Comment on "recording the evoked canine detrusor electromyogram," Neurourol Urodynam 1999;18:687-95.
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Animals↗
Biomedical subjects
A Ballaro
Publications and source records attributed to A Ballaro.
Do we do what they say we do? coding errors in urology.
OBJECTIVE: To determine the accuracy of routine data coding in a large multispeciality urological unit. Materials and methods From the clinical records, the diagnosis and procedure codes were ascribed to 106 finished consultant episodes (FCEs) in urology, by two urological trainees. The codes were compared with those ascribed by professional hospital coders (and of which the trainees were unaware) from information written on the audit form by junior medical staff. Where there were discrepancies in codes an error was recorded and the stage in the coding process in which it occurred was determined. RESULTS: Forty-eight coding errors were found in 38 of the 106 (36%) FCEs; 34 (71%) were caused by inaccurate coding and 14 (29%) were the result of the incorrect completion of audit forms. CONCLUSION: The clinical codes generated from the authors' department do not accurately reflect the clinical practice. If coding errors of this magnitude are typical of urology units in general, the concept of hospital performance tables (which will be generated using routine clinical data) is untenable unless data recording is given higher priority.
Forms and Records Control↗
Prosthesis implantation after radial free flap phalloplasty in patients with bladder exstrophy.
METHODS: Inflatable penile prosthesis were implanted into sensate radial free-flap phalloplasties in two adult patients with bladder exstrophy. RESULTS: Neither patient reported loss of sensation, and both were able to inflate the prosthesis and engage in sexual intercourse three months later. CONCLUSION: The construction of a functional neophallus is well described however has not previously been reported in exstrophy patients who are suited to this procedure due to the presence of crura, and the absence of a neourethra. Scarring from previous reconstructive procedures however may make implantation difficult, and long-term follow up is required to evaluate this procedure in patients with bladder exstrophy.
Adult↗
A computer generated interactive transurethral prostatic resection simulator.
PURPOSE: We developed a computer generated model of the prostate gland and an interactive simulator for use in training urologists in transurethral resection of the prostate. MATERIALS AND METHODS: Software was developed on a standard personal computer which allowed images of the lumen of the prostatic urethra and resectoscope loop to be generated and interacted with using a magnetic position sensor input device attached to a dummy resectoscope. RESULTS: An anatomically accurate computer model of the prostate was generated at low cost which permitted user interaction and which simulated key elements of transurethral prostatic resection. CONCLUSIONS: Although not a substitute for learning transurethral prostatic resection on patients, the simulator enabled the user to become familiar with the technique of transurethral prostatic resection in the absence of time constraints and without risk to patients. The simulator may become an important tool in training and assessing surgeon competency, and may reduce the costs of training. Further development is needed to refine the transurethral prostatic resection simulator and expand its surgical range.
Computer Simulation↗
A seasonal variation in the incidence of ruptured abdominal aortic aneurysms.
OBJECTIVE: To discover whether there is a seasonal variation in the incidence of rupture of abdominal aortic aneurysms. DESIGN: Deaths per month due to rupture of abdominal aortic aneurysm were analysed retrospectively using a cosinor regression model. SETTING: England and Wales. SUBJECTS: 19,599 patients who died from rupture of abdominal aortic aneurysm between January 1991 and December 1995 according to death certification data. INTERVENTIONS: None. RESULTS: A seasonal variation in the incidence of rupture of abdominal aortic aneurysm occurs, with a peak in winter (p = 0.003). The ratio of rupture of abdominal aortic aneurysm in males and females decreased from more than 12 to 1 below age 60 years to less than 5 to 1 over age 80 years. CONCLUSIONS: There is a seasonal variation in the incidence of recorded deaths from abdominal aortic aneurysm in England and Wales, with a peak of deaths in the cold winter months. The underlying cause is unknown, but hypertension and tobacco smoking are predisposing factors to aortic aneurysm rupture. Exposure to tobacco smoke is known to be greater indoors in cold weather and there is a winter peak of blood pressure in hypertensive patients.
Age Factors↗
Rupture of a popliteal artery pseudo-aneurysm secondary to a fibular osteochondroma.
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Adult↗
Acute colonic pseudo-obstruction after total hip replacement.
Acute colonic pseudo-obstruction is a poorly recognised and potentially fatal complication of hip surgery. Between 1991 and 1994 six patients were observed who required laparotomy after failure of medical management. In three the indication was signs of peritonism, while in the other three exploration was required to exclude segmental ischaemia and to decompress the bowel. In all, there was no evidence of mechanical obstruction. Patients having total hip replacement are at risk of developing pseudo-obstruction due to their age, comorbidity, high doses of analgesics and the nature of the operation. If postoperative ileus persists for more than 48 hours acute colonic pseudo-obstruction should be suspected and confirmed by plain radiography. Prompt recognition and treatment with early referral to a colorectal unit are indicated. Laparotomy appears to carry less risk than that for patients with idiopathic pseudo-obstruction, but should be performed only if colonic ischaemia is suspected.
Acute Disease↗