Stephen R. Payne

Inadvertent prescription of gelatin-containing oral medication: its acceptability to patients

When prescribing, doctors usually only consider the ‘active’ component of any drugs formulation ignoring the majority of the agents which make up the bulk of the tablet or capsule, collectively known as excipients. Many urological drugs contain the excipient gelatin which is, universally, of animal origin; this may conflict with the dietetic ideals of patients. A questionnaire-based study, undertaken between January and June 2010 in a mixed ethnicity inner-city population presenting with urological symptoms, asked which patients preferred not to ingest animal-based products, who would ask about the content of their prescribed treatment and who would refuse to take that medication if alternatives were available. Ultimately, the authors sought to find out how many patients had been inadvertently prescribed gelatin-containing oral medications and to suggest ways in which prescriptions might be more congruous with an individual patients dietetic wishes. This study demonstrated that 43.2% of the study population would prefer not to take animal product-containing medication even if no alternative were available. 51% of men with lower urinary tract symptoms were also found to have inadvertently been prescribed gelatin-containing products against their preferred dietary restriction. Education of healthcare professionals about excipients and getting them to ask about a patients dietetic preferences may help avoid inadvertent prescription of the excipient gelatin in oral medications. Substitution of gelatin with vegetable-based alternatives and clearer labelling on drug packaging are alternative strategies to help minimise the risks of inadvertently contravening a patients dietetic beliefs when prescribing oral medication.

How long is urinary cytology abnormal after flexible cystoscopy

To examine the urinary cytological changes caused by flexible cystoscopy and provide clinical guidelines for a reliable time interval for urinary cytological examination after flexible cystoscopy.

IMPROVING THE QUALITY OF OPERATION NOTES

Surgical outcomes vary greatly between individual surgeons performing complex urological operations [1,2]. Intraoperative surgical technique has a significant effect on morbidity in complex cases [3,4] and regular feedback about adverse outcomes, along with modifications in surgical technique, has been suggested as a method of improving surgical outcomes [1]. Analysis of operative technique is difficult, however, as there is a wide variation in the information recorded within operation notes [5–11].

The record of in-training assessments (RITAs) in urology: an evaluation of trainee perceptions.

AIMS To evaluate the effect of the Calman reforms on SpRs in urology with respect to their educational goals, their experience of the RITA process and its value in preparing them for their chosen consultant careers. PARTICIPANTS AND METHODS All urological trainees holding national training numbers who had completed at least one RITA review, but had not yet been awarded a CCST, were sampled. RESULTS A total of 100 completed replies were received. Of those replying, 87% had an appointed educational supervisor with marked variation between regions. Training expectations in the four main categories of knowledge, vocational skills, operative competencies and personal development for each particular year of training were clear to only 40%, 35%, 44% and 60% of trainees, respectively. In general, trainee satisfaction with their most recent RITA review was fair with a mean of 6 (range, 4-8) on an arbitrary 10-point scale. Of the trainees, 83% felt that they would be adequately trained for consultant practice at the end of their training although this confidence varied between years of training. CONCLUSIONS Unification in the registrar grade has initiated an improvement in urological education for SpRs. There has, however, been haphazard delivery of that education due to a lack of objectivity in definition and assessment of the educational goals in individual training years. The RITA process should be more prescriptive in its administration and the setting of annual targeted training objectives should help to optimise the training opportunities for individual SpRs.

The Problems of Gelatine and Prescribing Urologically Specific Medication to a Diverse Population in the UK. An Initial Study

Introduction: Gelatine is a setting agent used by the food and drug industries whose consumption is forbidden by religious and other faith groups. Gelatine-containing drugs are found in most of the drug classifications in Section 7.4 of the British National Formulary (BNF). We investigate the issues and seek to provide a solution to the use of gelatine-containing medications in urology. Methods: Forty representative urological practitioners were surveyed to ascertain if they knew of gelatine-containing urological drugs, had encountered patients enquiring about gelatine-containing medication, and where they would seek this information from. Results: Twenty-five percent of surveyed urologists had experience of patients refusing medication on the suspicion of gelatine content. 53% were unsure if urological drugs could contain gelatine, while 22%, wrongly, thought they did not. Regarding acquisition of drug constituent information, approximately a third did not know, a third looked to incorrect resources and a third referred to their pharmacys drug information service. Conclusion: Most urologists are unaware of the issues surrounding the prescribing of gelatine-containing urological medications, the most important being those given for the management of prostatic hypertrophy. A knowledge of alternative prescribing options can help avoid belief violation for our diverse community in the UK.

Choose and Book: An Audit of the Appropriateness of Referrals and Their Effect on Patients' Attendance to An Inner City Hospital Secondary Care Provider

Conventional, paper-based, urological referral has been challenged by the computer-based, choose and book (C&B) system. To determine the efficiency of this new system, we audited the appropriateness of these bookings, the percentage that required re-direction, the reasons for doing so and the ‘did not attend’ (DNA) rate. 1147 electronic bookings were made to different urological clinics between June 2006 and August 2007. The patients age, date and type of clinic originally booked to, via C&B, and finally re-directed to was collected from our C&B record, PAS and Medisec. 1952 referrals via all modes were identified between April and November, 2006 and data on patient demographics, type of referral and whether attended or DNA was recorded. Nearly a quarter of C&B appointments were re-directed, due to referrals being made to an inappropriate clinic, inappropriate consultant, inappropriate speciality, to the wrong hospital. Additionally, 32.3% were inappropriately prioritised, 7% being given inappropriate urgency and 25.3% not enough priority. DNA rate (18.9%) was higher for bookings made via C&B when compared to bookings made via standard paper-based GP referrals (15.3%). Although C&B facilitates patients to make their choice of appointments, nearly a quarter of our patients had arrangements made inappropriate to their needs. This meant consultants still had to screen referrals and increased workload on ancillary staff. Despite being offered a choice, DNA rate was high in referrals via C&B. Refinement of C&B pathways may reduce this inefficiency but the inflexibility of this system makes it an inefficient way of referring urological cases.

The use of prostate-specific antigen testing in men presenting with haematuria

To analyse prostate‐specific antigen (PSA) levels and clinical outcome in men presenting with haematuria, to develop an evidence‐base for the use of PSA testing in this setting, as haematuria is a known complication of locally invasive prostate cancer, and so PSA levels are often measured in patients presenting with haematuria.

Percutaneous Sperm Retrieval in Secondary Azoospermia

Introduction: Males presenting for assisted reproduction after vasectomy have a high chance of normal spermatogenesis and of successful surgical sperm retrieval. We aimed to evaluate simple percutaneous methods of retrieving sperm for intracytoplasmic sperm injection in males with secondary azoospermia due to previous vasectomy. Patients and Methods: We analyzed a series of post-vasectomy males who presented for sperm retrieval between 1999 and 2005 and who were not being considered for vasal reconstruction as their primary method of re-establishing their fertility. Results: All 132 men had sperm retrieved successfully, 97% with percutaneous methods. In seventy-five percent of the couples intracytoplasmic sperm injection was done, with a total number of 184 cycles being performed. The clinical pregnancy and live birth rates were 25 and 24%, respectively. There were no significant scrotal haematomas, and only 2 patients had postoperative pain after percutaneous sperm retrieval that required analgesia for more than 2 days. Conclusion: We have shown that percutaneous sperm retrieval, where normal spermatogenesis is assumed, is successful in all men following vasectomy. Percutaneous methods of retrieving epididymal or testicular sperm are inexpensive, simple and could replace open techniques in men who are not considering vasal reconstruction following vasectomy.

1061 FACTORS AFFECTING SUCCESSFUL OUTCOME FROM ICSI IN MEN FOLLOWING PREVIOUS VASECTOMY

There are conflicting reports as to whether the interval between vasectomy and surgical sperm retrieval (SSR) for intra-cytoplasmic sperm injection (ISCI) is related to clinical pregnancy (CPR), and live birth (LBR), rates. This study aimed to evaluate factors that may influence the outcome of ICSI in males with secondary azoospermia due to previous vasectomy. We analysed the medical records of 198 azoospermic males following vasectomy who underwent percutaneous epididymal sperm aspiration (PESA) and/or testicular sperm extraction (TeSE), between 1997 and 2005 by a single urologist, and whose sperm was subsequently frozen for use in an IVF treatment programme on their partner’s behalf. Hundred and forty-four (73%) males had a positive PESA, and the remaining 54 (27%) had a positive TeSE. Forty-four percent of males with no clinical evidence of epididymal distension still had epididymal sperm retrieved successfully. Hundred and twenty-eight patients proceeded with ICSI, and a total of 237 cycles were performed. The CPR and LBR overall were 29 and 27%, respectively. Using logistic regression there was no association between time since vasectomy and CPR (P = 0.17) or LBR (P = 0.31). A history of an attempted reversal of vasectomy did not negatively affect retrieval rates or CPR and LBR. The success of SSR and the outcome of ICSI, using frozen sperm, are independent of male age and time since vasectomy. Epididymal sperm may be retrieved in over 40% of men in whom there is no clinical evidence of epididymal distension.