Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 16 de 16
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Aging Male ; 24(1): 92-94, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34319201

RESUMO

Digital rectal examination (DRE) is routinely performed as part of a urology clinical assessment in patients with a clinical suspicion of prostate cancer. An abnormal DRE or a raised prostate specific antigen (PSA) level are part of the criteria for primary care referral to secondary care due to a suspicion of prostate cancer. The current Coronavirus-19 (COVID-19) pandemic has resulted in the rapid adoption of virtual consultations in the form of telephone or video consultations making clinical examination difficult. In the case of prostate cancer diagnostic pathways, often clinicians now rely on PSA measurements and MRI, where radiological services are available, without the requirement for a DRE. We discuss the limited role DRE has in the modern prostate cancer diagnostic pathway due to the widespread adoption of MRI particularly in the COVID-19 era.


Assuntos
Exame Retal Digital , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico , COVID-19 , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias da Próstata/diagnóstico por imagem , SARS-CoV-2
2.
Aging Male ; 23(5): 1217-1219, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32138580

RESUMO

INTRODUCTION: Vasectomy is a popular choice of contraception worldwide. In the UK, vasectomy reversal is not usually licensed under the NHS with reports on outcomes being limited. Microsurgical reversal is a technique commonly performed under the operating microscope. Loupe magnification, however, is emerging as a safe and reliable technique to perform microsurgery. METHOD: Loupe-assisted microsurgical vasovasotomies were performed on 14 men in a 3-year period. Indications for the procedure were for fertility only. Semen analysis variables were measured against European Association of Urologists (EAU) guidelines at six weeks. Patients were followed-up at clinic in three months. Data were collated using operation notes and cytology results, and analysed using descriptive statistics. Pearson's correlation coefficient was used to compare years after vasectomy, and age to sperm count. RESULTS: The average sperm count in our group was 41.3 million per millilitre (median 29.95, range 2.7-107.8) at 6 weeks. Seventy-five per cent were found to have positive sperm motility, and all had acceptable sperm morphology at follow-up. A very low to weak correlation between time after vasectomy and age, with sperm count. CONCLUSION: We have demonstrated that fertility and post-operative outcomes using a loupe-assisted microsurgical vasovasotomy approach are favourable as per EAU guidelines.

3.
Aging Male ; 23(2): 139-140, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29663843

RESUMO

A 65-year-old gentleman, with no past medical problems and not on any anticoagulation was seen in the urology clinic with persistent hematospermia for the last few years. A thorough history and examination including a digital examination of the prostate was unremarkable. Bleeding from his female partner was also ruled out. Investigations such as prostate specific antigen (PSA) blood test, urine culture, semen culture, and flexible cystoscopy were performed, and these investigations were also within normal limits. Due to his persistent hematospermia even after masturbation, a magnetic resonance imaging (MRI) of his pelvis was performed to rule out any sinister intrapelvic pathology. His MRI pelvis revealed a right seminal vesicle haemorrhage which was the cause of his hematospermia. He was treated conservatively with the advice to abstain from ejaculation for a few months. More importantly, we have also reassured the patient.


Assuntos
Hemospermia/diagnóstico por imagem , Hemospermia/terapia , Imageamento por Ressonância Magnética , Glândulas Seminais/diagnóstico por imagem , Idoso , Humanos , Masculino
4.
Aging Male ; 23(5): 953-957, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31318579

RESUMO

INTRODUCTION: The role of transperineal template biopsy for prostate cancer diagnosis is well established. Pre-biopsy multiparametric magnetic resonance imaging (MRI) is used in most centers for planning of prostate biopsies and staging. Cognitive and software fusion techniques are increasingly getting popular. METHODS: We retrospectively reviewed patients who underwent transperineal template biopsies from January 2016 till December 2018. This included patients on active surveillance, previous negative transrectal ultrasonography biopsies with persistently raised prostate-specific antigen/abnormal prostate on digital rectal examination and de-novo template biopsies. Two specialist uro-radiologists reported all the scans and the biopsies were performed by one experienced urologist. The cognitive biopsies were performed for PIRADS 3-5 lesions on MRI. Total of 330 patients underwent transperineal template biopsies and cognitive target biopsies were carried out in 75 patients who were included in the study. We evaluated the results as positive/negative cognitive biopsies and also according to the PIRAD scoring. Only the patients with prostate cancer on template biopsy histology were included. RESULTS: Fifty-seven (76%) of the cognitive biopsies were positive out of total 75.[Table: see text]. CONCLUSIONS: Combined cognitive and systematic biopsies have excellent diagnostic rate especially for PIRAD 4-5 MRI areas.

5.
Aging Male ; 23(4): 297-299, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30651031

RESUMO

Seminal Vesicle (SV) calculi are a rare pathology. Clinical presentation usually consists of nonspecific perineal pain and haematospermia. Adjuncts to aid diagnosis include US, MRI, and Vesiculography. This rare condition can be treated conservatively, however, surgical options are becoming more advanced with Vesiculoscopy now being the gold standard. Here, we present a case of a SV calculi treated conservatively.

6.
Aging Male ; 23(5): 770-779, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30955407

RESUMO

INTRODUCTION: Erectile dysfunction is an established, well known risk of any operative management of benign prostatic hyperplasia (BPH). However, there are some cases reported in which surgical treatment has paradoxically improved erectile function. Here, we present a systematic review of the literature pertaining to the effect of surgery on sexual function, focusing on reports of improvement in erectile function following surgery. MATERIALS AND METHODS: We searched PUBMED, EMBASE, Web of Knowledge, and SCOPUS databases for the following keywords: (("sexual function" OR "erectile function") AND "improvement" AND "benign prostatic hyperplasia" AND "surgery"). RESULTS: Sixteen studies (total n = 2087) were reviewed which reported a significant improvement in any aspect of erectile function. Ten of these studies had a follow-up period of 12 months or more while five had a follow up less than 12 months. Various surgical methods were included in the 16 studies; however, five reported TURP outcomes specifically. Eleven studies reported outcomes using the International Index of Erectile Function (IIEF). Overall, a further 87 studies showed no significant change and 8 studies showed a significant reduction. CONCLUSIONS: The majority of studies report no change in erectile function following surgical intervention for BPH. There seems to be no obvious correlating factor between the studies reporting an improvement in erectile function. Further research is needed to guide us in how to consent our patients for erectile function outcomes for BPH surgery.

7.
Aging Male ; 23(5): 437-439, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30270700

RESUMO

Acute vasitis is a rare infection of the vas deferens. Clinical presentation and disease rarity can cause difficulty in correctly diagnosing this condition. Adjuncts to aid diagnosis can be used that include ultrasound scan (USS) or computed tomography. We report a unique case of acute vasitis following vasectomy, reversal and subsequent re-do vasectomy diagnosed using USS.

8.
Aging Male ; 23(5): 1620-1626, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33818292

RESUMO

OBJECTIVES: Acute urinary retention (AUR) is one of the most significant complication of benign prostatic hyperplasia (BPH). The gold standard surgical treatment for BPH, transurethral resection of the prostate (TURP), is not without significant side effects and a prolonged hospital stay. The aim of this study is to evaluate the role of Rezum ™ steam ablation in the treatment of patients with AUR secondary to BPH. METHODS: Patients who developed AUR and failed their trial without a catheter (TWOC) were recruited. They were counselled about the procedure and offered the treatment. Pre-operative, intraoperative and post operate data were collected. RESULTS: All patients were followed up for a mean period of 7.2 months. 100% of patients passed their TWOC and stopped taking any BPH medications after. There was an average of 43.8% decrease in TRUS volume and a fall of 52.5% in PSA value after intervention. The mean operation time was 8.8 min and mean duration in hospital was 5.8 h. No deterioration in sexual function was reported. CONCLUSIONS: Rezum ™ steam ablation of the prostate is safe, fast and effective day case procedure in treating patients with AUR secondary to BPH. All patients were satisfied with the functional outcomes.

9.
J Endourol ; 33(3): 242-247, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30585739

RESUMO

OBJECTIVES: To present our experience of the Detour extra-anatomic stent (EAS; Porges-Coloplast, Denmark) to bypass ureteric obstruction. Use of the EAS is indicated in patients with complex ureteric strictures or malignant disease, where long-term nephrostomy drainage is undesirable. MATERIALS AND METHODS: Between December 2001 and October 2017, 20 Detour EAS were implanted into 13 patients. The primary indication was ureteric obstruction or injury secondary to metastatic malignancy, or from treatment for malignancy. Five patients required bilateral EAS, with two patients having bilateral EAS following initial unilateral insertion. In 11 patients, the stent was inserted into their bladder, with 2 diverted into a double-barreled stoma. The mean age at the time of implantation was 64 years (range: 50-83 years), and the median follow-up was 12 months (range: 1.5-42 months). RESULTS: Four patients required stent revision for urinary leaks, and two developed recurrent urinary tract infections in their stent requiring intravenous antibiotics. All EAS continued to drain successfully following treatment or revision. One patient died due to complications from dislodgement of the stent, leading to laparotomy and intra-abdominal sepsis. Seven patients died due to progression of metastatic malignant disease, and the Detour EAS was functioning in all seven at time of death. The remaining five patients are well with functioning Detour EAS. CONCLUSIONS: The Detour EAS system provides a suitable alternative option for urinary diversion, affording a good quality of life to carefully selected patients with multiple comorbidities and malignant disease.


Assuntos
Nefrotomia/métodos , Stents/efeitos adversos , Obstrução Ureteral/cirurgia , Derivação Urinária/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Constrição Patológica/complicações , Drenagem/efeitos adversos , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Período Perioperatório , Qualidade de Vida , Recidiva , Risco , Resultado do Tratamento , Ureter , Obstrução Ureteral/psicologia , Bexiga Urinária/cirurgia
10.
Case Rep Urol ; 2018: 5892438, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29850367

RESUMO

Renal matrix stones are a rare phenomenon and they present a diagnostic challenge due to their atypical radiological appearances in comparison to more commonly encountered renal tract calculi. We describe a case of known stone former presenting with loin pain and recurrent urinary tract infections who was diagnosed with a matrix stone. The video of the diagnostic flexiureterorenoscopy demonstrating the matrix stone occupying almost the entire right renal collecting system is also presented.

11.
Aging Male ; 20(3): 192-197, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28609136

RESUMO

BPH associated with LUTS and sexual dysfunction is common. We performed UroLift on 11 patients, average age 71 years (range 56-90). IPSS improved by an average of 9 points post-procedure. Pre-operatively their post-void residuals were 306.3 ml (range 120-499 ml SD [120.6]) and their QMAX was 7 ml/s (range 4-14 SD [2.8] ml/s). Post-procedure the post-void residual decreased by 35.4% at 4 months (mean difference - 106.3 ml). QMAX improved by an average of 1.7 ml/s, which was not statistically significant. No patients suffered any sexual dysfunction side effects and all patients were satisfied with their result. Hospital stay and theatre time were significantly reduced. Average length of stay was just 10.6 (6-18) hours and average theatre time just 18.7 (12-30) min. This is significantly faster than other surgery for LUTS. We therefore feel that there are significant benefits for both the patients, who are able to go home much faster, and also the hospital, who are able to perform far more surgeries for their patients. Patients also do not require an inpatient bed so patients should not be cancelled on the day of theatre.


Assuntos
Disfunção Erétil/prevenção & controle , Hiperplasia Prostática/cirurgia , Próteses e Implantes , Idoso , Idoso de 80 Anos ou mais , Humanos , Tempo de Internação , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Período Pós-Operatório , Próstata/fisiopatologia , Hiperplasia Prostática/complicações , Qualidade de Vida , Estudos Retrospectivos , Ressecção Transuretral da Próstata
12.
BJU Int ; 118(1): 140-4, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26765522

RESUMO

OBJECTIVES: To analyse the trends in the number of deaths attributable to urolithiasis in England and Wales over the past 15 years (1999-2013). Urolithiasis has an estimated lifetime risk of 12% in males and 6% in females and is not perceived as a life-threatening pathology. Admissions with urinary calculi contribute to 0.5% of all inpatient hospital stays, and the number of deaths attributable to stone disease has yet to be identified and presented. MATERIALS AND METHODS: Office of National Statistics data relating to causes of death from urolithiasis, coded as International Classification of Diseases (ICD)-10 N20-N23, was collated and analysed for the 15-year period from 1999 to 2013 in England and Wales. These data were sub-categorised into anatomical location of calculi, age, and gender. RESULTS: In all, 1954 deaths were attributed to urolithiasis from 1999 to 2013 (mean 130.3 deaths/year). Of which, 141 were attributed to ureteric stones (mean 9.4 deaths/year). Calculi of the kidney and ureter accounted for 91% of all deaths secondary to urolithiasis; lower urinary tract (bladder or urethra) calculi contributed to only 7.9% of deaths. The data revealed an overall increasing trend in mortality from urolithiasis over this 15-year period, with an increase of 3.8 deaths/year based on a linear trend (R(2) = 0.65). Overall, the number of deaths in females was significantly higher than in males (ratio 1.5:1, P < 0.001); kidney and ureteric calculi causing death had a female preponderance (1.7:1, female:male); whereas calculi of the lower urinary tract was more common in males (1:2.2, female:male). CONCLUSIONS: Stone disease still causes death in the 21st century in England and Wales. This trend of increasing deaths must be placed in the context of the concurrent rising incidence of urolithiasis in the UK and the number of stone-related hospital episodes. The primary cause of death relating to complications of stone disease for each individual case should be further investigated to facilitate prevention of complications of urolithiasis.


Assuntos
Cálculos Urinários/mortalidade , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Mortalidade/tendências , Fatores de Tempo , País de Gales/epidemiologia
13.
BMJ Case Rep ; 20142014 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-24792024

RESUMO

Intravesical BCG immunotherapy is commonly used in the treatment of superficial bladder cancer. We recount the case of an 82-year-old British man who completed a course of BCG immunotherapy in 2011 for superficial bladder cancer, and presented in January 2013 with a loss of appetite, loss of weight and severe back pain. CT scanning, followed by MRI displayed a 5.7 cm × 5 cm conglomerated necrotic, haemorrhagic mass of lymph nodes in the para-aortic region. A CT-guided biopsy revealed granulomatous inflammation, focal fibrosis and acid-fast bacilli consistent with Mycobacterium tuberculosis (TB). The patient was treated with combination antituberculous medication, and is recovering. To our knowledge, this is the only reported case of lymph node TB secondary to intravesical BCG immunotherapy. We suggest that in patients treated with postintravesical BCG with enlarged lymph nodes, a diagnosis of secondary TB should be considered.


Assuntos
Adjuvantes Imunológicos/efeitos adversos , Vacina BCG/efeitos adversos , Carcinoma de Células de Transição/tratamento farmacológico , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose dos Linfonodos/etiologia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Administração Intravesical , Idoso de 80 Anos ou mais , Humanos , Masculino , Tomografia Computadorizada por Raios X
14.
BMJ Case Rep ; 20132013 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-23907962

RESUMO

A 66-year-old Caucasian man with a background of prostate cancer presented with a progressive history of nausea, reduced appetite, shortness of breath and a distended abdomen. Radiological imaging revealed a left-sided renal mass and gross ascites suggestive of metastatic renal cell carcinoma (RCC). Subsequent histological examination and immunostaining of renal mass biopsy revealed features characteristic of metastatic moderately differentiated to a focally poorly differentiated, large duct type of prostatic adenocarcinoma.


Assuntos
Adenocarcinoma/secundário , Neoplasias Renais/secundário , Neoplasias da Próstata/patologia , Adenocarcinoma/diagnóstico , Idoso , Humanos , Neoplasias Renais/diagnóstico , Masculino
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...