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PubMed2004

Nosocomially acquired urinary tract infections in urology departments. Why an international prevalence study is needed in urology.

Nosocomially acquired urinary tract infection (NAUTI) is the most frequent nosocomial infection and a particular problem in urology departments. The incidence of NAUTI has become an important quality parameter and a legal issue. Several characteristics related to the health care provider, the patient and the procedures are known to increase the risk of NAUTI. The single most important risk factor for NAUTI is an indwelling catheter. NAUTI may be prevented by good health care facilities, evidence-based practice, wise patient selection and surgical skill. But the most important factors are tailored antibiotic prophylaxis and continuous monitoring of the incidence and pathogens causing NAUTI in each institution. Raising antimicrobial resistance in some countries calls for a closer monitoring of NAUTI on international level within urology. There is room for improvement in urinary catheter care in many hospitals, and the importance of patient and urological risk factors for development of NAUTI is not fully known. In order to meet these challenges the European Society for Infections in Urology is planning a prevalence study combined with a quality improvement initiative related to NAUTI.

Antibiotic Prophylaxis↗
PubMed2002

2001 American Urological Association Gallup Survey: changes in physician practice patterns, satisfaction with urology, and treatment of prostate cancer and erectile dysfunction.

PURPOSE: The Health Policy Survey and Research Committee of the American Urological Association and the Gallup organization have performed 9 surveys of American urologists since 1992 for the purpose of assessing demographics and practice patterns. The results of the 2001 survey are presented. MATERIALS AND METHODS: A random sample of 507 urologists was interviewed in February and March 2001. Major content areas were physician practice patterns, cryosurgery/brachytherapy, prostate specific antigen, erectile dysfunction, Medicare and the Internet. RESULTS: Membership in the American Urological Association continues to increase among American urologists. The number of patients seen weekly in the office also continues to increase. While age at retirement has not changed significantly, most urologists are satisfied with the specialty and increasing numbers are using the Internet. CONCLUSIONS: Minimally invasive procedures such as brachytherapy for prostate cancer continue to proliferate and there is evidence that the specialty of urology is continuing to become more office based. The demand for urological services appears to be continuing to increase.

Adult↗
PubMedDate not supplied

Applicability of the new ITKA GSD Basic 250 electrosurgical unit to urologic endoscopic surgery, laparoscopic surgery and urologic open surgery.

The purpose of the study was to assess the applicability of a new ITKA GSD Basic 250 electrosurgical unit (ESU) to urologic endoscopic surgery, laparoscopic surgery and open urologic surgery, its possible interference with videorecording and stray currents in healthy tissues. A new ITKA GSD Basic 250 ESU (test ESU) was used and compared to conventional ESU (Berchtold Elektrotom 390 as reference ESU). Experimental surgery was carried out on three female pigs, which underwent endoscopic, laparoscopic and open surgery. Altogether 29 patients underwent either endoscopic or open surgery with the test ESU. In experimental surgery, the ideal cutting and coagulation settings of the test ESU were in the range 15-25% for endoscopic surgery. In laparoscopic surgery, tissues were ideally resected and removed at 10-15% power settings. In open experimental surgery, the ideal power settings were 25-30%. In human surgery, the test ESU operated well at 25-35% power settings in endoscopic surgery, while in open surgery on humans the ideal settings were 25-35% in monopolar use and 20-25% in bipolar use. When used for endoscopic operations, the test ESU did not interfere with videorecording. Nor were any adverse effects seen in the surrounding tissues. The patients had neither early nor late complications. Histopathological findings revealed no differences in healing between the test ESU and reference ESU. Experimental and patient surgery showed the test ESU to be both safe and effective. It is suitable to be used in urologic endoscopic surgery, laparoscopic surgery and open urologic surgery. It does not interfere with videorecording or cause harmful stray currents in surrounding tissues. Power can be adjusted linearly and precisely. Low-power operation is also possible.

Abdominal Muscles↗
PubMed1999

A complex urologic problem demonstrates how far pediatric urology has progressed.

OBJECTIVE: We present the experience at Connecticut Children's Medical Center (CCMC) with single-system bilateral ectopic ureters (SSBUE), a rare clinical entity which continues to challenge the pediatric urologist. Innovative diagnostic and reconstructive techniques are utilized in an effort to preserve renal function and develop urinary continence in a select group of patients. METHODS: A review of the English language literature was performed to identify all female patients with SSBUE and evaluate their treatment and outcomes. In addition, we present our experience with three cases of SSBUE at CCMC and describe the recent advances in the management of such patients. RESULTS: From 1937 to 1999, 25 articles described 54 female patients with SSBUE. Patients were treated with a variety of reconstructive procedures that resulted in a low overall continence rate of 20% (eight of 39 reported outcomes). We evaluated three patients with SSBUE at CCMC. Our first patient had undergone three previous operations prior to her successful procedure at CCMC utilizing a new technique to achieve urinary continence in which a portion of the anterior bladder wall is used for bladder neck reconstruction. Our last patient was identified antenatally by the maternal-fetal obstetrician, evaluated postnatally by the pediatric urologist, and underwent formal urodynamics and proximal urinary diversion for an obstructed upper collecting system. No previous reports focus on antenatal identification, accurate postnatal diagnosis, urodynamic assessment and early intervention including upper urinary tract diversion, and staged Pippi Salle bladder neck reconstruction. CONCLUSION: The CCMC experience with SSBUE demonstrates the recent achievements in complex urinary tract reconstruction that have taken place in pediatric urology. We describe diagnostic studies such as formal urodynamics and the growing trend to identify urologic problems antenatally. A team approach involving the obstetrician, pediatric urologist, neonatologist, and the pediatrician has been beneficial. As pediatric urology moves into the new millennium there are prospects for even more innovative diagnostic and therapeutic options for children with urologic problems.

Child↗
PubMed1993

[Electronic data processing in urologic clinics. Results of a survey. Electronic Data Processing in Urology Group of the Graduate and Continuing Education Commission of German Urologists].

Computer equipment in Departments of Urology in Germany was evaluated by a nation-wide questionnaire. One hundred and fifty-three questionnaires were returned with detailed information on computer hardware, software and applications in Urology. Most departments were equipped with at least one computer. Computer equipment varied considerably among the participants including both stand alone personal computers (PCs) and local area networks (LANs) with several PCs connected by cable. Typically, PCs were IBM-compatible and ran the MS-DOS operating system Word processing and related applications were the most frequently mentioned computer tasks in urology. In some departments computers are also used in research for production of databases and graphics and for statistical applications. When computers were used for documentation of therapy and/or medical records, software was often custom-made according to the department's specific needs. In the future, more computers will be needed in departments of urology, because medical records will have to meet higher standards of documentation.

Computer Literacy↗
PubMed1992

Current urological practice: routine urological examination and early detection of carcinoma of the prostate.

With the increasing incidence of carcinoma of the prostate, the interest in early diagnosis through screening has dramatically increased. Several organizations, including the American Urological Association (AUA) and the American Cancer Society, have promulgated recommendations on suggested early detection methods. To determine the current practice patterns of United States urologists, a survey was sent to a random sample of 10% of all urologist members of the AUA. The survey was designed to determine what are current recommendations for an annual urological checkup for older men, what tests should be included in screening for carcinoma of the prostate and what age groups of men should undergo prostate cancer screening. A total of 562 surveys was returned, constituting a 4.7% sample of all urologist members of the AUA. The use of digital rectal examination was unanimously recommended for the urological examination as well as for prostate cancer detection. Prostate specific antigen was recommended by a majority of respondents for both situations. Screening was recommended for men ages 50 to 80 years. Demographic factors had a significant role in clinical recommendations by urologists.

Adult↗
PubMed1990

Cooperative study of pirarubicin against urological cancers and future direction of its combination use. The Clinical Study Group of THP for Urological Malignant Tumors.

In the urological field, one of the most effective drugs is doxorubicin. A cooperative phase II study on pirarubicin (THP), a new anthracycline with less cardiotoxicity than doxorubicin, was performed in 14 institutions for treating urological tumors. THP was administered intravenously 3 or more times (as one course, 30-40 mg/m2 once a week, every 3 weeks or 20 mg/m2 2 consecutive days a week every 3 weeks). Fifty-four of the 63 patients included in this study were evaluable. An overall efficacy rate was 18.5% (10/54), consisting of transitional cell carcinoma 24.3% (9/37; bladder cancer 6/27 (22.2%), tumors of the renal pelvis and ureter 3/10 (30.0%), and prostatic cancer 1/15 (6.7%). Adverse effects were mostly slight especially alopecia (15.9%, WHO grade 1:7 patients and grade 2:3 patients), and there was no problem attributable to cardiotoxicity of THP. Leukocytopenia was seen for 65.1% (grade 1:14 patients, grade 2:13 patients, grade 3:13 patients, and grade 4:1 patients). The nadir was observed about 2 weeks later and it took about 2 weeks for the recovery. Thus, it can be concluded that the usefulness of THP in treating urological tumors is comparable to or better than that reported for doxorubicin. Based on the above results, a combination regimen including THP has been investigated in Japan.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2004

2003 American Urological Association Gallup survey: physician practice patterns, cryosurgery/brachytherapy, male infertility, female urology and insurance/professional liability.

PURPOSE: The Health Policy Survey and Research Committee of the American Urological Association and the Gallup Organization have performed 10 surveys of American urologists since 1992 for the purpose of assessing demographics and practice patterns. The results of the 2003 survey are presented. MATERIALS AND METHODS: A random sample of 510 urologists who have completed urological residencies was interviewed by telephone in February 2003. Major content areas were physician practice patterns, cryosurgery/brachytherapy, male infertility, female urology and insurance/ professional liability. RESULTS: Urologists are older, staying in practice longer and planning to retire later than ever before. Urologists are also seeing more patients in the office every year. Most urologists treat male infertility and female voiding dysfunction. CONCLUSIONS: American urologists are older, working harder and planning on continuing to do so for longer than in any year sampled in the last decade.

Adult↗
PubMed1996

[Problems raised by representation of activities in urology. Cooperative study by the urology services of the AP - HP (Public Services - Paris Hospitals)].

Paris public hospital urology departments conducted a study which had three objectives: - to test the indicators of activity to determine whether they were well adapted to measurement of the surgical activity performed, - to determine the contribution of the PMSI to the measurement of this activity, - to propose actions designed to improve the representation of the surgical activity actually performed by urology departments. The results of this study show that one half of the operations performed do not correspond to the field of PMSI (day-only admissions, outpatients department). The indicators currently used for budget allocation or interdepartment comparisons of activity are inadequate and, most importantly, induce deformities, variable from one department to another, which severely affect the image of the activity produced by these indicators. Two main reasons can explain these deformities: - the use of the NGAP and the score to measure activity: there is a marked variation of the score for the same operation, from one department to another. - the very poor census of activity performed in outpatient surgery. These two reasons are not related to the medical activity. Definition of a unique nomenclature for surgical procedures would constitute a great progress, provided that this nomenclature allows us to accurately describe our activity and can be modified according to our needs. Although the PMSI is a marked improvement of the information system, its application, in its current state, will not radically change the situation. The PMSI must be enlarged in one way or another, to outpatient activity including procedures performed in the outpatients department. For these measuring tools of activity, which determine the calculation of our budgets, to be adapted to our practice, we must be able to analyse their relevance and introduce changes. We need to develop this field of medico-economic research in urology.

Paris↗
PubMed1996

[The urologic work of Doctor Alejandro Settier (1858-1915). (I). Spanish urology during the second half of the 19th century].

Until, at the beginning of our Century, the Spanish Urology finally achieved the acknowledgement that it was due to it as a specialty different from General Surgery, surgical practice of urinary tract disorders remained, all through the 19th Century, in the hands of general surgeons. As from the last quarter of the century, however, a clear trend can be glimpsed in some professionals in Spain towards specialization in this branch of surgery. Albeit the influence of the French School and French publications on the first specialists is manifest, since most of them were training in Paris, it is obvious that the genesis and progress of specialization on genitourinary organs disorders, as well as other areas, in Spain would have not been possible without the concourse and political support received from relevant personalities such as Dr. Federico Rubio y Gali and Dr. Angel Pulido Fernández, both with partial dedication to the urinary tract and to whom the Spanish Association of Urology still owns further recognition for the role they played in the promotion of these earlier specialists and the establishment of centres and hospital services where their work could be carried out. Since, during the final third of last century, the number of Spanish publications, journals and monographs devoted to urological topics, a extensive revision of which is covered in this paper, is increasingly profuse, the boom of the specialty in genitourinary tract disorders will determine its ultimate consolidation at the beginning of the 20th Century.

History, 18th Century↗
PubMed1996

[The urologic work of Doctor Alejandro Settier (1858-1915). (II). The consolidation of the urology specialty in Spain].

By the end of the 19th Century, and after the creation in 1896 of the French Society of Urology, the specialty on genitourinary organs disorders began to take shape in Spain, and its particular idiosyncrasy, recognized both within the hospital and private practices, becomes irreversible. Aside political support, certain writings published astride the last century and this one, will prove to be decisive to consolidate the urological specialty in our country. Such is the case with those written by Rafael Mollá y Rodrigo and Angel Pulido Martin, where the creation of the new discipline is postulated and defended, linking the related pathologies, outlining their competence and assembling the surgical procedures to be followed in order to resolve them. The Academies of Medicine and Surgery, in Madrid, also played a significant role in this task of promotion and diffusion of these specialties, in particular Urology; it is quite likely that the seed of new vocations would have germinated during their institutional meetings. At any rate, it is easy to demonstrate documentally how, since mid 19th Century, the nation's capital was witness of the attention given to the urinary tract which began to occupy a preferential position in the work of the most renowned general surgeons from the School of Madrid, such as Diego de Argumosa, Alejandro San Martin, Federico Rubio y Gali and Jesus Creus y Mansó.

History, 19th Century↗
PubMed1996

[The history of urologic journalism in Spain (III). Chronology of Spanish specialized publications in urologic topics (continuation)].

The fourth period, which can be defined as the period of specialized publications, commenced with the founding of the Asociación Española de Urología (Spanish Urological Society) in 1911. As in other European countries, the expressions 'Genitourinary Disorders' or 'Genitourinary Organs' were replaced and all publications dealing with the genitourinary tract, its disorders or their surgical management, adopted the generic term 'Urology', although the terms relating to other specialties were retained. From 1924 until the Spanish Civil War in 1936, there was always a representative and official journal of the Asociación Española de Urología. Fifteen new journals, which are analyzed in the present article, were published during this long and fruitful period abruptly broken by the Spanish Civil War. This period culminated in 1977, when Actas Urológicas Españolas, the official journal of the Society, was established. Most of the journals of this last period have disappeared, but some have endured, like Archivos Españoles de Urología, which is now in its 50th year. Despite the formidable and sustained competition of the foreign specialized journals, their activity continues with the same vigour that denotes the perseverance, thrust and intellectual vitality of Spanish urologists who have unfalteringly supported these publications. In my view, Spanish urological publications have a brilliant and enduring future.

History, 20th Century↗
PubMed2005

Normative values for the American Urological Association Symptom Index (AUA-7) and short form Urogenital Distress Inventory (UDI-6) in patients 65 and older presenting for non-urological care.

OBJECTIVE: To determine the scores of two commonly used urologic questionnaires in community dwelling elderly patients receiving non-urologic primary care. METHODS: Patients 65 years and older presenting for routine non-urologic primary care from April to July 2004 were eligible for enrollment. They completed a questionnaire evaluating demographics, AUA-7, UDI-6, and one visual analogue quality of life (QOL) question (range 0, pleased to 10, terrible). Total and question specific scores were analyzed. In addition, correlations among urinary symptoms and QOL scores were performed. RESULTS: In 157 patients who satisfied the study criteria, total and question-specific scores for the AUA-7 and UDI-6 were mildly elevated and similar across age groups in both sexes. Question 1 (frequency) rendered the highest score for both women and men from the UDI-6 questionnaire (mean 1.3 and 0.74, respectively). Question 7 (nocturia) rendered the highest score for both women and men from the AUA-7 questionnaire (mean 1.87 and 0.940, respectively). A total of 32 (27%) of 118 women and 6 (15%) of 39 men were found to have high elevation in QOL scores (>5). CONCLUSION: The total scores for the AUA-7 and UDI-6 were found to be mildly elevated but stable with age over time in this older population. These data provide useful information for urologists regarding baseline ranges for urinary symptoms in the elderly population. Over one-third of women were found to have a significant elevation in QOL scores (>5) which suggest a need for improvement in identifying and addressing urinary symptoms among elderly women.

Aged↗
PubMed1997

The agreement among urological experts on the diagnostic management of patients with common urological problems.

OBJECTIVE: To assess the level of agreement among randomly selected international urologists on the diagnostic management of patients with prostate cancer, bladder cancer, urinary stones or lower urinary tract symptoms (LUTS) arising from benign prostatic hyperplasia (BPH). METHODS: A computer program was used to provide an unbiased format of 53 simulated patients, comprising 13 with prostate cancer, 10 with bladder cancer, 10 with stones in the upper urinary tract and 20 with LUTS from BPH. For each case, the history was provided to the user while information from 60 diagnostic tests could be chosen interactively. Thirty-three university-based urologists participated in the study. The probability that a certain test was used by them in a certain patient [P(test)] and the related costs (Swedish 1995 prices) were recorded. The probability that two urologists would agree (relative measure of agreement, RMA) on whether or not to use one particular test in a certain case was RMA(test) = P(test)2 + [1-P(test)]2 and the mean of this RMA(test) for a certain patient [RMA(case)] was used as a measure of the inter-individual agreement among the urologists on the diagnostic management. The significance levels of the generalized kappa statistic, KG, were also calculated. The correlation between the RMA(case) and the diagnostic groups was analysed. RESULTS: The KG was statistically significant for all cases; the RMA(case) was significantly correlated with the diagnostic groups (rs = 0.86). The agreement in the diagnostic management was the strongest for stones, then for bladder cancer and prostate cancer, and the weakest for BPH. The mean cost for the diagnostic evaluation for one case varied from $455 to $1771 (mean 898) and varied in the diagnostic groups, i.e. $1718 for prostate cancer, $947 for bladder cancer, $400 for stones and $594 for BPH. CONCLUSION: The diagnostic management of urological patients varies greatly among urological experts from the industrial world. As a consequence, the related diagnostic costs might vary by about 400% if prices were similar everywhere. The agreement on the diagnostic management of cases is strongly correlated to the diagnosis. LUTS from BPH seems to be managed with the poorest agreement.

Attitude of Health Personnel↗
PubMed1987

[Our urologic heritage: Maximilian Nitze (1848-1906). His importance in the development of urology].

In this article we remember the Berlin urologist Maximilian Nitze (1848-1906) who with his invention of the cystoscope 110 years ago founded a new epoch of the urologic-endoscopic diagnostics and therapy. After a short description of his life the importance of his scientific work for the development of urology as an independent medical special subject in the second half of the 19th century is pointed out.

Germany↗
PubMed1996

[The urologic work of Doctor Alejandro Settier (1858-1915). (III). The consolidation of the urology specialty in Spain].

As years go by during the last quarter of the 19th Century, the number of Spanish specialists devoted to the "urinary tract" or to the "disorders of the genitourinary organs" increased gradually. The first generation of specialists (Martra, Suender and Rodríguez Viforcos, among others) are mainly professionals who studied in Paris or other European clinics and who preferentially use the techniques of transurethral surgery: lithotrity and litholapaxy, catheterism, dilations, uretrotomy, etc. as well as minor operations on the genitalia, occasionally performing some major procedures such as perineal dissection. Many of them also become experts in Dermatology and Syphiliography. Until progress of anaesthetics and surgical techniques in the last decade of the century, do not allow to conduct more risked procedures, urology surgery of greater substance will continue in the hands of general surgeons who retain a certain degree of specialization in the urinary tract. Only after the arrival to Spain of the second generation of specialists (Azcarreta, Lluria y Despau, Suarez de Mendoza, Mollá y Rodrigo, etc.), equipped with greater preparation and more advanced surgical training, the Spanish Urology will accomplish the desired position required for its ultimate segregation from General Surgery.

History, 19th Century↗
PubMed1977

[Urological and nephrological complications after general surgery. Urological complications. Kidney and ureter].

Urologic complications can result from abdominal, gynecologic, and retroperitoneal operations. As a result, surgical treatment of colonic tumors, genital tumors, the vertebral column, the lymphatic system, and the aortoiliacal vessels assumes a greater importance. Immediate therapy is possible as a result of intraoperative diagnosis. The postoperative diagnosis may become manifest as early or late symptoms. Certain criteria for avoiding such complications are mentioned. Following diagnosis of a urologic complication, immediate therapy seems to produce the best results and the shortest period of hospitalization.

Abdomen↗
PubMed1996

Urologic problems in anorectal malformations. Part 2: functional urologic sequelae.

A consecutive series of 90 children with anorectal malformations was reviewed for urologic problems related to lower urinary tract dysfunction. Neurogenic bladder-sphincter dysfunction was seen in 22 patients (24%), all but one of whom had sacral agenesis. Vesicoureteral reflux was present in 60% of the patients with dysfunction, and 32% had reflux nephropathy. Urinary incontinence was present in 91% of the patients who had bladder-sphincter dysfunction. However, the management of bladder-sphincter dysfunction and urinary incontinence was not as straightforward as for patients with myelodysplasia because the parents were more reluctant to accept the therapeutic measures. It was particularly difficult to introduce clean intermittent catheterization (CIC), especially in older patients, because genital and urethral sensation often was undisturbed. Only if CIC had been started in the neonatal period or early infancy were there no problems with acceptance and parental compliance. The authors emphasize the importance of urodynamic testing of neonates and infants who have an anorectal malformation and associated sacral agenesis in identifying those who have neurogenic bladder-sphincter dysfunction. Consequently, patients with lower urinary tract dysfunction should receive prompt treatment, including CIC if necessary, to prevent or reduce secondary urologic morbidity, especially loss of renal function.

Anus, Imperforate↗