Assessment of association between lower ureteric excision technique and oncological outcomes for upper urinary tract urothelial carcinoma: retrospective analysis from the Scottish Renal Cancer Consortium.

PURPOSE: Nephroureterectomy(NU) remains the gold-standard surgical option for the management of upper urinary tract urothelial carcinoma(UTUC). Controversy exists regarding the optimal excision technique of the lower ureter. We sought to compare post-UTUC bladder tumour recurrence across the Scottish Renal Cancer Consortium(SRCC). METHODS: Patients who underwent NU for UTUC across the SRCC 2012-2019 were identified. The impact of lower-end surgical technique along with T-stage, N-stage, tumour location and focality, positive surgical margin, pre-NU ureteroscopy, upper-end technique and adjuvant mitomycin C administration were assessed by Kaplan-Meier and Cox-regression. The primary outcome was intra-vesical recurrence-free survival (B-RFS). RESULTS: In 402 patients, the median follow-up was 29 months. The lower ureter was managed by open transvesical excision in 90 individuals, transurethral and laparoscopic dissection in 76, laparoscopic or open extra-vesical excision in 31 and 42 respectively, and transurethral dissection and pluck in 163. 114(28.4%) patients had a bladder recurrence during follow-up. There was no difference in B-RFS between lower-end techniques by Kaplan-Meier (p = 0.94). When all factors were taken into account by adjusted Cox-regression, preceding ureteroscopy (HR 2.65, p = 0.001), lower ureteric tumour location (HR 2.16, p = 0.02), previous bladder cancer (HR 1.75, p = 0.01) and male gender (HR 1.61, p = 0.03) were associated with B-RFS. CONCLUSION: These data suggest in appropriately selected patients, lower ureteric management technique does not affect B-RFS. Along with lower ureteric tumour location, male gender and previous bladder cancer, preceding ureteroscopy was associated with a higher recurrence rate following NU, and the indication for this should be carefully considered.

Population-based linkage of health records to detect urological complications and hospitalisation following transrectal ultrasound-guided biopsies in men suspected of prostate cancer.

BACKGROUND: Transrectal ultrasound-guided prostate biopsy is a common urological procedure with known complications. We determined the urological complication and 30-day hospital admission rate in a population-based cohort using unique identifier and deterministic methodology of record linkage. METHODS: 715 men who underwent a transrectal ultrasound-guided biopsy in Tayside region of Scotland between April 2007 and September 2011 were identified from hospital records using their unique Community Health Index Number. Multiple hospital electronic databases (Central Vision, Insite, Wisdom, and TOPAS) and departmental-based resources (morbidity and mortality records, daily ward electronic records) were linked to estimate urological complications (urinary tract infection, urinary retention, haematuria) and rates of hospital admission. Cross-validation of information was obtained by searching a drug dispensing information network and microbiology database for infective complications. The hospital admission rate was compared for two different prophylactic antibiotic regimens used during the study period. RESULTS: Of the 715 men who underwent transrectal ultrasound biopsy, 386 (53.9 %) were diagnosed with prostate cancer and 329 (46.1 %) were found to have benign histology. The hospital admission rate for urological complications within 30 days of the procedure for men without cancer was 1.95 % (14/715). The 30-day hospital admission rate was not different for different regimens of prophylactic antibiotics. There were 50 (6.99 %; 50/715) urine cultures requested to the microbiology department within 30 days of procedures; out of which 20 (2.79 %; 20/715) were positive. Most of these were generated from general practice requests. Eight blood cultures obtained within the same period were all negative. Eleven patients (1.7 %) presented with urinary retention during the same period and required indwelling catheterisation. None of them had any surgical procedure. Validation of electronic record linkage against telephonic questionnaires by specialist nurse showed a high reliability of the methodology (κ = 0.91). CONCLUSION: High quality validated record linkage of cohort data in the present study using a unique identifier, protocol-based procedure and antibiotic prophylaxis showed that hospitalisation following TRUS biopsies occurs in less than 2 % of patients. However, a significant number of patients report to primary care, and centrally held records based on coding alone could underestimate the true incidence of complications.

Pubic hair and sexuality: a review.

INTRODUCTION: Hair is a distinguishing feature of mammals, though the persistence of visible head, axillary, and pubic hair remains anthropologically unclear. Humans throughout the ages have modified their head and body hair, but aesthetic removal of pubic hair has become the "the ultimate barometer of how fashionable you really are" in the 21st century. The aim of the article is to examine the trends in pubic hair removal and its impact on health and sexuality. METHODS: A literature search was performed, with a further search performed using an Internet-based search engine. For discussion, the results have been classified into the topics of "Development and anthropology","Cultural and artistic significance", "Medical implications", "Psychological and sexual significance and popular culture", "Impact of body hair loss on sexuality" and "Style and terminology." RESULTS: Pubic hair removal has been common since the ancient times. Pubic hair was rarely depicted in artistic representations of the nude until the late 19th century. It is postulated that the current trend of pubic hair removal may be related to the increased accessibility of Internet-based pornography. Anecdotally, pubic hair removal may carry benefits regarding increased sexual sensation and satisfaction though there is no quantative research in this field. There is a recognized morbidity to pubic hair removal, and also a lack of standardization of terms for styles adopted. We propose a definitive grading system for male and female body hair based on the widely used Tumor Node Metastasis staging system. CONCLUSIONS: Pubic hair removal appears to be an important aspect of expressing one's sexuality and participation in sexual activity. This practice has an interesting psychosexual basis which, to date, has not yet been fully explored in sexual medicine.

How to manage a urinary catheter balloon that will not deflate.

On occasion, difficulty will be encountered removing an indwelling urethral catheter. This may be as a consequence of failure of the catheter balloon to deflate. This article reviews the published data on managing the non-deflating Foley catheter balloon, and suggests an evidence-based sequence of interventions to deflate the catheter balloon.

Skeletal myopathy associated with nucleoside reverse transcriptase inhibitor therapy: potential benefit of coenzyme Q10 therapy.

Zidovudine (ZDV) has been associated with 'ragged-red' fibre myopathy, due to its effects on myocyte mitochondria. Usually this is reversible with cessation of ZDV. We report a 52-year-old man, who in 1985 developed ragged-red fibre myopathy 14 years after diagnosis of HIV infection while on effective ZDV-based combination antiretroviral therapy (ART). He was treated with the mitochondrial anti-oxidant coenzyme Q10 and made an excellent recovery, without change of ARTs. This suggests a novel therapy for further investigation targeted at ZDV induced myopathy, potentially allowing continuation of antiviral treatments including ZDV.

Preliminary validation of Thiel embalmed cadavers for laparoscopic radical nephrectomy.

PURPOSE: This study evaluated face, content, construct validity, and reliability of Thiel embalmed cadavers (TEC) as a training tool for transperitoneal laparoscopic nephrectomy (TLN). MATERIALS AND METHODS: The study participants were prospectively recruited through an advanced laparoscopic renal resection teaching skill course. The participants were grouped into: nonexperts (performed fewer than 50 TLNs) and experts (performed more than 50 TLNs). All the participants performed TLN on TEC, which was video recorded. All participants rated their overall experience of performing TLN on TEC with emphasis on realism (face validity). The participants were asked to rate the appropriateness of TEC for training in TLN (content training). Two experienced laparoscopic surgeons, using validated modified Objective Structured Assessment of Technical Skills, assessed the individual videos. The parameters studied were: Respect for tissues, time and motion, and instrument handling for each step of laparoscopic nephrectomy (LN) (construct validity). Test-retest and interrater reliability was also evaluated. RESULTS: Twenty-four participants (4 experts and 20 nonexperts) took part in this study. The mean overall rating for the experience of TLN on TEC was 4.5 (Face Validity). The mean score for the appropriateness of TEC as a training tool for TLN was 4.6 (content validity) when evaluated by the four experts. The mean scores for the nonexperts and experts using video recordings for various variables were: Respect for tissue-1.74 (standard deviation [SD]-0.62) vs 3.63 (SD-1.06), (P<0.01), time and motion-1.74 (SD-0.58) vs 4 (SD-0.76), (P<0.01), and instrument handling-1.84 (SD-0.61) vs 4.25 (SD-0.71), (P<0.01) (construct validity). The study also suggested test-retest and interrater reliability. CONCLUSIONS: This study suggests face, content, and constructs validity and reliability of the TEC as a training tool for TLN.

Laparoscopic nephrectomy for adult polycystic kidney disease: safety, feasibility, and early outcomes.

BACKGROUND AND PURPOSE: Indications for laparoscopic renal surgery are increasing; however, benefits in adult polycystic kidney disease (APKD) remain uncertain. Our objective was to systematically synthesize the reported literature on safety, feasibility, complications, and early outcomes of laparoscopic nephrectomy in APKD to determine clinical benefits for surgical practice. METHODS: We conducted a meta-analysis of the published literature reporting on laparoscopic nephrectomy in APKD between 1991 and 2013. The criteria from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) study were used to assess the quality of reported literature. RESULTS: One prospective and 15 retrospective studies of low to modest quality (according to the STROBE checklist) were identified, reporting on 293 patients who underwent laparoscopic nephrectomy for APKD. None of the studies was a randomized clinical trial (RCT). The transperitoneal approach was the most commonly used technique. Body mass index ranged from 16 to 57 (mean 26.2 kg/m(2); 53% of patients were dialysis dependent, and 31% had a previous or simultaneous transplant. Kidney length ranged from 8 to 50 cm (mean 34.5cm), and the mean mass of affected kidneys was 1647 g (range 132 g-7200 g). Duration of hospital stay ranged from 2.6 to 11 days (mean 4.9 days). Operative time ranged from 90 to 568 minutes, with 16.2% of patients needing blood transfusion. There were 24 intraoperative complications and 68 postoperative complications, a rate of 8% and 24%, respectively. A total of 16 (5%) cases were converted to an open technique. No mortality was reported in any of the included studies. CONCLUSION: The quality of the included studies is poor, and it is difficult to argue for or against change in clinical practice because the evidence included is of level 3 and 4 only. Higher quality studies are needed to demonstrate that the technique is generalizable across all populations.

Does surgery have a role in management of chronic intrascrotal pain?

OBJECTIVES: To assess the role of epididymectomy in the treatment of chronic postvasectomy and epididymal pain syndrome and to identify the factors that predict the outcome. METHODS: A total of 38 patients, aged 20 to 70 years (mean 45), who had undergone epididymectomy for intractable intrascrotal pain, were identified retrospectively from the pathology records. The clinical notes were reviewed, and details on patient demographics, previous vasectomy, investigations, and histologic features were collected and analyzed. The outcome was assessed by routine outpatient clinic review and telephone interview. RESULTS: Overall, 32% of patients reported resolution of symptoms after epididymectomy; 17 patients had undergone previous vasectomy, and this group was significantly more likely to have ongoing pain. Abnormal examination and ultrasound findings preoperatively did not correlate with a better outcome from surgery. CONCLUSIONS: The results of our study have shown that epididymectomy has a limited role in the management of chronic intrascrotal pain.