Jonathan Charles Goddard

Incidence and factors predicting the detection of prostate cancer after transurethral resection of the prostate for clinically benign disease.

Introduction: Transurethral resection of the prostate (TURP) is commonly performed as the surgical management of lower urinary tract symptoms due to clinically benign disease. However, prostate cancer is not uncommonly diagnosed after such a procedure. We, therefore, determined in a retrospective study the incidence and factors that might predict the detection of prostate cancer after TURP. Patients and Methods: Between June 2005 and June 2007, a total of 476 men underwent TURP at our department. Of these, 411 men (86%) were thought to have benign disease and were included in the study. Univariate and multivariate logistic regression analyses using age, serum prostate-specific antigen (PSA), urinary retention status, prostate resection weight, FBC and U&E were performed to determine whether prostate cancer could be predicted. Results: A total of 47 men (11.4%) were diagnosed with prostate cancer [24/47 with pT1a (51%) and 23/47 with pT1b (49%)]. Furthermore, the Gleason scores ranged from 5 to 9. Univariate logistic regression analyses revealed that only age (mean: 76 years, range: 54–90 vs. mean: 71 years, range: 49–91 for prostate cancer and non-cancer cases, respectively) and serum PSA (mean: 14.9 ng/ml, range: 0.4–78.0 vs. mean: 7.4 ng/ml, range: 0.2–90.0 for prostate cancer cases and non-cancer cases, respectively) were able to distinguish between cancer and non-cancer cases. In addition, using multivariate logistic regression, age and serum PSA were also the only variables that separated the two groups with a ROC-AUC of 70%. Conclusions: Our retrospective study has demonstrated that a substantial percentage of men are unexpectedly found to have prostate cancer after TURP. In addition, age and serum PSA were independent predictors of those who are likely to have prostate cancer.

Intravesical hyaluronic acid and chondroitin sulfate for recurrent urinary tract infections: systematic review and meta-analysis

Introduction and hypothesisThe objective was to assess the efficacy of intravesical hyaluronic acid (HA) and chondroitin sulfate (CS), alone or in combination, for recurrent urinary tract infections (RUTIs) in adult female patients using a systematic review and meta-analysis.MethodsEnglish-language articles were obtained from the MEDLINE, Embase, and Cochrane databases through November 2016, by manual searching and cross-referencing. Randomized and nonrandomized trials of adult female patients with a documented history of RUTIs who received HA, CS or HA plus CS were included. The random effects model was applied to all pooled analyses. Risk of bias was assessed for individual studies and across studies.ResultsTwo randomized (nxa0=xa085) and six nonrandomized (nxa0=xa0715) studies met the inclusion criteria. These studies assessed HAxa0±xa0CS; studies of CS alone were not identified in the search. HAxa0±xa0CS decreased the UTI rate per patient-year (pooled mean difference [MD] –2.56; 95% confidence interval [CI] –3.86, −1.26; pxa0<xa00.001) and increased the time to first UTI recurrence (pooled MD 130.05xa0days; 95% CI 5.84, 254.26; pxa0=xa00.04). There was heterogeneity in most outcomes considered, and publication bias in many studies. The standard of trial reporting was low. The patient population size, and the number of studies included, were small.ConclusionsHAxa0±xa0CS appears to reduce the rate of UTI and increase the time to recurrence in women with RUTI. As randomized controlled studies are available only for HA plus CS, the quality of evidence is higher for the combination than for HA alone.

Harold Hopkins: a visionary across specialties

www.trendsinmenshealth.com TRENDS IN UROLOGY & MEN’S HEALTH MARCH/APRIL 2018 On 7 June 2018, the Urology Section of the Royal Society of Medicine (RSM) is hosting a symposium, in the elegant surroundings of Chandos House, on the life and work of Harold Hopkins (1918–1994). Hopkins is well known to urologists: his brilliant work on the rod lens was pivotal to the development of endourology in the last quarter of the 20th century. Although the symposium is being hosted by the Urology Section, this will not be a urological meeting; Hopkins’ work affected many spheres of medicine and, indeed, non-medical areas. Speakers from upper and lower gastrointestinal (GI) surgery, hepatobiliary surgery, gastroenterology, gynaecology and orthopaedics will join with urologists and optical scientists to remind us all how the inspired work of Hopkins influenced and furthered science and medicine.

70 years of the NHS - from cradle to grave?

The National Health Service was 70 years old on 4 July this year. As Jonathon Goddard describes it was, and still is, a pioneering venture in national health services around the globe. In this article he provides a potted history from early beginnings to the present day, including how urology developed as a specialty alongside the new NHS.

A Series of Fortunate Events: Harold Hopkins:

Harold Hopkins is known to most urologists for his innovations in the field of endourology: fibreoptics which led to the flexible cystoscopes and ureteroscopes and the rod lens system that revolutionised rigid cystoscopy and endourological surgery. Of course these inventions have benefitted many other areas of medicine such as gynaecology, orthopaedics and gastroenterology. Harold Hopkins however was an optical physicist; his genius was not limited to medical devices. Indeed he could quite easily have concentrated his skills in theoretical physics, optical theory or applied it to optics and lenses in industry. In fact, he could have become an expert linguist eschewing science altogether. As a matter of fact Hopkins did all of these things but it was a series of coincidences that led him to pursue the path of optics and that brought him together with certain doctors in need of a genius with the ability to see novel approaches to their problems.

Vis Unita Fortior – united strength is stronger

2020 will see not only the 75th anniversary of the foundation of BAUS, but also the centenary of the Urology Section of the Royal Society of Medicine. Clearly, it will be a year that sees many celebrations in British urology. Here, Jonathan Goddard looks back at the origins of these two august bodies.

Cystitis and pelvic pain management: guidelines versus real-world practice

Clinical practice guidelines for the management of bladder pain syndrome/chronic pelvic pain aim to help guide clinicians in diagnosing and treating patients they see on a day-to-day basis in the clinic. However, the approaches suggested by current clinical guidelines may not always align with the practicalities of routine clinical practice, where patient expectations must also be taken into consideration.Clinical practice guidelines for the management of bladder pain syndrome/chronic pelvic pain aim to help guide clinicians in diagnosing and treating patients they see on a day-to-day basis in the clinic. However, the approaches suggested by current clinical guidelines may not always align with the practicalities of routine clinical practice, where patient expectations must also be taken into consideration.

Tom Chapman and the Glasgow Punch

Thomas Lightbody Chapman (1903 – 1966) founded the urological department at the Victoria Infirmary, Glasgow. After travelling to the Mayo Clinic in America to learn the new technique of punch prostatectomy he brought that procedure back to Glasgow. The prostatic punch required skill to master but could be successful in the right hands. Chapman was a great teacher who used innovative techniques to educate his students in the skills of punch prostatectomy. These included a training model where the trainee surgeon could be observed punching out a phantom prostate and a cine-film using both live action and animation to demonstrate the technique. Keen to share his enthusiasm for the punch prostatectomy he organized a meeting of like-minded urologists, a group which became the Punch Club, a travelling urology club still active today. Tom Chapman was a colourful and dynamic individual, devoted to his work and his patients. His name will be remembered as being almost synonymous with the punch prostatectomy in Great Britain.

Reginald Harrison; Liverpool’s first Urologist

Reginald Harrison (1837 – 1908) was one of Liverpool’s most famous surgeons; in the late 19th Century he was well known to both the London and provincial medical world. Working at both the Royal Infirmary and Northern Hospital in Liverpool he developed an interest in genito-urinary surgery, becoming a notable expert. Hence, in 1899 he moved to London where he was appointed Surgeon to St Peter’s Hospital for the Stone, England’s first urology hospital. Harrison observed Bigelow’s early cases of litholapaxy in Boston, USA and championed the technique in England. He was an expert in urethral stricture disease, favouring gentle dilatation with filliform bougies, which became known as Harrison’s Whips. He was an energetic Dean of the Liverpool Medical School and was active in its eventual rise and transformation into the University of Liverpool. He also tirelessly campaigned for the introduction of ambulances to Britain’s towns and cities. His efforts led to Europe’s first civilian hospital ambulance being introduced in 1883 at the Northern Hospital in Liverpool. Reginald Harrison is a somewhat forgotten name in urology today, but his contributions to Liverpool’s University, the Ambulance Service and British urology should be celebrated and remembered.

Inguinal lymphadenectomy for squamous cell cancer of the penis—-Experience of a UK supra-regional network

Objective: To present a case series of patients undergoing inguinal lymphadenectomy (IL) for squamous cell cancer (SCC) of the penis within an UK Supra-Regional Network (SRN). Patients and methods: Retrospective case note analysis was undertaken of all patients who underwent IL following referral from the network units across a wide region. Information was cross-referenced from clinician, pathology and hospital episode databases. Results: A total of 79 modified ILs and 11 radical ILs were performed in 49 patients over 5 years. Metastatic involvement was found in 59.1% of patients. Of these 58.6% were found to have extranodal spread at the time of operation. The finding of extranodal spread significantly impacted upon survival. One year survival rates post IL were 100% for pN0 and pN1, compared with 67% for pN3. Kaplan—Meier curves were plotted and showed a significant difference in survival from primary surgery on log rank comparison between pN0/pN1 and pN3 nodal categories. As in most series, IL has a considerable morbidity rate. No perioperative mortality was seen. Conclusions: This case series emphasizes the negative prognostic impact of finding extranodal spread (pN3) at IL. In those with unilateral intranodal metastases (pN1), IL is curative for the majority of patients.