Gregory Boustead

Sildenafil influences lower urinary tract symptoms

Objective  To assess the possible relationship between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) in men, and whether treatment of their ED with sildenafil influences their LUTS.

The tension-free vaginal tape for treating female stress urinary incontinence.

The use of pubovaginal slings for the treatment of incontinence was first described by Goebell [1] almost a century ago. Historically, pubovaginal slings have a favourable cure rate but have been perceived as having unacceptably high rates of prolonged urinary retention, secondary detrusor instability and risk of urethral erosion. For these reasons slings were reserved for patients with type III stress incontinence or what has more recently been called intrinsic sphincter deficiency (ISD) [2]. Before the 1990s slings were generally not used as the primary treatment for uncomplicated stress incontinence. However, the high success rates and durability of sling surgery have made this an increasingly attractive treatment option for both primary and previous surgical failures [3,4]. The indications for insertion of a sling have therefore been extended to address all three groups of women with stress incontinence, i.e. ISD alone, ISD with urethral hypermobility and urethral hypermobility alone [5]. Several new surgical procedures have recently been developed for treating stress incontinence, using a variety of sling types. The tension-free vaginal tape (TVT, Ethicon Gynecare, UK) is a relatively new procedure that uses a synthetic polypropylene mesh sling placed in the midurethral position. Early published data suggest good success rates, with a minimally invasive procedure that can be performed under local anaesthesia with low morbidity. The procedure has gained widespread popularity amongst both urologists and urogynaecologists, although long-term results are not yet available. This review summarizes the development, outcomes and complications of the TVT procedure. New theories on the pathophysiology of stress incontinence

A study comparing various noninvasive methods of detecting bladder cancer in urine

Objectives To compare the nuclear matrix protein (NMP)‐22 assay, bladder tumour specific antigen (BTAstat) test, telomerase activity (using the telomeric repeat amplification protocol assay, TRAP) and a haemoglobin dipstick test for their ability to replace voided urine cytology (VUC) for detecting bladder cancer.

Prevalence of undiagnosed diabetes mellitus in male erectile dysfunction

Objective To determine the prevalence of previously undiagnosed diabetes mellitus (DM) in men presenting with erectile dysfunction (ED), using fasting blood glucose (FBG) compared with urinary dipstick testing for glycosuria.

Increased patient satisfaction from transrectal ultrasonography and biopsy under sedation.

Objective To determine the acceptability and patient satisfaction of transrectal biopsy undertaken with the patient under sedation.

Systematic review of early vs deferred hormonal treatment of locally advanced prostate cancer: a meta-analysis of randomized controlled trials

To compare the effectiveness of hormonal treatment (luteinizing hormone‐releasing hormone agonists and/or antiandrogens) as an early or as a deferred intervention for patients with locally advanced prostate cancer (LAPC), as radiotherapy is currently the standard treatment for LAPC, with hormonal treatment considered a reserve option.

Stage, grade and pathological characteristics of bladder cancer in the UK: British Association of Urological Surgeons (BAUS) Urological Tumour Registry

To investigate Tumour‐Node‐Metastasis (TNM) stage and demographics at presentation in a very large, contemporary UK cohort of patients with bladder cancer and compare them with other published series, as little published data exists on the pathological characteristics of bladder cancer at presentation.

Time trends in case selection, stage and prostate-specific antigen recurrence after radical prostatectomy: a multicentre audit.

To report an audit of preoperative staging variables, case selection, stage migration and prostate‐specific antigen (PSA) recurrence at five large centres in the south of England. To establish PSA outcome values after radical prostatectomy for clinically localized prostate cancer in the UK, and enable appropriate patient counselling.

The total percentage of biopsy cores with cancer improves the prediction of pathological stage after radical prostatectomy

To examine whether the simple variable ‘percentage of cancer‐positive biopsy cores’ is a significant predictor of true pathological stage after radical prostatectomy and can be used to improve pathological stage prediction by simple means.

Developing a robotic prostatectomy service and a robotic fellowship programme - defining the learning curve.

Introduction: Robotic radical prostatectomy (RRP) is an established treatment for prostate cancer in selected centres with appropriate expertise. We studied our single-centre experience of developing a RRP service and subsequent training of 2 additional surgeons by the initial surgeon and the introduction of United Kingdoms first nationally accredited robotic fellowship training programme. We assessed the learning curve of the 3 surgeons with regard to peri-operative outcomes and oncological results. Patients and Methods: Three hundred consecutive patients underwent RRP between November 2008 and August 2012. Patients were divided into 3 equal groups (Group 1, case 1-100; Group 2, case 101-200; and Group 3, case 201-300). Age, ASA score, preoperative co-morbidities and indications for laparoscopic radical prostatectomy were comparable for all 3 patient groups. Peri-operative and oncological outcomes were compared across all 3 groups to assess the impact of the learning curve for laparoscopic radical prostatectomy. All surgical complications were classified using the Clavien-Dindo system. Results: The mean age was 60.7 years (range 41-74). There was a significant reduction in the mean console time (p < 0.001), operating time (p < 0.001), mean length of hospital stay (p < 0.001) and duration of catheter (p < 0.001) between the 3 groups as the series progressed. The two most important factors predictive of positive surgical margins (PSM) at RRP were the initial prostate specific antigen (PSA) and tumor stage at diagnosis. The overall PSM rate was 26.7%. For T2/T3 tumors the incidence of PSM reduced as the series progressed (Group 1- 22%, Group 2- 32% and Group 3- 26%). The incidence of major complications i.e. grade Clavien-Dindo system score ≤ III was 2% (6/300). Conclusion: RRP is a safe procedure with low morbidity. As surgeons progress through the learning curve peri-operative parameters and oncological outcomes improve. This learning curve is not affected by the introduction of a fellowship-training programme. Using a carefully structured mentored approach, RRP can be safely introduced as a new procedure without compromising patient outcomes.