITATIONS: This is the first study to assess current practice in the emergency management of priapism in the United Kingdom. Its strength is that most UK urologists were invited to participate through collaboration with the BAUS. Although the response rate of 16.3% is acceptable for a national survey of this nature, responses were self-reported, rendering them susceptible to bias. CONCLUSION: This study demonstrates that some UK urologists lack confidence in key steps in the emergency management of priapism and identifies a strong level of support for the development of up-to-date UK-specific guidance. Bullock N, Steggall M, Brown G. Emergency Management of Priapism in the United Kingdom: A Survey of Current Practice. J Sex Med 2018;15:476-479.

Penile rehabilitation for postprostatectomy erectile dysfunction.

BACKGROUND: Despite efforts to preserve the neurovascular bundles with nerve-sparing surgery, erectile dysfunction remains common following radical prostatectomy. Postoperative penile rehabilitation seeks to restore erectile function but results have been conflicting. OBJECTIVES: To evaluate the effects of penile rehabilitation strategies in restoring erectile function following radical prostatectomy for prostate cancer. SEARCH METHODS: We performed a comprehensive search of multiple databases (CENTRAL, MEDLINE, Embase), the Cochrane Library, Web of Science, clinical trial registries (ClinicalTrials.gov, International Clinical Trials Registry Platform) and a grey literature repository (Grey Literature Report) from their inception through to 3 January 2018. We also searched the reference lists of other relevant publications and abstract proceedings. We applied no language restrictions. SELECTION CRITERIA: We included randomised or quasi-randomised trials with a parallel or cross-over design. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. Two review authors independently screened the literature, extracted data, assessed risk of bias and rated quality of evidence according to GRADE on a per-outcome basis. Primary outcomes were self-reported potency, erectile function measured by validated questionnaires (with potency defined as an International Index of Erectile Function (IIEF-EF) score of 19 or greater and or an IIEF-5 of score of 17 or greater) and serious adverse events. For all quality of life assessments on a continuous scale, higher values indicated better quality of life. MAIN RESULTS: We included eight randomised controlled trials with 1699 participants across three comparisons. This abstract focuses on the primary outcomes of this review only.Scheduled phosphodiesterase type 5 inhibitors (PDE5I) versus placebo or no treatmentScheduled PDE5I may have little or no effect on short-term (up to 12 months) self-reported potency (risk ratio (RR) 1.13, 95% confidence interval (CI) 0.91 to1.41; very low quality evidence), which corresponds to 47 more men with self-reported potency per 1000 (95% CI 33 fewer to 149 more) and short-term erectile function as assessed by a validated instrument (RR 1.11, 95% CI 0.80 to 1.55; very low quality evidence), which corresponds to 28 more men per 1000 (95% CI 50 fewer to 138 more), but we are very uncertain of both of these findings. Scheduled PDE5I may result in fewer serious adverse events compared to placebo (RR 0.32, 95% CI 0.11 to 0.94; low quality evidence), though this does not appear biologically plausible and may represent a chance finding. We are also very uncertain of this finding. We found no long-term (longer than 12 months) data for any of the three primary outcomes.Scheduled PDE5I versus on-demand PDE5I Daily PDE5I appears to result in little to no difference in both short-term and long-term (greater than 12 months) self-reported potency (short term: RR 0.97, 95% CI 0.62 to 1.53; long term: RR 1.00, 95% CI 0.60 to 1.67; both very low quality evidence); this corresponds to nine fewer men with self-reported short-term potency per 1000 (95% CI 119 fewer to 166 more) and zero fewer men with self-reported long-term potency per 1000 (95% CI 153 fewer to 257 more). We are very uncertain of these findings. Daily PDE5I appears to result in little to no difference in short-term and long-term erectile function (short term: RR 1.00, 95% CI 0.65 to 1.55; long term; RR 0.74, 95% CI 0.48 to 1.14; both very-low quality evidence), which corresponds to zero men with short-term erectile dysfunction per 1000 (95% CI 80 fewer to 125 more) and 119 fewer men with long-term erectile dysfunction per 1000 (95% CI 239 fewer to 64 more). We are very uncertain of these findings. Scheduled PDE5I may result in little or no effects on short-term adverse events (RR 0.69 95% CI 0.12 to 4.04; very low quality evidence), which corresponds to seven fewer men with short-term serious adverse events (95% CI 18 fewer to 64 more), but we are very uncertain of these findings. We found no long-term data for serious adverse events.Scheduled PDE5I versus scheduled intraurethral prostaglandin E1At short-term follow-up, daily PDE5I may result in little or no effect on self-reported potency (RR 1.10, 95% CI 0.79, to 1.52; very low quality evidence), which corresponds to 46 more men per 1000 (95% CI 97 fewer to 241 more). Daily PDE5I may result in a small improvement of erectile function (RR 1.64, 95% CI 0.84 to 3.20; very low quality evidence), which corresponds to 92 more men per 1000 (95% CI 23 fewer to 318 more) but we are very uncertain of both these findings. We found no long-term (longer than 12 months) data for any of the three primary outcomes.We found no evidence for any other comparisons and were unable to perform any of the preplanned subgroup analyses based on nerve-sparing approach, age or baseline erectile function. AUTHORS' CONCLUSIONS: Based on mostly very-low and some low-quality evidence, penile rehabilitation strategies consisting of scheduled PDE5I use following radical prostatectomy may not promote self-reported potency and erectile function any more than on demand use.

Haematuria: from identification to treatment.

Haematuria has a prevalence of 0.1% to 2.6%. Potential diagnoses may include infection, kidney stones, trauma, exercise or spurious causes, such as foods, drugs or menstruation, and a tumour. Approximately 20% of patients with haematuria have a urological tumour, with a further 20% found to have a significant underlying pathology. Haematuria is subsequently known as the 'classic presentation' of bladder cancer with 70-80% of patients experiencing painless, gross (visible) haematuria. However, in all cases of visible haematuria, a tumour should be suspected until proven otherwise. A patient with visible haematuria requires urgent, stringent investigation, warranting specialist assessment and subsequent selective referral through a series of patient-centred investigations at a haematuria clinic. One-stop clinics have been shown to improve the patient experience in early diagnosis of potentially life-threatening conditions. Yet despite morbidity and mortality from bladder cancer increasing, the haematuria service has remained largely unchanged for several decades. This paper will discuss the tests and investigations that need to be undertaken in an individual with either visible or non-visible haematuria, and outline the care that is needed to support patients through the investigation process, with special focus on bladder tumour.

Erectile dysfunction following retropubic prostatectomy.

Prostate cancer is the most common cancer to affect men in the UK. Treatment options depend on the grade of tumour, the patient's co-existing diseases and choice of treatment. One potentially curative option is surgery, specifically a radical retropubic prostatectomy or variation thereof. As a consequence of the surgery, men commonly experience two side-effects: urinary incontinence and erectile dysfunction (ED). This paper outlines the clinical management of ED following surgery and aims to provide an overview of how to assess a man who has developed ED and discuss the various treatment options available, along with the efficacy in terms of recovery of erections.

Post-operative urinary retention.

Urinary retention is a common complication of surgery and anaesthesia. The risk of post-operative urinary retention is increased following certain surgical procedures and anaesthetic modalities, and with patients' advancing age. Patients at increased risk of post-operative urinary retention should be identified before surgery or the condition should be identified and treated in a timely manner following surgery. If conservative measures do not help the patient to pass urine, the bladder will need to be drained using either an intermittent catheter or an indwelling urethral catheter, which can result in catheter-associated urinary tract infections. This article provides an overview of normal bladder function, risk factors for developing post-operative urinary retention, and treatment options. Guidance drawn from the literature aims to assist nurses in identifying at-risk patients and inform patient care.

How has Covid-19 impacted the training of Urology trainees in South Wales?

OBJECTIVES: To determine whether Covid19 had a tangible effect on urology training in Wales. There has been no Welsh data available concerning how training has changed during the covid pandemic. This survey evaluated the overall impact on training, with the primary aims to identify changes in clinical and academic activities and evaluate a trainees' wellbeing during the crisis. MATERIALS AND METHODS: Online questionnaires were sent to all Urology Trainees; n = 20 (83% response) working in the Welsh deanery in the United Kingdom, asking about changes in training particularly within operating list, out-patient clinics, diagnostic activities, educational courses, teaching sessions and examinations. RESULTS: Across Wales trainees experienced a reduction in operating procedures, clinics and teaching courses. Due to a redesign of services, there was only a minimal impact on training for cancer diagnostics and Multi-Disciplinary Team (MDT) meetings. The majority of trainees felt their index procedures and ability to complete training will be affected. CONCLUSION: Cancer work, including cancer related theatre lists, diagnostics and MDT were maintained. Trainees lacked confidence that they would reach their operative competencies and struggle to successfully complete training. Following BAPIO discussion, we suggest that training programmes readjust to focus on areas where exposure has been lacking.

Urinary incontinence in women: quality of life and help-seeking.

Urinary incontinence on its own is not considered life-threatening, yet it has been shown to negatively affect a patient's wellbeing. While it is considered a common problem, with approximately 3 million women in the UK affected, the number of those women seeking help is much lower. This article will explore the relationship between urinary incontinence, quality of life (QoL), and barriers to help-seeking behaviour. Developing an understanding of this patient group will highlight implications for nursing practice. A number of factors appear to contribute to how women experience urinary incontinence, and how it impacts on QoL. While not all of these can be fully explored, the predominant factors appear to be: severity of urinary incontinence; type of urinary incontinence; age; and the actual QoL score itself. QoL 'scores' are significant when women decide whether or not to seek help for urinary incontinence. Seeking help often depends on beliefs and an understanding of how the condition can be treated. Health promotion, the training of health professionals, and further research are required to improve the understanding of women's experiences, and to develop appropriate services with which to manage this condition.

Treatment of patients with urge or stress urinary incontinence.

This article outlines the nursing assessment of urinary incontinence, and describes both conservative management of individuals with incontinence and common pharmacological treatment options. The article focuses on therapeutic options for patients with urge or stress incontinence.

Urinary tract stones: types, nursing care and treatment options.

Stones (calculi) in the urinary tract (urolithiasis) or kidney (nephrolithiasis) occur in 5% of the population. The lifetime risk of passing a stone is 8-10%. Men are twice as likely to develop stones, with the first episode occurring before 30 years of age. Stones are caused by the aggregation of crystalline mineral deposits in the urine. Calcium stones are the most common type of stone. Investigations for stone disease include plain X-ray, X-ray with contrast media, ultrasound imaging, and computed tomographic (CT) scanning. Treatment of stones is dependent on the size and location, e.g. lithotripsy is used to break down stones in the ureter or kidney, whereas litholapaxy is used for stones in the bladder that are too large to be passed urethrally. Alpha-blocker medication (e.g. tamsulosin) can facilitate spontaneous passing of a stone. Nurses have a crucial role in assessment, management and provision of discharge advice for patients. Strategies for preventing stones include increasing the urine output (by giving 2-3 litres of fluid per day) and dietary modification, particularly reduction in animal protein and salt content.

Digital rectal examination.

This article discusses the indications for digital rectal examination (DRE) in adults. The procedure for DRE is outlined and an overview of the potential findings from performing this test is provided.

The 100 most influential manuscripts in andrology: a bibliometric analysis.

BACKGROUND: As the specialty of Andrology expands it is important to establish the most important studies that have shaped, and continue to shape, current research and clinical practice. Bibliometric analysis involving a citation rank list is an established means by which to identify the published material within a given field that has greatest intellectual influence. This bibliometric analysis sought to identify the 100 most influential manuscripts in Andrology, as well as the key research themes that have shaped contemporary understanding and management of andrological conditions. METHODS: The Thompson Reuters Web of Science citation indexing database was interrogated using a number of search terms chosen to reflect the full spectrum of andrological practice. Results were ranked according to citation number and further analysed according to subject, first and senior author, journal, year of publication, institution and country of origin. RESULTS: The Web of Science search returned a total of 24,128 manuscripts. Citation number of the top 100 articles ranged from 2819 to 218 (median 320). The most cited manuscript (by Feldman et al., The Journal of Urology 1994; 2819 citations) reported the prevalence and risk factors for erectile dysfunction (ED) in the Massachusetts Male Ageing Study. The Journal of Urology published the highest number of manuscripts (n = 11), followed by the New England Journal of Medicine (n = 10). The most common theme represented within the top 100 manuscripts was erectile dysfunction (n = 46), followed jointly by hypogonadism and male factor infertility (n = 24 respectively). CONCLUSION: Erectile dysfunction should be considered the most widely researched, published and cited field within andrological practice. This study provides a list of the most influential manuscripts in andrology and serves as a reference of what comprises a 'highly citable' paper for both researchers and clinicians.

CONTEXTE: Etant donné que la spécialité Andrologie se développe, il est important de dresser un inventaire des études les plus importantes qui ont façonné, et qui continuent à façonner, la recherche actuelle et la pratique clinique. L'analyse bibliométrique, qui inclue une liste de rang de citations, est un moyen bien établi pour identifier le matériel publié, dans un champ donné, qui a la plus grande influence intellectuelle. La présente analyse bibliométrique cherche à identifier les 100 manuscrits les plus influents en Andrologie, ainsi que les principaux thèmes de recherche qui ont façonné la compréhension et la prise en charge contemporaines des situations andrologiques. MÉTHODES: La base de données d'indexation des citations du Web of Science de Thompson Reuters a été interrogée en utilisant un nombre de termes de recherche choisis pour refléter l'éventail complet de la pratique andrologique. Les résultats ont été classés selon leur nombre de citations, puis ensuite analysés en fonction du sujet, des premier et dernier auteurs, du journal, de l'année de publication, de l'institution et du pays d'origine. RÉSULTATS: La recherche sur le Web of Science a rapporté un total de 24 128 manuscrits. Le nombre de citations des 100 premiers articles va de 2 819 à 218 (médiane 320). L'article le plus cité (de Feldman et al., The Journal of Urology 1994 ; 2 819 citations) rapportait la prévalence et les facteurs de risque de la dysfonction érectile (DE) dans l'étude du Massachusetts menée chez l'homme vieillissant. The Journal of Urology a publié le plus grand nombre de manuscrits (n=11), suivi du New England Journal of Medicine (n=10). Le thème le plus souvent représenté dans les manuscrits du top 100 était la dysfonction érectile (n=46), suivi conjointement par l'hypogonadisme et l'infertilité d'origine masculine (respectivement n=24). CONCLUSION: La dysfonction érectile devrait être considérée comme le champ de la pratique andrologique qui a le plus largement fait l'objet de recherches, de publications et de citations. La présente étude fournit une liste des manuscrits les plus influents en andrologie, et constitue une référence sur ce que signifie un article 'fortement cité' à la fois pour les chercheurs et pour les cliniciens.

Erectile dysfunction: physiology, causes and patient management.

This article examines the prevalence, causes, identification, assessment and treatment options for men with erectile dysfunction. Erectile dysfunction is thought to affect one in ten men across the UK and is often a consequence of pathology and/or pharmacology. Treatment can be offered to all patients, but the keys to management are identification, accurate assessment and focused therapy. Nurses are well placed to identify and support men who have this distressing problem.

Urine samples and urinalysis.

Urinalysis is a routine screening and diagnostic tool that can be used to identify infections and diseases. This article discusses methods of collecting and testing urine using reagent strips and provides a guide for interpreting the results.

Novel chromosome findings in bladder cancer cell lines detected with multiplex fluorescence in situ hybridization.

Bladder cancer is a common neoplasm worldwide, consisting mainly of transitional cell carcinomas, while squamous, adenocarcinoma, and sarcomatoid bladder cancers account for the remaining cases. In the present study, multiplex fluorescence in situ hybridization (M-FISH) has been used to characterize chromosome rearrangements in eight transitional and one squamous cell carcinoma cell line, RT112, of UMUC-3, 5637, CAT(wil), FGEN, EJ28, J82, 253J, and SCaBER. Alterations of chromosome 9 are the most frequent cytogenetic and molecular findings in transitional cell carcinomas of all grades and stages, while changes of chromosomes 3, 4, 8, 9, 11, 14, and 17 are also frequently observed. In the present study, alterations previously described, including del(8)(p10), del(9)(p10), del(17)(p10), and overrepresentation of chromosome 20, as well as several novel findings, were observed. These novel findings were a del(15)(q15) and isochromosome 14q, both occurring in three of nine cell lines examined. These abnormalities may reflect changes in bladder tumor biology. M-FISH represents an effective preliminary screening tool for the characterization of complex tumor karyotypes.

Assessing patients with actual or potential erectile dysfunction.

Asking question about sexuality forms part of the nursing assessment but is often overlooked because of the embarrassment of both nurse and patient. However, failure to identify erection problems, either actual or potential, can result in distress, making eventual treatment more difficult. A prompt assessment and referral to an erectile dysfunction clinic are required.