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To analyse current practice in the management of acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH) in the UK, and to assess how much of this is evidence-based. In all, 410 consultant urologists practising in UK hospitals were sent a questionnaire about the management of AUR secondary to BPH. Data were collected on practice relating to initial management, trial without catheter (TWOC), the use of α-blockers and the follow-up. The need for a uniform guideline in the management of AUR secondary to BPH was also assessed. We received 270 (66%) replies, of which six were excluded because they were from subspeciality interests (e.g. paediatric urology) or had ambiguous answers; 264 (64%) were therefore available for analysis. Urethral catheterization was the initial management of choice (98%), failing which a suprapubic catheter was inserted. Two-thirds (65.5%) admitted the patient after catheterization. Most consultants initiated α-blockers (70.5%), with 64% (118) of these using a TWOC 2 days after starting them. One failed TWOC was an indication for transurethral resection of the prostate for 192 (72.8%), with 136 (49.8%) re-admitting the patient for surgery later. Routine follow-up after a successful TWOC was advocated by 77.3%. Just over half the respondents (52.6%) felt that there was no need for uniform guidelines in the management of AUR secondary to BPH. This survey identified a reasonable national uniformity in managing AUR secondary to BPH in the UK, but significant aspects of current practice are not evidence-based. [ABSTRACT FROM AUTHOR]

OBJECTIVE To determine the partner's influence on the patient's choice of treatment for early prostate cancer, and whether partner characteristics and biases predict the preference. PATIENTS, SUBJECTS AND METHODS Questionnaires for partners to complete retrospectively were sent to consecutive patients recruited in a study comparing treatment options for early prostate cancer. The partners’ perceptions about prostate cancer were explored and the partners asked to comment on the suitability of each treatment option. Partners recorded their influence on the patient's choice using a 10-point visual linear analogue scale. RESULTS Questionnaires were sent to 116 eligible patients and 82 were returned for analysis (mean partner age 63 years). When asked to recall the treatment options initially discussed, all partners recalled radiotherapy (EBRT), all but one radical prostatectomy (RP), 51% brachytherapy, but only 29% watchful waiting (WW); 41% of partners stated RP as their chosen option, 37% EBRT, 12% brachytherapy and 10% no clear favourite. None preferred WW. Employment and education status were not significant predictors of partners’ preference but retired partners and those aged > 65 years were 3 times more likely to prefer EBRT than were their employed and younger counterparts, respectively. The partners’ mean (median, sd) self-assessed influence factor was 4.8 (5, 3.4). Of the partners, 88% reported active involvement throughout the process, identifying information-gathering and emotional support as their primary roles. Most deliberately chose not to influence the patient's final decision. CONCLUSION Partner preference is influenced by pre-existing conceptions about cancer and its treatment. While undoubtedly influential throughout the decision-making process, partners deliberately left the final decision to the patient. [ABSTRACT FROM AUTHOR]

OBJECTIVE To recommend a standard technique for the renographic evaluation of the dilated upper urinary tract, and for evaluating the results of surgery. METHODS This review is an update of the previously recommended consensus report of the 9th International Symposium of Radionuclides in Nephrourology. RESULTS State-of-the-art recommendations are detailed for standardizing common radionuclide investigations. CONCLUSIONS Where open, laparoscopic or endourological techniques for treating pelvi-ureteric junction obstruction are under study, results can only be compared by standardizing the investigational techniques. The guidelines produced here are recommended for this purpose. [ABSTRACT FROM AUTHOR]

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. Patients and methods A questionnaire was developed and administered to patients with sickle-cell disease. Questions were designed to define the incidence, nature, precipitants, duration, treatment and complications of priapism. A distinction was made between acute (severe) priapism and the recurrent, ‘stuttering’ type. Results The questionnaire was completed by 130 patients (mean age 25 years, sd 11, range 4–66) from the five centres; 102 (78%) were homozygous Hb SS genotype, 19 (15%) were Hb SC genotype and two (1.5%) were Hb Sα-thalassaemia. Of the patients, 46 (35%) reported a history of priapism, and of these, 33 (72%) had a history of stuttering priapism, while 24 (52%) had had an acute episode of priapism. The mean age of onset of priapism was 15 years, with 75% of patients having the first episode before their 20th birthday. Sexual activity was the most frequent precipitating factor, with fever and/or dehydration being the next most common. Of the 46 patients, 10 (21%) with a history of priapism reported having erectile dysfunction. A similar proportion reported dissatisfaction with sexual intercourse, including a fear of engaging in sexual activity. Conclusion The incidence of priapism among patients with sickle-cell anaemia is high (35%). The implications of priapism for erectile and sexual function are significant and documented in this large series. The treatment of this condition in these patients remains unstandardised. This study highlights the need for an increased awareness of the problems associated with priapism among patients, families and medical professionals. [ABSTRACT FROM AUTHOR]

Objective To investigate a method of diuresis renography where the radiopharmaceutical and frusemide (diuretic) are given simultaneously, in contrast to conventional renography which involves an intravenous injection with frusemide 20 min after administering the radiopharmaceutical (F+20) or 15 min before (F-15), with particular interest in the effect of this change on assessing split renal function and interpreting upper tract drainage dynamics. Patients and methods In a prospective study, 29 patients (18 women and 11 men, mean age 47 years, range 21–86) were assessed. Each patient had two renograms taken over a 48-h period, either by the F+20 or F-15, and the F+0 method. Data for split renal function and drainage curves were obtained in the usual way. Two independent assessments of the drainage curves were obtained and the results compared. Results The split function assessments were identical (<5% variation) in all but two patients; 26 of 29 (90%) gave identical conclusions about the drainage curves. The three patients with discrepancies between the studies had either hugely dilated upper tracts or otherwise had multiple complicating factors, e.g. impaired renal function, neuropathic bladder. Conclusions F+0 renography has been used in paediatric urological practice before, but there are no comparative studies and no data on its use in adults. This prospective study confirmed that in investigating dilated upper tracts, the F+0 technique gives similar results to the conventional techniques. The F+0 method has the potential to reduce the time required to undertake standard F+20 renography but it may not be useful in evaluating the grossly dilated upper tract, where the F-15 technique has the best record in terms of reducing equivocal results. [ABSTRACT FROM AUTHOR]

Objectives To evaluate whether the short‐term prostate‐specific antigen (PSA) velocity before biopsy can be used to predict prostatic histology, and to assess the role of a second PSA measurement before prostate biopsy. Patients and methods The study comprised 197 patients who were referred for transrectal ultrasonography (TRUS) and prostate biopsy. The PSA level was initially measured at the first outpatient assessment; patients with a serum PSA level of < 4 ng/mL and > 50 ng/mL were excluded. Blood samples were taken just before prostate biopsy for the second PSA measurement. The mean interval between the measurements was 2.2 months. The short‐term PSA velocity was calculated and correlations between this variable and age, prostate volume and initial PSA levels determined. Results There was a statistically significant difference between the short‐term PSA velocity of patients with benign prostate histology and those with prostate cancer (P < 0.05). The short‐term PSA velocity alone had the same diagnostic accuracy as the serum PSA level (area under the receiver‐operating characteristic curve 0.612). There was only a weak correlation between the short‐term PSA velocity and prostate volume. However, there was no correlation with age and initial PSA level in patients with benign histology. The second PSA measurement had higher specificity without losing sensitivity. Conclusion The short‐term PSA velocity estimated before biopsy can be used to predict prostatic histology. By measuring serum PSA 2 months after the first in patients with serum PSA level of 4–10 ng/mL, the number of negative biopsies can be reduced by 17%. [ABSTRACT FROM AUTHOR]

Examines the renographic and operative findings of pressure chronic retention among patients. Progress of renal impairment; Occurrence of bilateral hydronephrosis and hydrourer; Symptoms of outflow tract obstruction.

Examines the role of modern radiological investigations in obstructed urinary tract. Determination of the renal blood flow and glomerular filtration rate; Evaluation of the urinary tract dilatation; Effects of obstruction on ureteric reflux.

Objectives To assess the accuracy and reproducibility of methods used to measure glomerular filtration rate (GFR) in clinical practice. Patients and methods Simultaneous clearances of iohexol, 99mTc-diethylene-triamine-penta-acetic acid (DTPA), 24 h renal creatinine clearance and creatinine clearance estimated from a serum sample only, were obtained in 31 patients. Accuracy was calculated relative to iohexol clearance. The reproducibility of each method was determined by repeat measurements in the same individuals: three 99mTc-DTPA clearances in 21 patients; three 24 h creatinine clearance estimations in 12 patients; and three serum creatinine clearance estimations in 21 patients. Results The mean differences between 99mTc-DTPA clearance, 24 h renal creatinine clearance and estimated creatinine clearance compared with the reference method were 0.2 mL/min, 21.6 mL/min and 0.6 mL/min, respectively. 99mTc-DTPA clearance had fairly tight 95% limits of agreement (12.2 mL/min) compared with 35.4 mL/min for 24 h creatinine clearance and 25.8 mL/min for estimated creatinine clearance. The reproducibility for each method was 5.4%, 24.3% and 6.1%, respectively. Conclusion Single-injection 99mTc-DTPA clearance provides an accurate and reproducible method of GFR measurement that is suitable for objective monitoring of renal function. Twenty-four hour creatinine clearance is neither sufficiently accurate nor reproducible for this purpose. Creatinine clearance estimation from a serum sample without urine collection may be preferable to the more traditional 24 h collection method. [ABSTRACT FROM AUTHOR]

Focuses on the revision of name and diagnostic services for interstitial cystitis (IC). Response of IC patients to the diagnostic test; Confirmation on the efficacy of the diagnostic tests; Problem of IC diagnosing.

Objectives To examine the durability of open pyeloplasty for pelvi-ureteric junction obstruction. Patients and methods The records of 56 Anderson-Hynes pyeloplasties undertaken by two surgeons between 1981 and 1994 were examined. Attempts were made to trace all patients and for them to undergo diuretic renography to examine the current status of the operated renal unit. Results In all, 41 evaluable patients were identified; 24 agreed to return for reassessment. The mean (range) time from surgery was 10.6 (6–19) years. The results showed an improvement over the preoperative split renal function in 19 patients (79%) and an improvement in drainage in 23 (96%). Conclusions The Anderson–Hynes pyeloplasty is an excellent procedure for treating pelvi-ureteric junction obstruction, and produces a lasting improvement in function and drainage in most patients. It is the ‘gold standard’ against which newer techniques should be compared. [ABSTRACT FROM AUTHOR]

Objective To evaluate prospectively the efficacy of extracorporeal shock wave therapy (ESWT) as a conservative treatment for Peyronie's disease. Patients and methods After obtaining ethical committee approval, 37 patients with Peyronie's disease were treated using ESWT. Before treatment the degree of angulation was assessed by artificially inducing an erection with a vacuum device. The severity of pain on erection was assessed using a visual analogue scale (0–5). Each patient was treated with a minimum of three sessions of ESWT (3000 shock waves at an energy density of 0.11–0.17 mJ/mm2) at 3-week intervals. The results were analysed using the Wilcoxon signed-rank test. Results Of the 37 patients, 34 completed the protocol; the mean (range) duration of the disease was 19.43 (4–60) months and the mean follow-up 7.5 (5–11) months. Almost half (47%) of the patients reported an improvement in angulation, with a mean reduction of 29.3° (10°-60°) (P < 0.001); 12 of the 20 (60%) patients with pain on erection reported immediate relief, the mean reduction being 2.3 (1–4) on the visual analogue scale (P < 0.001). There was only minimal bruising at the site of treatment and no major side-effects were reported. Conclusion ESWT is an effective and safe treatment for Peyronie's disease; the long-term follow-up and results are awaited. [ABSTRACT FROM AUTHOR]

Objective To assess the effect of prostatic manipulation on complexed prostate‐specific antigen (cPSA), as various forms of prostatic manipulation are known to increase the serum free and total PSA level. Patients and methods A series of 92 men (58 after prostatic biopsy, 16 after digital rectal examination and 18 after flexible cystoscopy) were assessed. Blood samples were taken from each patient before and 30 min after manipulation. Total and cPSA levels were measured using appropriate assays, respectively. Results There was no significant increase in cPSA levels after flexible cystoscopy and digital rectal examination, but prostate biopsy caused a statistically significant although minimal rise in cPSA level. There was no statistically significant increase in cPSA level after prostate biopsy in patients with prostate cancer (P = 0.35) although there was a statistically significant but minimal rise in cPSA level in patients with benign histology (P < 0.01, mean increase 2.13 ng/mL) compared with that of total PSA, which increased markedly (P < 0.01, mean increase 19.79 ng/mL). Conclusion Prostatic manipulation has minimal effects on cPSA levels. [ABSTRACT FROM AUTHOR]

Examines the method in determining the glomerular filtration rate. Use of an x-ray fluorescence technique in measuring disappearance; Measurement on the clearances of chromium-51 labeled edetic acid; Correlation between the creatinine clearance and clearances of chromium-51 labeled edetic acid.

Compares the use of radionuclide, ultrasound, and computed tomographic scanning in investigating renal space-occupying lesions. Clarification of the nature of lesions; Effectiveness of the methods on the investigation; Advantages and disadvantages of the methods.

Presents peculiar practices on urology in Great Britain. Effects of diuresis on an obstructed kidney; Rationale in clamping the catheter; Occurrence of catheter leakage.

Objectives To prospectively evaluate scrotal ultrasonography (SUS) in patients presenting with scrotal symptoms and to make recommendations about use of SUS in clinical practice. Patients and methods Forty‐eight men with scrotal symptoms were examined by a urologist and independently underwent SUS by one radiologist with no knowledge of the clinical diagnosis. The clinical and SUS diagnoses were compared and the effect on subsequent management recorded. Results The clinical and SUS diagnoses agreed in 35 men (73%) although SUS provided an additional diagnosis in half of these men. The SUS diagnosis differed in 13 men (27%) although the management was altered in only four patients. Conclusion The clinical diagnosis is correct in most men with scrotal symptoms; the routine use of SUS is inappropriate and should be reserved for specific indications. [ABSTRACT FROM AUTHOR]

Investigates the use of cardiopulmonary assessment in patients before transurethral prostatectomy in Great Britain. Importance of spinal anesthesia; Administration of clinical evaluation; Examination of patients for fitness for anesthesia.

Objective To prospectively compare two local anaesthetic techniques for prostatic biopsies, which are usually taken with no anaesthesia; because multiple biopsy techniques are becoming more common and there is an increasing need for analgesia/anaesthesia during the procedure. Patients and methods The study group comprised 86 consecutive men (median age 67.7 years) undergoing prostatic biopsy because of either an abnormality of prostate specific antigen level or digital rectal examination. They were randomized into four groups; men in group 1 received 10 mL of 1% lignocaine infiltrated into the periprostatic nerve plexus bilaterally; men in group 2 received 11 mL of 2% lignocaine gel rectally; men in groups 3 and 4 were recruited as controls, and given either plain gel rectally or an injection with saline into the periprostatic nerve plexus. Sextant prostate biopsies were taken in all cases using a standardized protocol. Immediately after the procedure patients were asked to indicate the degree of pain on a 10-cm visual analogue scale. Results Men in group 1 had significantly less pain than the others ( P < 0.001). There was no statistically significant difference in pain between men who received plain gel rectally or saline injection ( P = 0.35). The rectal instillation of 2% lignocaine gel did not reduce pain significantly ( P = 0.186) compared with the controls. Conclusion A periprostatic nerve block with 1% lignocaine was associated with significantly less pain during prostatic biopsy than was rectal lignocaine gel or placebo. [ABSTRACT FROM AUTHOR]

Examines the postoperative urinary retention in men. Effects of surgery and postoperative pain; Physiology and pathophysiology of micturition; Complications of infections and stricture.