bluuebunny/crossref_metadata_2025_split huggingface dataset:
56  Prostate glands larger than 75 cc result in worse outcomes following radical prostatectomy: implications for registrar training
Authors: PATEL M.I. , CHAN W. , WOO H. , LAU H. , DRUMMOND M. , BROOKS A. 
Published: February 2006

Introduction and Objective:  Open radical prostatectomy is a difficult and complex operation to teach residents. Many patient factors can increase the complexity of the operation, with the majority not being predictable prior to the operation. We hypothesised that large prostate glands (>75 cc) would result in increased difficulty, higher intraoperative complications, and subsequently poorer cancer and functional outcomes.Methods:  A retrospective analysis of the records of patients in our database of radical prostatectomies performed at Westmead Hospital. Patients operated on by the training urology registrar were identified and further analysed. Intraoperative as well as postoperative complications, pathology results and postoperative gain of potency and continence were evaluated.Results:  Between 2/6/1998 to 14/8/04, 181 open radical prostatectomies were performed at Westmead Public Hospital by the training registrar. Preoperative variables revealed that the majority of these patients had large volume cancer (171 pts with cT2 cancer, 70 pts with Gleason Score ≥7). PSA ranged from 1.2–27 ng/ml (median 6.9 ng/ml). Prostate size ranged from 11–112 cc (median 31 cc) measured by TRUS ultrasound. Correlation between calculated TRUS volume and prostate weight at surgery was high (r = 0.93). Prostate glands greater than 75 cc were associated with older age (P = 0.001), longer operation time (P < 0.001)and higher estimated blood loss (P < 0.001). Postoperatively, prostate glands >75 cc required median of 7 vs 3 months to achieve continence (P < 0.001). At a median follow time of 45 months, men with prostates <75 cc had a 62% chance of achieving potency compared to 10% of men who has glands >75cc (P < 0.001). Oncologically, larger prostates had less positive surgical margins (P = 0.006) and less PSA recurrence (P = 0.024).Conclusions:  Prostates larger than 75 cc result in longer operative times, higher blood loss as well as poorer continence and potency. Patients should be counselled accordingly and trainers should be prepared to supervise more carefully when teaching inexperienced trainees.
58  Robotic laparoscopic radical prostatectomy for non‐laparoscopic surgeons ‐ what is the learning curve?
Authors: BOUCHIER‐HAYES D.M. , VAN APPLEDORN S. , CROWE H. , PETERS J.S. , COSTELLO A.J. 
Published: February 2006

Introduction:  Laparoscopic radical prostatectomy (LRP) has been shown to have many advantages over open surgery, but has proven difficult for many to become adept at. The use of the Da Vinci® robotic system greatly facilitates the performance of LRP. We set out to analyse how many cases it takes to become proficient at Robotic Assisted Laparoscopic radical Prostatectomy (RALRP).Methods and Methods:  Two experienced open surgeons began performing RALRP using the Da Vinci® robotic system in December 2003. Duration of various steps were measured prospectively. Results were grouped sequentially in groups of 10 patients and analysed statistically to determine at what point these results reflected increased operative proficiency. Surgeons results were analysed separately to provide internal validation.Results:  One hundred and ten consecutive patients were evaluated. Overall operative times for both surgeons decreased significantly (P < 0.05) over the first 30 cases after which they plateaued at an average of 191 min (36.3% reduction). Actual operative time also decreased significantly (P < 0.01) at or before the 30th case until plateauing at 146 min (39% reduction).Conclusion:  RALRP is a procedure that can be mastered much more quickly than standard LRP by experienced open surgeons inexperienced in laparoscopic surgery, with surgical proficiency being attained at/before the 30th case.
64  Pilot study of local anaesthetic infusion pump for analgesia following radical prostatectomy
Authors: WOO H. 
Published: February 2006

Introduction:  The PainbusterTM is a local anaesthetic(LA) infusion pump placed into wounds as a means of reducing postoperative pain. A reservoir is filled with LA under pressure and a controlled constant output of LA is delivered into the wound immediately overlying the muscular closure using epidural‐like catheters. The use of these devices have not previously been reported in the specific setting of open radical prostatectomy. The objective of this pilot study was to assess the impact of the PainbusterTM on postoperative pain scores and narcotic analgesic requirements with a view to providing a basis for power calculations for a randomised study with or without the use of a PainbusterTM.Methods:  Analgesic requirements of 24 consecutive patients undergoing radical prostatectomy were studied. The first 12 (Group A) had PainbusterTM devices in addition to Pain Controlled Analgesia (PCA) devices and the following 12 (Group B) only had PCA devices. As part of standard ward protocol, patients are scored for pain using a 0 to 10 numerical pain score every 1 to 2 h unless asleep.Results:  Conclusions:  Statistical significance was not to be expected given the small numbers in each limb. The PainbusterTM does significantly reduce the maximum pain the patient will experience at any time during the postoperative period in hospital. Use of the PainbusterTM appears to halve narcotic analgesic requirements following radical prostatectomy and allows for some basis upon which appropriate power calculations can be made for Phase 3 studies.

Group A
Group B
P‐value

Mean pain score in first 24 h
1.67
2.74
0.06

Mean pain score overall
1.70
2.50
0.10

Masimum pain score reported
3.25
5.91
<0.002

Morphine equivalent requirement
26
51
0.12

Length of stay
3.4
5.1
0.10
65  Multi‐resistant Escherichia coli septicaemia following transrectal ultrasound guided prostate biopsy – an emerging risk
Authors: DAVIDSON A.‐J. , LAWRENTSCHUK N. , JENNENS I.D. , SUTHERLAND M. , WEBB D.R. 
Published: February 2006

Introduction:  Transrectal ultrasound (TRUS) guided biopsy of the prostate is the standard procedure for diagnosing prostate carcinoma. Complications range from discomfort and bleeding to asymptomatic bacteruria and sepsis. Rarely, sepsis is fatal. E. coli is the most common pathogen causing infection and although no international standard for the use of prophylactic antibiotics exists their use has decreased the incidence of infection to around 2%. Worldwide the incidence of multi‐resistant E. coli (MREC) is increasing, and we report two cases of septicaemia secondary to MREC infection postprostate biopsy.Methods:  We performed a review of case records involving postprostate biopsy MREC infection. A comprehensive literature review of TRUS guided biopsy of the prostate was also performed.Results:  All patients in our series had MREC cultured following TRUS guided biopsy of the prostate. All received the same prophylactic antibiotic regime (norfloxacin and gentamicin). They required admission to hospital for intravenous antibiotics and in two cases inotropic support, eventually making full recoveries. All had a history of recent travel to a developing country whilst two had self‐limiting diarrhoea and this is the first report in the English literature of MREC following prostate biopsy. Other risk factors for acquiring multi‐resistant urinary tract infections have been identified including age and previous quinolone therapy.Conclusion:  Antibiotic prophylaxis for biopsy of the prostate, being predominantly quinolones, will continue to aid in reducing morbidity. However, with the prevalence of MREC increasing current regimens will not cover such organisms potentially leading to sepsis. In our cases travel to developing countries appeared to be a risk factor for being colonised with MREC. We believe through careful history risk factors for multi‐resistant urinary tract infection including travel may alert doctors to the potential risk of MREC at the time of biopsy leading to the addition of a broader spectrum antibiotic such as intravenous meropenem.
67  Double blind randomised controlled trial of topical cophenylcaine forte spray in prostatic biopsy
Authors: GOGIA R. , LLOYD M. 
Published: February 2006

Introduction:  It is well known patients find prostate biopsy uncomfortable, and in many instances painful. There may also be discomfort and embarrassment of postbiopsy bleeding. Cophenylcaine Forte spray (Lignocaine Hydrochloride 5.0%, Phenylephrine Hydrochloride 0.5%) is a drug with local anaesthetic and vasoconstrictor properties currently used as a topical preparation in Ear, Nose and Throat surgery. It is suggested that topical application of Cophenylcaine Forte spray to the rectal mucosa prior to prostate biopsy will reduce the discomfort associated with the insertion of the ultrasound probe into the rectum and possibly reduce postbiopsy bleeding. We are unaware of any previous studies addressing these issues.Methods:  After human ethics committee approval and informed consent, 30 consecutive patients presenting for prostate biopsy were randomised to receive either Cophenylcaine Forte spray or placebo saline spray topically to the rectal mucosa ten minutes prior to biopsy. All patients then proceeded to have a 12 core prostate biopsy performed with bilateral periprostatic block (Lignocaine 1.0%, 10 ml) under transrectal ultrasound guidance by a single operator. An investigator questionnaire consisting of pre and postbiopsy pulse and blood pressure and a visual analogue score for observed patient discomfort and bleeding were completed by the single investigator. In addition, a patient questionnaire 30 min postprocedure and the day after the procedure were also completed assessing discomfort and postbiopsy bleeding from the patient's perspective. Patients with painful anorectal abnormalities or anal stenosis were excluded and biopsied under general anaesthetic.Results:  No statistically significant differences were observed between the two treatment groups for any of the parameters considered. Specifically there was no improvement in rectal discomfort or bleeding with the use of Cophenylcaine Forte spray.Conclusion:  Cophenylcaine Forte topical rectal spray appears to make no difference to patient discomfort, postbiopsy bleeding or ease of the procedure during transrectal ultrasound and prostate biopsy.
68  Junior medical officers and basic urology: a questionnaire
Authors: LOUIE‐JOHNSUN M. , MUNZEL B. , MURPHY D. 
Published: February 2006

Purpose:  Urological disease is very common. In certain settings, urological assistance may not be easily accessible. Undergraduate and postgraduate programs must provide a basic level of training to deal with common problems. We assessed JMOs (junior medical officer) confidence and capability in managing every day urology.Methodology:  At a regional hospital, a questionnaire was distributed to 42 JMOs. The number of and confidence in performing basic urological procedures were assessed. A second part involved multiple choice questions on clinical scenarios.Results:  Response rate was 100% with 15 interns, 13 residents and 14 registrars from various specialties returning completed questionnaires. Eight (19%) JMOs had previously worked in a urology unit (UJMOs). 54% of HMOs had inserted >10 male urethral catheters compared to 28% >10 female catheters. They were also more confident with male catheters (51% vs. 18% very confident). Despite 18(43%) JMOs performing >30 rectal examinations, only 1 felt very confident in assessing prostate gland characteristics. UJMOs had performed more and were more confident (P < 0.05) in these simple procedures. Only six JMOs (14%) had inserted a suprapubic catheter. Overall, only 59% answers to clinical scenarios were correct.Conclusion:  This simple questionnaire highlights JMOs perceived deficiencies in areas such as female urethral catheterization and interpretation of rectal examination. Questionnaires like this can be used to help structure undergraduate curriculum and postgraduate workshops to improve confidence and competence.
7  Positive margin rates in patients with a single positive core on extended TRUS biopsy
Authors: DANGERFIELD D. , SAMARATUNGA H. , YAXLEY J. 
Published: February 2006

Introduction:  Extended TRUS biopsy (12 biopsies or more) is now a standard technique performed in many centres. The management of small volume prostate cancer (<0.05cc) found in a single TRUS biopsy is controversial and may have implications in nerve‐sparing versus non‐nerve sparing radical prostatectomy. The aims of this study are:• To assess the incidence of prostate cancer in the unaffected contralateral prostate lobe on final histopathology• To assess the incidence of extracapsular extension and margin status in the ipsilateral and contralateral lobesPatients and methods:  Of 897 radical prostatectomy specimens examined through Sullivan Nicolaides Pathology between 2002 and 2005, 78 had a single positive core in preoperative TRUS biopsy. Histopathalogy, PSA and Gleason sum were reviewed.Results:  For patients with a Gleason sum of 6 on TRUS biopsy the mean PSA was 7.00 mcgm/dl. A majority (85%) of the positive cores had low volume disease with tumour occupying less than 30% of the core. Of those with Gleason 3 + 3 = 6 on TRUS biopsy, 34% had their Gleason sum upgraded on final histopathology. Ipsilateral positive margin was seen in 14% of cases. Contralateral positive margin was present in only 2.8% of cases despite tumour being found in 61% of cases in the contralateral lobe on final histopathology.Conclusion:  This study shows that in patients with a single positive core of low volume disease, the incidence of contralateral margin involvement on final histopathology is very low. This data is useful in counselling patients who intend to undergo nerve sparing radical prostatectomy.
72  Urodynamics in the octogenarian: is it worthwhile?
Authors: DORKIN T.J. , BROMAGE S.J. , CHAN L. , TSE V. 
Published: February 2006

Introduction:  Treatment of lower urinary tract (LUT) dysfunction is often based on symptoms, which may correlate poorly with definitive diagnosis and carry significant side‐effects. We analysed the utility of urodynamic assessment in an elderly population to determine how closely symptoms predict urodynamic diagnosis.Materials and Methods:  One hundred fifty‐seven patients over the age of 80, who underwent multi‐channel fluoroscopic urodynamics for the assessment of voiding dysfunction, were included. The studies were conducted according to ICS standards. The clinical records were analysed retrospectively to collect data on patient symptoms and management. The clinical and urodynamic diagnoses were compared to assess the predictive value of symptoms in this population.Results:  There were 122 males and 35 females. The mean age was 84 (range 80–94). Detrusor overactivity (DO) was the most common urodynamic finding in male patients, seen in 56/122 (46%), whereas decreased bladder compliance was the most common in females, seen in 11/35 (31%). 70/157 (45%) patients presented with pure storage symptoms (39 men and 31 women), and DO was found in only 30 of these (43%). 31/157 patients (20%) presented with pure voiding symptoms (29 males and 2 females), and bladder outlet obstruction was identified in only 15 of these (48%).Conclusion:  In octogenarians, there is a poor correlation between LUT symptoms and urodynamic diagnosis. We suggest that, in suitable elderly patients, urodynamic evaluation is useful and can guide patient management. This is particularly important for patients with presumed DO, in whom empirical prescribing of antimuscarinic agents may be associated with significant side effects.
75  Long‐term follow up of tension free vaginal tape for stress urinary incontinence in females with neuropathic bladder
Authors: PATKI P. , HAMID R. , ARUMUGAM K. , WOOD S. , SHAH P.J.R. 
Published: February 2006

Introduction:  We evaluated safety and long‐term efficacy of TVT in treatment of urodynamic stress incontinence (USI) in females with neuropathic bladders.Method:  Sixteen incontinent female patients were treated. 11 women were postlumbar spinal surgery and five postspinal cord injury. Four had previously failed surgery for USI. Patient demographics, pre and postoperative clinical and videocystometrogram (VCMG) parameters were recorded. Continence assessment at 6 weeks (voiding diary and pad test), 3 months (VCMG) and yearly follow up was recorded.Results:  Mean age was 55 years with mean follow up of 52.7 months (range 12–86). At last follow up 87.5% patients (14/16) were continent. The two failures were due to persistent USI and postoperative detrusor hyperreflexia (DH). DH was pre operatively present in 4, requiring simultaneous intra detrusor botulinum toxin injections in two and anticholinergic medications in rest. Bladder perforation was seen in one and urinary infections in three. Mean pre and postoperative detrusor pressures were 23.8 and 15 cm of water. Two patients continued to use pads (3/day) similar to pre operative cumulative average of three pads/day. Preoperatively 11 patients performed intermittent catheters (SIC), three spontaneous voids (SV) and one combination of the two with one on indwelling urethral catheter (IDUC). One patient each on SV, SIC and IDUC changed to SIC. Conversely one each on SIC and SV changed to combination.Conclusion:  TVT is safe, effective long‐term treatment for USI in females with neuropathic bladders. DH needs adequate suppression with regular VCMG follow up. Previous incontinence surgery did not affect complications or outcome.
77  Vanilloid receptor expression in body and trigone of female urinary bladder: changes in urgency without detrusor overactivity
Authors: LIU L. , KRISTIANA I. , MANSFIELD K.J. , VAUX K. , MILLARD R.J. , BURCHER E. 
Published: February 2006

Introduction:  Patients with sensory urgency (SU): the symptom complex of urgency associated with pain, burning or discomfort, often accompanied by frequency and nocturia, are difficult to treat. Vanilloid receptors on afferent neurons and on urothelium may participate in signalling from the bladder. Our aim was to examine whether changes in VR1 expression occur in bladder from SU patients compared with controls.Patients:  Biopsies from body and trigone were obtained from patients with SU (female, aged 21–82) who had undergone videourodynamics to exclude detrusor overactivity and define first sensation. Asymptomatic age‐matched females with prior history of carcinoma acted as controls. Biopsies were collected into ‘RNALater’. Specimens were dissected into two layers, mucosa and detrusor muscle, before RNA extraction and quantitative competitive RT‐PCR (Mansfield et al 2005 Br J Pharmacol 144: 1089–99).Results:  In control biopsies, VR1 mRNA was present in greater density in mucosa than in detrusor muscle (15.3 × 105cf. 4.6 × 105 copies/μg RNA, both n = 15, P < 0.01). In SU, VR1 mRNA expression was significantly higher in trigonal mucosa than in body mucosa (19.1 × 105 cf. 7.4 × 105 copies/μg RNA, n = 21‐‐23, P < 0.01). There was no significant change in VR1 expression in body mucosa from SU specimens compared with matched controls. In SU patients, the level of VR1 expression in trigonal mucosa (but not body mucosa) was significantly inversely correlated with the volume at first bladder sensation (r2 = 0.41, P < 0.01).Conclusion:  We hypothesise that excessive afferent signalling via VR1 receptors in the trigone region may be related to an early first bladder sensation and sensory urgency.
79  Examination of potential sources of smooth muscle for use as a transplantable, innervated sphincter.
Authors: BRAMICH N.J. , O'CONNELL H.E. , HIRST G.D.S. 
Published: February 2006

Aim:  To examine the electrical and mechanical properties of different smooth muscle tissues for their suitability to assist the malfunctioning urethral sphincter in the treatment of stress urinary incontinence.Methods:  Changes in contractile state and membrane potential, in response to nerve stimulation, were measured from guinea‐pig mesenteric veins, detrusor smooth muscle and rat dartos.Results:  Intracellular recordings made from mesenteric veins (diameter 100–250 ??m) displayed stable resting membrane potentials (RMPs) of –65.2 ± 2.7 mV (10 cells, five animals). Stimulation with long trains at low frequencies (80s, 0.5–2 Hz), evoked slow sustained membrane depolarizations and constrictions which reached a peak within 50s. Stimulation at 2Hz evoked a membrane depolarization of 16.3 ± 4mV and a 17 ± 7% reduction in vessel diameter. Upon cessation of stimulation, the membrane potential and blood vessel diameter rapidly returned to baseline levels. Detrusor smooth muscle cells had RMPs of –40 ± 4 mV (n = 3). Stimulation at frequencies of 1 to 5 Hz evoked muscle action potentials and contractions. Contractions evoked by long trains of nerve stimulation were not sustained for the duration of stimulus. For example, a stimulus train of 80 s at 1 Hz, evoked a contraction of 20 ± 9 mN which reduced to 3 ± 1 mN (n = 3). Hyoscine reduced the secondary phase of the contraction from 3 ± 0.4 mN to 0.7 ± 0.4 mN (P < 0.01, n = 3). Rat dartos smooth muscle had a RMP of –64 ± 1 mV (n = 38). Long trains of low frequency nerve stimulation (1 Hz for 80s), evoked a slow membrane depolarization of 15 ± 4 mV and sustained contraction of 12 ± 2 mN. Increasing the frequency of stimulation caused a graded increase in the amplitude of both the membrane depolarization and contraction. Following the cessation of stimulus, the membrane potential and force generated by the smooth muscle immediately returned to baseline. All responses were blocked by the α‐adrenoceptor antagonists phentolamine (1 μM) and prazosin (0.1 μM).Conclusion:  Smooth muscles of the mesenteric vein and dartos display contractile properties which make them suitable for use as transplantable sphincters. In addition, dartos smooth muscle possesses similar pharmacological properties to the proximal urethral sphincter.
86  A prospective study for the treatment of stress urinary incontinence arising from intrinsic sphincter deficiency with ACT™ balloons (adjustable continence therapy)
Authors: CHARTIER KASTLER E. , CARDOT V. , MOZER P. , BASTIEN L. , RICHARD F. , DENYS P. 
Published: February 2006

Introduction:  The study assessed the treatment of intrinsic sphincter deficiency with the ACT™ system in neurogenic patients.Material and methods:  The ACT™ consists of two postoperatively adjustable silicone balloons placed paraurethrally in females and at the prostatic apex, or vesico‐urethral anastomosis in males. Balloon titration is via tubing connected to a titanium port in the labia majora or scrotum. Efficacy assessment was based on technical feasibility and patient assessment of leakage and acceptance.Results:  Eighteen implantations including three revisions were performed on 12 females and three males. Mean age was 51.9 years, mean follow‐up was 18 (8–40) months with a mean neurogenic history of 15 years (1 to 54). Aetiology of neurogenic disease was mixed and included degenerative; spinal cord injury; oncological, vascular and congenital disorders with most patients self catheterising and using either anticholinergics and/ or Botox or had previously undergone enterocystoplasty. Procedure was performed using local (72%), general (5.5%) or no anaesthesia (22%). At follow up, seven patients were dry and pad free(46%), six improved (not requesting any further adjustment)(40%), two failed. 8/30 devices were explanted in five patients due to erosion (six), device failure (one) and treatment failure (one). 3/5 have been reimplanted, with 1/5 planned for reimplantation. Of these three patients, two were dry and one significantly improved. No major complication has been described.Conclusion:  ACT balloons may be considered for treatment of ISD in neurogenic patients provided that patients are informed of the increased risk of erosion, and the possibility of secondary implantation.