bluuebunny/crossref_metadata_2025_split huggingface dataset:
37  Incidental renal tumours: the frequency of benign lesions and the role of preoperative core biopsy
Authors: VASUDEVAN A. , DAVIES R.J. , SHANNON B. , COHEN R. 
Published: February 2006

Objective:  The growing use of abdominal imaging has increased the detection of small incidental renal tumours. The aim of this study was to determine if the incidence of benign lesions in these radiologically detected masses is similar to the reported incidence of more advanced tumours and if preoperative renal core biopsy is effective in identifying benign lesions where nephrectomy can be safely avoided.Materials and Methods:  In a retrospective study, renal core biopsy data of incidental tumours were analysed over a 5 year period. The biopsies were correlated with the final pathology of the nephrectomy specimens and with patient follow‐up if nephrectomy was avoided.Results:  Of 70 diagnostic core biopsies, a third of cases were considered benign. The sensitivity and specificity for both benign and malignant lesions when compared to definitive pathology was 100% in all cases subjected to nephrectomy. Of the 30 non‐diagnostic biopsies, 3 were proven to be benign and a further 18, likely to be benign. The only complication of renal biopsy was one case of postbiopsy bleeding.Conclusion:  A higher than previously anticipated proportion of incidentally detected small renal masses are benign. Based on the high sensitivity and specificity, there is value in core biopsy of small incidental renal lesions, a procedure which has a low complication rate (1%). When analysed by an experienced pathologist familiar with renal biopsy this may avoid radical nephrectomy in a significant number of patients.
39  A sterile disposable sheath system for flexible cystoscopes
Authors: LAWRENTSCHUK N. , BOLTON D.M. , CHAMBERLAIN M. 
Published: February 2006

Introduction:  Flexible cystourethroscopy is a routine procedure in urology. Sterilization of instruments is time‐consuming and may damage flexible instruments but is essential to prevent contamination. This study is the first to document experience using a flexible cystoscope with a disposable sheath as an alternative to sterilization in a urological setting.Methods:  Two hundred consecutive patients (172 men; 28 women) had flexible cystourethroscopy performed in an office setting using flexible endoscopes with disposable sheaths (Endosheath System, Vision‐Sciences Inc, Natick, MA) using a standardised procedure. Cystoscopies were performed for surveillance of bladder carcinoma (107), haematuria for investigation (59), lower urinary tract voiding systems (16), removal of stent (12), assessment of urethral stricture (5) and removal of calculus (1). Costings were calculated comparing a session using standard cystoscopes for ten procedures to the first ten procedures with this disposable sheath system.Results:  There were no breaches of the sheath or contamination of the cystoscope and no infections recorded. There were nine technical failures with the disposable sheath system due to an inability to insert the cystoscope easily using the sheath, but these all occurred in the first one hundred procedures. Costings were comparable.Conclusions:  Potential advantages of a disposable sheath system include eliminating sterilizing of the cystoscope between patients, saving staff time and minimising exposure to hazardous cleaning and sterilizing preparations. Costs are comparable but there is a learning curve for placing the instrument within the sheath. Endoscopes with disposable sheaths are safe, comply with universal precautions and are an alternative to current instrumentation and sterilizing systems.
44  Erythropoietin reduces functional impairment following renal ischaemia/ reperfusion injury in pigs
Authors: FORMAN C.J. , NICOL D. , JOHNSON D. 
Published: February 2006

Introduction:  The advent of laparoscopic partial nephrectomy has led to renewed interest in tolerance of, and treatments for, ischaemic renal injury.Materials and Methods:  Thirteen pigs underwent a 2‐stage procedure. First a right nephrectomy, followed a week later by clamping of the left renal artery for one hour and placement of a catheter. They were randomised to receive either i.v. Erythropoietin one hour prior to clamping, followed by daily s/c doses (n = 6) or no treatment (n = 7). 24 h urine collections and daily blood tests were used to calculate creatinine clearances.Results:  Creatinine clearance expressed as a percentage of pre‐op baseline.

Pre‐op
Day 1
Day 2

Control
100
68 ± 6
74 ± 13

Treatment
100
95 ± 8.9
96 ± 12

Significance

P = 0.027
P = 0.23

By day 5 both groups had recovered to baseline levels. Serum creatinine concentration in umol/l, mean ± SEM.

Pre‐op
Day 1
Day 2
Day 5

Control
92 ± 9
132 ± 14
123 ± 13
89 ± 7

Treatment
94 ± 6
113 ± 10
106 ± 7
76 ± 3

Significance
P = 0.86
P = 0.29
P = 0.28
P = 0.15

The difference in means did not reach significance at the 0.05 level, but results are included to illustrate the degree of injury.Conclusion:  Recent research has shown erythropoietin to be more than just a promoter of erythropoiesis. It is a tissue‐protective cytokine active in brain, heart and kidney. This is the first time that a functional benefit has been shown in a large animal model of renal ischaemic injury.
54  Robotic assisted laparoscopic pyeloplasty – the initial Australasian experience
Authors: KEARSLEY J.A. 
Published: February 2006

Introduction:  Laparoscopic pyeloplasty is a proven treatment for PUJ obstruction but can be difficult to master due to the laparoscopic suturing involved. The Da Vinci operating system (Intuiative, CA, USA) has been used for other urological procedures, notable radical prostatectomy, and has been shown to reduce the learning curve for laparoscopically naïve surgeons. The initial Australasian experience of robotic assisted laparoscopic pyeloplasty is presented.Patients and Methods:  Six patients with PUJ obstruction requiring treatment (five primary, one recurrent) who were suitable for pyeloplasty were offered the option of having their surgery using the Da Vinci operating system. The initial dissection was undertaken laparoscopically and the robot used for dismemberment and anastomosis.Results:  Five of the six had their surgery completed robotically; open conversion was required in the patient who had undergone previous open pyeloplasty, the same patient required a blood transfusion due to haemolysis. Other surgical parameters (length of stay, operating time, complications, return to normal activities) were all in an acceptable range.Six month postoperative nuclear renography revealed no obstruction in any patient and all were asymptomatic.Conclusion:  Robotic assisted pyeloplasty is technically feasible for the surgeon with little experience of laparoscopic suturing. Operative data and early follow‐up results are encouraging.
69  Are we succeeding in teaching urology and encouraging it as a career choice for future doctors?
Authors: DIAS M. , LIM K. , TEMELCOS C. 
Published: February 2006

Introduction:  With Australia's ageing population, there will be increased demand for urologists and their services in the future. We examine students’ perceptions of urology, and identify factors influencing career choice.Methods:  Questionnaires were distributed to 135 final year medical students. Respondents were asked questions regarding career interests and their perceptions of urology. Their exposure to common clinical problems, examinations, and procedures of the specialty were also assessed.Results:  One hundred and seventeen questionnaires were completed (response rate 82%). 68% of respondents received less than 10 h structured teaching in urology. 45% were interested in a surgical career, with 35% of these in urology. 47% indicated males were more suited to a career in urology, and 53% indicated both genders were equally suited. Compared to other surgical specialties, respondents rated urology as being amongst the easiest to gain entry, involved the least hours worked and least intellectual stimulation. The two most typical problems thought to occupy an urologist's time were prostatomegaly and outlet obstruction (75%) and incontinence (57%). The two least typical areas were bladder cancer (71%) and other non‐prostate urological malignancies (89%). Only 43% of respondents ranked stone disease amongst the three most typical problems. 52% of respondents had seen a TURP, 19% a nephrectomy and 13% a radical prostatectomy. 41% were comfortable performing a scrotal examination, 58% for male catheterisation and 53% for rectal examination.Conclusion:  Deficiencies are evident in students’ knowledge of and exposure to urology and this may have an impact on the recruitment of young doctors into the specialty.
71  2005 Australia and New Zealand female urology survey: where are we and where are we going?
Authors: PILLAY S. , FOREMAN D. 
Published: February 2006

Introduction:  Historically Urologists have had more training in the management of incontinence than prolapse, yet these conditions often coexist. As public hospitals perform less elective surgery there is an erosion of trainee exposure to female urology. Do Urological Society members see incontinence and prolapse as important areas for Urologists to continue managing?Methods:  A survey was sent to all Urologists and Trainees in Australia and New Zealand about training, current practice and interest in female urology.Results:  Sixty‐nine per cent perform SUI surgery in current practice, and 94% of these had exposure to SUI surgery during their training. 50% of those performing SUI surgery would have liked more training, and 99% believe Urologists should be able to perform SUI surgery. 23% perform prolapse surgery in current practice, and 52% of these had exposure to prolapse surgery during their training. 55% of those performing prolapse surgery would have liked more training. 92% believe Urologists should be able to competently assess women for prolapse and 76% believe Urologists should be able to perform prolapse surgery. 51% have a chaperone present when performing vaginal examination and greater than 50% indicated an interest in attending workshops in female urology. 99% believed trainees should be trained in female urology, and 67% believed there should be a fellowship in female urology.Conclusions:  Most believe Urologists should manage incontinence and prolapse. Many wish they had more training in this area. Female urology fellowships are widely supported. There is sufficient interest to run workshops in this area.
73  Utility of video‐urodynamic studies in adults with neurogenic voiding dysfunction
Authors: KAMALAKANNAN R. , LEE T.K. , TUCKEY J. 
Published: February 2006

Objective:  To study the utility of Video‐Urodynamics (VUDS) in patients with neurogenic voiding dysfunction (who were managed on clinical signs and symptoms) and compare the results of Multi‐Channel urodynamics (UDS) and VUDS in these patients.Introduction:  Patients with neurogenic bladder may present with similar symptoms even though the underlying voiding dysfunction are different. In addition, it is difficult to predict bladder behavior based on the level and nature of neurological deficit as the correlation with the type of voiding dysfunction is poor.Materials:  One hundred and six VUDS were performed over 36‐month period, of which 80 were for adults (68 males and 12 females) with neurogenic voiding dysfunction. Mean age was 47 (12–81 years). 73 were spinal cord patients (91%).Results:  In addition to cytometrogram and pressure flow study findings, fluoroscopy revealed reflux in three (4%) patients, diverticuli in 16(20%), Fir‐tree appearance in nine (11%) and bladder outlet obstruction in nine (11%). The anatomic sites of obstruction were external sphincter in two patients and prostate in seven. Overall 53 patients (66%) had change in management after VUDS. Of the 53 patients three had reflux and nine had obstruction (External sphincter‐2 and prostate‐7) accounting for total 12 (15%) which could have been missed in UDS. Twenty patients had prior standard urodynamic studies and yet nine (45%) had to have their diagnoses updated and management changed.Conclusion:  VUDS gives more information compared to UDS on the function and anatomy of the lower urinary tract and helps in the better management of patients with neurogenic voiding dysfunction.
80  Trial use of salmon calcitonin in chronic bladder pain
Authors: KUAN M. 
Published: February 2006

Purpose:  To pilot use of Salmon Calcitonin (a peptide hormone for treatment of hypercalcaemia) in chronic bladder pain syndromes including interstitial cystitis. Calcitonin has been trailed with some success on other chronic regional pain syndromes such as phantom limb pain.Method:  This is an ethics approved, double blinded, randomised crossover trial of 200IU intravenous Salmon Calcitonin vs. Placebo (Saline). Chronic bladder pain patients were recruited using standard NIDDK exclusion criteria. Patients were randomised to two arms, to receive either calcitonin or a saline infusion over 4 h. Bladder pain scores, bother, nocturia and frequency voiding were noted via visual analogue scales immediately prior to and 24 h after administration. Two weeks after first administration, patients arms were crossed over and the alternative infusion administered, again noting pre and postinfusion symptom scores.Results:  Eight patients were enrolled in the trial. Analysis of pain scores via Wilcoxon Matched‐Pairs Signed‐Ranks Test showed a significant difference between pre and postcalcitonin (P ≤ 0.04688) as opposed to pre and postplacebo (P ≤ 0.125). No statistically significant difference was found in bother scores pre and post calcitonin or placebo. There was no significant difference found between pre and postcalcitonin or placebo for nocturia and daytime frequency.Conclusions:  Calcitonin is a possible adjunct to conventional analgesia with little benefit for voiding symptoms. More numbers are required to further quantify the exact analgesic benefit.
83  Cystoscopic injection of polydimethylsiloxane to treat mitrofanoff channel leakage ‐ is it effective?
Authors: AGRAVAL V. , PATKI P. , ARUMUGAM K. , SHAH P.J.R. 
Published: February 2006

Introduction:  Leakage of urine via the Mitrofanoff channel is a difficult clinical problem. We report use of injections of Polydimethylsiloxane as a bulking agent to cure this problem.Methods:  We performed 21 Polydimethylsiloxane implantations in the leaking Mitrofanoff channels in 14 women at a tertiary referral centre. Analysis of improvement in leakage was done at six‐weeks. Patients with partial or no improvement in leakage were re‐injected. Twelve bladders were neuropathic treated with augmentation ileo‐cystoplasty and Mitrofanoff and two were overactive. Double Monti technique was used in nine and appendix in five.Results:  The mean age was 45 years (range 26–60), with a mean follow up of 11 months (range 2–29). The mean volume injected was 2.78 ml. (range 0.5–5). Multiple implantations were required in 4. Leakage stopped in 4/14 patients requiring only one injection. Partial improvement was seen in 3 patients. In seven no improvement was seen after an average of two injections (range 1–4). Urinary diversion was performed in two while three have had revision of Mitrofanoff channel.Conclusions:  Injection of bulking agent like Polydimethylsiloxane was successful in 28.5% of patients, and partially successful in 21.4% patients. Half the patients (7/14) found no benefit from the procedure.
9  Open radical retropubic prostatectomy ‐ a single surgeon series assessing long term oncological outcomes
Authors: RAO R. , CORCORAN N. , BOUCHIER‐HAYES D. , PETERS J. , COSTELLO. A. 
Published: February 2006

Purpose:  •To critically analyse a single surgeon experience of open RRP over 8 years• To assess outcomes up to 10 years• To analyse mortality• To analyse positive margin rates and outcomes• To identify prognostic indicators of PSA failure• To assess outcomes of those patients with PSA failureMethods:  A retrospective chart review of all patients between 1994 to 2002 was performed. Sub group analysis of those patients with positive margins and PSA failures was performed.Results:

Intra‐op/Early mortality‐
0 (0%)

Overall mortality‐
4 (2.5%)

Cancer Specific mortality
2 (1.25%)

Positive margins‐
16 (9.9%)

Positive nodes‐
1 (0.6%)

PSA failures
48 (29.6%)

Conclusions:  Open RRP is a durable oncological procedure with low mortality and morbidity
94  Postoperative prostate specific antigen (PSA) decline predicts adequacy of adenoma removal with BPH surgical techniques.
Authors: GILLING P.J. , FONG E. , KENNETT K.M. , WESTENBURG A.M. , WILSON L. , FRAUNDORFER M.R. 
Published: February 2006

Introduction:  PSA, in patients with BPH, is correlated with total prostate and transition zone volume. The decline in serum PSA levels may therefore be an important marker of completeness of tissue removal in patients undergoing invasive surgical procedures for BPH (Tinmouth et al 2005). In many techniques no tissue is retrieved therefore PSA decline may be a surrogate for adequacy of surgical treatment.Methods:  A Medline search of original articles concerning current endoscopic BPH therapies was undertaken to identify papers in which PSA decline was documented. The amount of tissue retrieved (when relevant) and change in US volume was also recorded.In addition four RCT's performed at this institution involving TURP(two studies) HoLEP(2 studies, HoLRP, Gyrus Enucleation and HoBNI (one study each) were analysed. PSA decline, TRUS and urodynamic data before and after surgery and tissue weight were recorded and correlated.Results:  The mean % PSA and %TRUS volume decline noted following various treatments by literature search was as follows: TUNA (0% and 0%), BNI (NA and 0%) CLAP (45% and 15%) PVP (41% and 37%) TURP (73% and 50%) and HoLEP (83% and 76%).Local RCT data ‐ PSA% and TRUS volume decline : HoBNI (36% and 0%), TURP (51% and 46%) HoLRP (56% and 44%), HoLEP (86% and 67%). The following significant correlations were noted on pooled analysis of the four RCT's: PSA % decline and % TRUS volume decline with path. weight and PSA % decline with improvement in urodynamic parameters. Path. weight also correlated with symptom score improvement.Conclusions:  BNI, laser ablation and microwave appear to result in less PSA decline and TRUS volume fall than after TURP and by inference less complete removal of adenoma. HoLEP gives larger % falls. A greater fall appears to be associated with better clinical results and may ultimately impact on durability.
95  Critical review of a modified technique in buccal mucosa graft urethroplasty
Authors: WONG J. , WANG A. , PAPADOPOULOS B. , SOWTER S. 
Published: February 2006

Introduction:  This presentation will be discussing the modified technique used by the author in his repair of complex urethra strictures. Barbagli et al renewed interest in buccal mucosa (BM) onlaid graft urethroplasty in early 90's. He described the technique of dorsal onlaid graft to improve the revascularisation of the free graft, to prevent shrinkage of the graft, and minimised diverticulum formation. The technique has one major drawback, namely the dorsal onlaid graft is limited to mid and distal bulbar urethra only. The author modified this original technique by employing the BM graft as a ventral onlaid graft and successfully repaired over 126 urethral strictures extending from urethral meatus to proximal bulbar urethra over the period of 1996 to 2005.Result:  Using this modified ventral onlaid BM graft, mobilisation of the urethra is not necessary. This preserves the integrity of the urethral blood supply. After the stricture is identified using the Lister sound, a ventral urethrotomy is carried out. The extend of the stricture and surrounding spongiofibrosis are carefully evaluated visually as well as re‐calibration of the distal and proximal extension of the stricturing process until normal urethra is identified. 1.5 cm wide graft is then harvested with variable length depending on the extend of the stricture. All donor sites are closed primarily. Finally, the graft is sutured in situ and surrounding spongiosum is re‐deployed to provide a vascular and supporting bed for the free graft. At the penile urethra, the dartos fascia is employed to provide support to the free graft. The length of the graft ranged from 2.5 to 15 cm. The stricture sites varied extending from urethra meatus to proximal bulbar urethra just below the external sphincter. 12% recurrent stricture was reported in this group after follow up longer than 15 months. All patients had cystoscopy at 3 and 15 months to evaluate their graft calibre and recurrent stricture rate. Two out of 126 patients required complete graft revision due to sclerosing of the entire graft secondary to recurrent UTI postoperatively. Recurrent stricture tends to occur at the junctional site of the graft and usually diagnosed at their first cystoscopy. Postmicturition dribbling, UTI, ejaculatory dysfunction, erectile dysfunction, stone formation and diverticulum formation is rarely reported when compared to pedicle penile skin graft urethroplasty or pedicle scrotal graft urethroplasty. No patients have reported donor site morbidity.Conclusion:  The modified ventral onlaid BM graft has proven to be a reliable graft in dealing of complex urethral stricture.
97  Flap or no flap in repair of urethral stricture
Authors: WONG J. , WANG A. , PAPADOPOULAS B. , SOWTER S. 
Published: February 2006

Introduction:  When recurrent strictures become troublesome to deal with endoscopically and excision and anastomotic repair is not possible, substitution urethroplasty employing various pedicle flaps repair is the treatment of choice. In the past, foreskin flap, penile skin and scrotal skin had been employed with varying success. Unfortunately with long term follow up all skin repairs have high degree of recurrent UTI, recurrent stricture, stone formation, lichen sclerosus changes at the flap and diverticulum formation. Buccal mucosal free patch graft repair has gained wide acceptance after early reporting by G Barbagli in its use as dorsal onlaid graft in early 90's. The author reported his early work back in 1998, modifying the dorsal onlaid graft to ventral graft attracted criticism. With long‐term follow up and recent reporting from the Barbagli unit using the dorsal onlaid graft, the result presented from our unit is comparable to other major units around the world with minimal complications.Result:  Between 1996 and 2005, 126 patients had BM ventral onlaid graft urethroplasty for recurrent strictures. All patients tertiary referred had previous dilatation, optical urethrotomy and some had previous substitution urethroplasties. Before 1996, pedicle penile skin graft was commonly used in our unit to repair urethral stricture at the bulbar or penile urethra. Many scrotal onlaid grafts were revised. In this group of pedicle skin urethroplasties, UTI and postmicturition dribbling were commonly reported by pts. All pts after BM graft urethroplasty had follow up cystoscopy at 3 and 15 months to assess and calibrate their graft luminal size before discharge from the unit. The length of the graft ranged from 2.5 to 15 cm. The graft has been employed to repair stricture from meatus to proximal bulbar urethra. The recurrent stricture usually occurs at the junctional area, either proximal or distal graft anastomotic site. Recurrent stricture tends to occur in the three and six months period. Revision urethroplasty for recurrent stricture in this group of patients was 12%. Two out of 126 patients required complete revision of their graft due to significant shrinkage secondary to recurrent UTI. One pt developed urethral cutaneous fistula at the penile scrotal junction. Postmicturition dribbling secondary to diverticulum formation is not a feature in this group of pts and ejaculatory dysfunction has not been reported.Conclusion:  Modified ventral onlaid BM graft urethroplasty has been proven a reliable long‐term solution to pts with recurrent stricture that require substitution urethral reconstruction. The use of pedicle skin flap substitution urethroplasty is limited due to high complication rate in long‐term follow up.