Adebanji Adeyoju

Priapism in sickle-cell disease; incidence, risk factors and complications: an international multicentre study

Objective  To define the incidence, risk factors and complications of priapism in a large population of patients with sickle‐cell anaemia in five centres in the UK and Nigeria, as priapism is common among these patients, but the precise characteristics of the condition in this population are poorly documented.

Laparoscopic pyeloplasty: the first decade

ports introduced to enable dissection and identification of the PUJ. The technical principles and goals are similar to those of open surgery. Depending on the type of procedure the PUJ is either incised or dismembered, and reductive pyeloplasty performed if indicated. The ureteric JJ stent is typically inserted retrogradely before (the authors’ preference being 4.7 F, 26 cm) or during surgery. A drain is inserted to lie adjacent to the completed repair and a Foley catheter is left in the bladder.

A Prospective Diary Study of Stuttering Priapism in Adolescents and Young Men With Sickle Cell Anemia: Report of an International Randomized Control Trial—The Priapism in Sickle Cell Study

Priapism is defined as a prolonged, persistent, and purposeless penile erection. It is a common (35%) but frequently understated complication in young men and adults with sickle cell disease. We had previously demonstrated an association between stuttering attacks (<4 hours) and an acute catastrophic event with its consequent problems of erectile dysfunction and impotence. We describe a randomized, placebo-controlled, clinical study looking at medical prophylaxis with 2 oral α-adrenergic agonists, etilefrine and ephedrine, in preventing stuttering attacks of priapism. One hundred thirty-one patients were registered into a 2-phase (observational and intervention phase) study, and 86 patients (66%) completed Phase A diary charts. Forty-six patients (59%) completed a 6-month treatment phase (Phase B), and the remaining patients were lost to follow-up despite persistent efforts to contact them. Various reasons are postulated for the high attrition rates. The drugs were well tolerated, and no serious adverse events were reported. There was no significant difference among the 4 treatment groups in the weekly total number of attacks in Phase B (analysis of covariance P = .99) nor among the average pain score per attack after adjusting for attack rates and pain scores in Phase A (analysis of covariance P = .33). None of the patients who completed the study required penile aspiration at study sites while on medical prophylaxis. Young men with sickle cell disease are not comfortable engaging with health care providers about issues relating to their sexual health. The full impact of an improved awareness campaign and early presentation to hospital merits further standardized study. Priapism still contributes seriously to the comorbidity experienced by this previously inaccessible group of patients and medical prophylaxis with oral α-adrenergic agonists is feasible. Future international collaborative efforts using some of the lessons learnt in this study should be undertaken.

Laparoscopic radical cystectomy and urinary diversion: fad or future?

DAVID HROUDA, ADEBANJI A.B. ADEYOJU* and INDERBIR S. GILL† Department of Urology, Charing Cross Hospital, London (British Urological Foundation Preceptee at the Cleveland Clinic), *Department of Urology, Stepping Hill Hospital, Stockport, UK (British Urological Foundation/Shackman Fund Preceptee at the Cleveland Clinic) and †The Minimally Invasive Surgery Center, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Nephroptosis: seriously misunderstood?

Nephroptosis has been one of the most controversial and often debated urological diagnoses for more than a century. Anatomically, it is defined as a significant descent ( > 5 cm or two vertebral bodies on IVU) of the kidney as the patient moves from supine to erect [1]. The kidney might move into an abnormal position but is capable of moving back into a normal anatomical site, which differentiates it from an ectopic kidney, which would constantly remain in an abnormal position. The gross downward displacement of the kidney can give rise to symptoms either due to effects on the ureter or the renal hilar vessels.

Diethylstilboestrol for the treatment of prostate cancer: past, present and future

Abstract The aim of this review was to discuss the most recent data from current trials of diethylstilboestrol (DES) to identify its present role in advanced prostate cancer treatment as new hormonal therapies emerge. The most relevant clinical studies using DES in castration-refractory prostate cancer (CRPC) were identified from the literature. The safety, efficacy, outcomes and mechanisms of action are summarized. In the age of chemotherapy this review highlights the efficacy of oestrogen therapy in CRPC. The optimal point in the therapeutic pathway at which DES should be prescribed remains to be established.

The effect of perioperative distal vasal lavage on subsequent semen analysis after vasectomy: a prospective randomized controlled trial

Objective To determine the effect of perioperative distal vasal lavage with 50 mL of normal saline on subsequent time to azoospermia after vasectomy.

A prospective evaluation of scrotal ultrasonography in clinical practice

Objectives To prospectively evaluate scrotal ultrasonography (SUS) in patients presenting with scrotal symptoms and to make recommendations about use of SUS in clinical practice.

Anaesthesia for Supine and Modified Supine PNL

Anaesthetists need to be aware of the difficulties and complications specific to PNL, a well-established endourological means of kidney stone removal. Although traditionally PNL has been performed in the semi-prone or prone position, more recently some centres have been successfully performing the procedure in a supine or modified supine position. This presents some significant advantages from the viewpoint of the anaesthetist, as well as a small number of disadvantages. However, many of the anaesthetist’s concerns regarding PNL are similar whatever the position used. Patient’s features and co-morbidities should be preliminarily evaluated in order to choose the best anaesthetic technique. Intraoperative management is also described, facing not only specific PNL complications such as blood loss or septic risk but also often overlooked issues including fluid balance and thermal control.

The Use and Misuse of the PSA Test: A Retrospective Case Note Review of Testing in a UK Teaching Hospital

Introduction: PSA testing is commonly performed by non-urological specialties in the hospital setting. The indications for requesting a PSA test can vary widely in this group and may not always be appropriate. This may generate unnecessary patient anxiety and additional testing. This study was designed to assess the appropriateness of PSA requests by non-urologists in the hospital setting. Methods: A computer search for patient details of all PSA requests within a 3 month period by non-urologists was generated by the pathology department. 130 consecutive case notes were then reviewed of which 95 met the inclusion criteria. The reason for each request was then determined to be appropriate or inappropriate according to standard urological practice. Results: 95 patients were included. Of these, 61 (64%) requests were made by medical specialties, 17 (18%) were requested by orthopaedics, 12 (13%) by general surgery and the remaining 5 (5%) by other specialties. There were 26 (27%) requests deemed appropriate and 69 (73%) inappropriate. Of the inappropriate requests in 52 cases no reason was given, 14 were made immediately after acute urinary retention and 9 were during a suspected urinary infection. A rectal examination was performed in conjunction with the test in 24 cases. Conclusion: In this setting the majority of PSA requests made by non-urologists was inappropriate. This may be due to a lack of knowledge of the indication for PSA testing and the factors which may cause a false positive result. There was a low level of rectal examination. More education is needed to improve this situation.