DOCSLIB.ORG

A Tale of Four Prostates

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

Kirby Tale of Four Prostates_Layout 1 18/03/2013 14:49 Page 1 PROSTATE DISEASE 29 A tale of four prostates ROGER KIRBY, DAMIAN HANBURY, JOHN ANDERSON AND SEAN G. VESEY Four urologists relate CASE 1: ROGER KIRBY their personal experiences Roger Kirby, aged 62, an otherwise of prostate cancer and fit, asymptomatic individual who highlight some important had measured his prostate- learning points. specific antigen (PSA) for more than a decade, noticed a gradual rise in PSA to 4.3ng/ml. 3-Tesla uring the past two years, rather ironically, magnetic resonance imaging Dall four authors of this article, each a busy (MRI; Figure 1) revealed a urologist in practice with an interest in prostate suspicious focus in the right cancer, have themselves been diagnosed and peripheral zone adjacent to but not penetrating the capsule. treated for prostate cancer. Rather than hush Figure 1. 3-Tesla magnetic resonance image it up, as if it were a dark secret, we decided Transrectal ultrasound (TRUS)- of the prostate showing a suspicious focus in that there would be some merit in terms of guided biopsy confirmed Gleason the right peripheral zone adjacent to but not education, debate and awareness, if we were to 3+4=7 adenocarcinoma in three penetrating the capsule make public the presentation and treatment of out of 12 cores. A bone scan was negative. A robotically assisted radical prostatectomy was performed, by each of our four individual cases. Professor Prokar Dasgupta, without complications. Pathology confirmed complete excision of a Gleason 4+3=7 1.3cc tumour with invasion of the LEARNING POINTS capsule but negative surgical margins. Recovery has been uneventful. There are more than 1000 urologists presently practising in the UK. As there is a one in nine lifetime chance of being diagnosed with prostate cancer, the fact that there are at least four working urologists currently afflicted by fact, thanks to the work of Parker3 and Klotz,4 the disease is probably not surprising. The four and the publication of the NICE guidelines5 on Go to the Trends website to view a cases summarised here illustrate several prostate cancer, the majority of patients with video discussion on this subject important aspects of the management of low-risk, Gleason pattern 3+3=6 prostate with the authors: prostate cancer, an area of medicine that is cancer are now managed by active surveillance www.trendsinurology.com/videos currently changing very rapidly.1 rather than by surgery or radiotherapy.6 The first case (RK) illustrates the value of early A second learning point from this case is detection using serial PSA testing in terms of the value of high-resolution 3-Tesla MRI Roger Kirby, MA, MD, FRCS(Urol), FEBU, diagnosing prostate cancer, while it is still scanning, with gadolinium enhancement, in Director, The Prostate Centre, London; confined within the capsule of the gland, and identifying suspect areas within the gland Damian Hanbury, MS, FRCS(Urol), therefore potentially still curable. The results that can be targeted by either transrectal or Consultant Urologist, The Lister Hospital, of the European Randomized Study of transperineal ultrasound-guided biopsy (see Stevenage, Herts; John Anderson, 2 Screening for Prostate Cancer (ERSPC) Figure 1). Comparison of the preoperative MB ChB, ChM, FRCS, Consultant Urologist, confirm that mortality from prostate cancer MRI scan with the prostate itself after Royal Hallamshire Hospital, Sheffield; can be reduced by early detection, but the robotic surgery confirms the accuracy of this Sean G. Vesey, FRCS, FEBU, Retired authors worry that the lives saved will be technology in localising the tumour. This in Consultant Urologist, Southport and counterbalanced by those low-risk cases turn aids the surgeon in achieving negative Ormskirk Hospital NHS Trust, Merseyside identified who are at risk of ‘overtreatment’. In surgical margins. TRENDS IN UROLOGY & MEN’S HEALTH MARCH/APRIL 2013 www.trendsinurology.com Kirby Tale of Four Prostates_Layout 1 18/03/2013 14:49 Page 2 PROSTATE DISEASE 30 pelvic bones, which may or may not have CASE 2: DAMIAN HANBURY represented a metastasis. Fortunately, this area could be encompassed in the external Damian Hanbury, aged 55, a busy urologist in Hertfordshire, presented in beam radiotherapy field, which was used to 2010 with worsening lower urinary tract symptoms of frequency and poor treat the primary lesion. flow. A PSA measurement came back at 29ng/ml. Biopsy confirmed Gleason 4+5=9 adenocarcinoma and an MRI suggested locally advanced Case 3 (JA) is most unusual in presenting disease. There was a single suspicious focus in the pelvic bone on both with liver metastases, in spite of a normal MRI and bone scanning. A decision was made to proceed with androgen PSA only a few months before and no ablation followed by external beam radiotherapy to include the presumed metastatic focus in the pelvis. Two years on, his PSA remains undetectable other evidence of disease elsewhere. It at 0.06ng/ml. does illustrate how the PSA level can be misleading, in spite of quite large-volume metastases, especially in very poorly differentiated tumours. Hormonal therapy produced a useful but relatively short-lived The second case (DH) illustrates the not may not represent metastatic disease. In response, and fortunately taxane-based uncommon dilemma of whether to use this case there was a biopsy-proven locally chemotherapy seems to be producing a external beam radiotherapy in addition to advanced disease involving the prostate, second remission. androgen ablation when there are equivocal which was responsible for the lower urinary skeletal or soft tissue lesions, which may or tract symptoms, and a lesion within the The final case (SV) illustrates the not uncommon presentation of locally advanced disease with lymph node metastases and the subsequent development of symptomatic CASE 3: JOHN ANDERSON bone metastases requiring local radiotherapy John Anderson, aged 58, a urologist from Sheffield and President Elect of to resolve. A combination of androgen the British Association of Urological Surgeons, was perfectly well and ablation with taxane-based chemotherapy without symptoms in early October 2011, and had a routine PSA test, and additional abiraterone7 has produced a which came back at 1.7ng/ml. On 27 January 2012 (only four months prolonged response. The new oral agent later) he felt a mass in the upper abdomen and a computed tomography enzalutamide,8 which has produced (CT) scan confirmed multiple liver metastases with no other detectable impressive results in clinical trials, and abnormality. With a normal PSA four months earlier, no urinary symptoms the encouraging clinical profile of the and no extrahepatic disease visible on the scan, the possibility of this alpha-pharmaceutical Alpharadin,9 are being related to the prostate never really crossed anyone’s mind. A the next therapeutic options. couple of weeks later, a liver biopsy confirmed a poorly differentiated adenocarcinoma. Subsequent immunohistochemistry of the liver biopsies DISCUSSION stained positive for PSA, which confirmed the diagnosis of metastatic Anxieties about overtreatment of low-risk, prostate cancer. It was only then that the serum PSA was measured, which had risen from normal 1.7 to 92.7ng/ml in four months. low-volume Gleason 3+3=6 prostate cancers Androgen deprivation therapy resulted in a PSA nadir of 0.2ng/ml have fostered the myth that prostate cancer after four months of treatment, but the PSA then started to climb. In is somehow a toothless tiger. Consideration November, he developed sudden-onset severe right-sided abdominal pain of the four clinical situations above, drawn requiring opiates to control symptoms. A further CT still showed no from the ranks of actively practising evidence of disease outside of the liver, although the liver metastases had urologists, clearly illustrates that this is not increased considerably in size and were considered the likely explanation always the case. for the pain. The PSA at this time was 483ng/ml. In view of the symptoms and progressive disease, docetaxel-based chemotherapy was commenced. Progress with treatment is being made with After two cycles the pain has improved significantly, the PSA has fallen kinder, minimally invasive, robotically somewhat and he is back playing golf. The side-effects from the assisted surgery and better targeted, more chemotherapy are not too bad, other than he has lost his taste for white powerful radiotherapy. Androgen ablation wine! Abiraterone/enzalutamide are further treatment options if there is therapy still provides the mainstay of therapy further disease progression. for metastatic disease, but abiraterone, enzalutamide, Alpharadin and chemotherapy www.trendsinurology.com TRENDS IN UROLOGY & MEN’S HEALTH MARCH/APRIL 2013 Kirby Tale of Four Prostates_Layout 1 18/03/2013 14:49 Page 3 PROSTATE DISEASE 31 triggers for intervention. Curr Opin Urol CASE 4: SEAN VESEY 2012;22:210–5. 4. Klotz L. Active surveillance for favorable-risk Sean Vesey, aged 58, a laparoscopic radical prostatectomist from prostate cancer: background, patient Merseyside, presented in early 2010 with left iliac fossa discomfort, which selection, triggers for intervention, and prompted investigations, including a PSA. This came back at 78ng/ml. outcomes. Curr Urol Rep 2012;13:153–9. His PSA had been just 1.4ng/ml some 18 months earlier. TRUS biopsy 5. NICE. Prostate cancer: diagnosis and confirmed T3b Gleason 4+3=7 adenocarcinoma in all cores and an MRI treatment. Clinical guideline 58. February revealed pelvic and para-aortic lymphadenopathy. Although the original 2008. http://guidance.nice.org.uk/CG58 bone scan was clear, a subsequent bone scan at one year confirmed the 6. Godtman RA, Holmberg E, Khatami A, et al. presence of bone metastases in the cervical and lumbar spine. Initial hormonal therapy reduced the PSA to a nadir value of 8.9ng/ml. Three Outcome following active surveillance of cycles of chemotherapy followed by abiraterone further reduced the PSA men with screen-detected prostate cancer.
Recommended publications
  • How to Avoid the Seven Deadly Sins of Surgery

    How to Avoid the Seven Deadly Sins of Surgery

    INTRODUCTION HOW TO AVOID THE ‘ SEVEN DEADLY SINS OF SURGERY ’ † † Roger Kirby * , Ben Challacombe * , Prokar Dasgupta * and Increasingly, especially as surgeons, we live ‡ † in a world where the hue and cry resulting John M. Fitzpatrick – * The Prostate Centre , and Department of Urology, MRC from one single untoward incident can Centre for Transplantation, Guy ’ s Hospital, King ’ s College London, King ’ s Health Partners, drown out the plaudits that ought to be due London, UK , and ‡ Mater Misericordiae Hospital and University College Dublin, Dublin, Ireland for literally thousands of cases that have Accepted for publication 14 September 2011 gone smoothly. As a result, it is essential for each and every one of us to try by every means possible to avoid medical accidents, errors and untoward incidents. And when they do occur, we need to deal with their to the patient and his or her relatives, with A similar failure to appreciate what is really aftermath calmly and professionally. follow-up meetings, can avoid months, if happening may arise in the operating not years, of anxiety-inducing litigation. theatre. If advice from the team, including Looking back over seven decades of the assistant, the anaesthetist, the scrub combined experience in urological surgery, The increased focus on teaching these nurse and even the medical student is we thought it might be useful to consider non-technical skills aims to improve factored in, it can sometimes help to avoid a the seven key lessons (mainly learned the standards of communication [ 1 ] . The launch fatal error being made. An operation with hard way) in an attempt to help others of the BAUS national simulation program, ‘ unusual anatomy ’ often suggests that a avoid falling into the traps that lurk in wait SIMULATE, should achieve standardisation of surgeon is in the wrong tissue plane or for the unwary.
  • Ilk Sayfalar 7/6/04 14:13 Page 1 ANDROLOJ‹ BÜLTEN‹

    Ilk Sayfalar 7/6/04 14:13 Page 1 ANDROLOJ‹ BÜLTEN‹

    ilk sayfalar 7/6/04 14:13 Page 1 ANDROLOJ‹ BÜLTEN‹ TÜRK ANDROLOJ‹ DERNE⁄‹ YAYIN ORGANIDIR Türk Androloji Derne¤i Cemil Aslan Güder Sok. ‹dil Ap. B Blok D.1 80280 Gayrettepe, ‹stanbul Tel: 0212 288 50 99 Faks: 0212 288 50 98 E-posta: [email protected] Web: www.androloji.org.tr TÜRK ANDROLOJ‹ DERNE⁄‹ ADINA SAH‹B‹ Prof. Dr. Atefl Kad›o¤lu GENEL YAYIN YÖNETMEN‹ Uz. Dr. Memduh Ayd›n REDAKTÖR Uz. Dr. Ertan Sakall› YÖNET‹M KURULU Atefl Kad›o¤lu (Baflkan) Bülent Semerci (Genel Yazman) ‹rfan Orhan (Sayman) Ramazan Aflç› (Üye) M. Önder Yaman (Üye) Selahittin Çayan (Üye) Mustafa F. Usta (Üye) Nisan 2004 Say› 17 2 Ayda Bir Yay›nlan›r ilk sayfalar 7/6/04 14:14 Page 2 GENEL YAYIN YÖNETMENİ REDAKTÖR Uz. Dr. Memduh Aydın Uz. Dr. Ertan Sakallı BİLİMSEL KURUL ERKEK CİNSEL SAĞLIĞI Yaşlılık ve Cinsellik Ejakülasyo PrekoksRekonstrüktif Cerrahi ED ve Farmakoterapisi Doç. Dr. Ali Atan Prof. Dr. Ahmet Metin Prof. Dr. Erdal Apaydın Uz. Dr. Ertan Sakallı Uz. Dr. Melih Beysel Temel Araştırma Psikolojik ED Doç. Dr. Emin Özbek Yrd. Doç. Dr. Hakan Kılıçarslan Yrd. Doç. Dr. Mustafa Faruk Usta Doç. Dr. Doğan Şahin INFERTİLİTE Varikosel Endokrinoloji Doç. Dr. Selahittin Çayan Uz. Dr. Necati Gürbüz Doç. Dr. Turhan Çaşkurlu Doç. Dr. İsa Özbey Yardımla Üreme Teknikleri Genetik Prof. Dr. Kaan Aydos Doç. Dr. Barış Altay Uz. Dr. Lütfi Tunç Uz. Dr. A. Arman Özdemir Yrd. Doç. Dr. Murat Şamlı Obstrüktif İnfertilite Kadın İnfertilitesi Doç. Dr. Hamdi Özkara Doç. Dr. İrfan Orhan Prof. Dr. Cihat Ünlü Doç. Dr. Erkut Attar Pediatrik Androloji Androloji Laboratuarı Doç.
  • That Silly Operation! the Introduction of TURP Into Great Britain

    That Silly Operation! the Introduction of TURP Into Great Britain

    That Silly Operation! The introduction of TURP into Great Britain Jonathan Charles Goddard 1 Jonathan Charles Goddard Curator of the Museum of Urology, BAUS Consultant Urological Surgeon Leicester General Hospital Acknowledgements I’m very grateful to Mr Bernard Ferrie FRCS, retired Urological Surgeon, who acted as expert editor. Thanks to Miss H.P.H. Goddard, Junior Curator, for photographing the instruments from the collection. I’m extremely grateful to KARL STORZ Endoscopy (UK) Ltd. who generously published this booklet for the 2019 BAUS Annual Meeting in Glasgow. 2 “That Silly Operation!” The introduction of TURP into Great Britain “We want you to give up that silly TURP operation John, it will bring St Peter’s into disrepute”. This is what John Blandy, one of the icons of Twentieth Century British Urology, was told by his “greaters and betters” at St Peter’s Hospital (the famous London urology centre) as late as the 1960’s[1]. TURP even at that stage was still seen as a “silly” new and dangerous operation that should not replace open prostatectomy. However, Transurethral Resection of the Prostate, TURP, is now seen as one of the operations that define Urology. Certain procedures, over time, have stood out as key indicators of Urology; lithotomy, lithotrity, cystoscopy, open prostatectomy, radical prostatectomy and now robotic prostatectomy. They are each surgeries of their age, their names associated with Urology and even certain urologists. A brief roll call of names are easily linked with each one; Cheselden (lithotomy), Civiale and Sir Henry Thompson (blind lithotrity), Nitze and Hurry Fenwick (Cystoscopy), Sir Peter Freyer (open prostatectomy), Patrick Walsh (Radical Retropubic Prostatectomy), Roger Kirby and Prokar Dasgupta (Robotic prostatectomy in the UK).
  • Urethro-Vesical Dysfunction in Progressive Autonomic Failure with Multiple System Atrophy

    Urethro-Vesical Dysfunction in Progressive Autonomic Failure with Multiple System Atrophy

    Journal of Neurology, Neurosurgery, and Psychiatry 1986;49:554-562 Urethro-vesical dysfunction in progressive autonomic failure with multiple system atrophy ROGER KIRBY,* CLARE FOWLER,* JOHN GOSLING,t ROGER BANNISTER$ From the Department of Urology, Middlesex Hospital,* London, The National Hospitalfor Nervous Diseases, London, and the Department ofAnatomy, University ofManchester,t UK SUMMARY Fourteen patients with progressive autonomic failure and multiple system atrophy have been investigated by urodynamic, electromyographic and neurohistochemical means and the results compared with a series of age-matched controls. Three fundamental abnormalities of lower urinary tract function have been identified: (1) Involuntary detrusor contractions in response to bladder filling. It is suggested that these may be the result of a loss of inhibitory influences from the corpus striatum and substantia nigra. (2) Loss of the ability to initiate a voluntary micturition reflex. This may reflect the degeneration of neurons in pontine and medullary nuclei and in the sacral inter- mediolateral columns. In addition, these studies have demonstrated a significant reduction in the density of acetylcholinesterase-containing nerves in bladder muscle. (3) Profound urethral dys- function. This appears to be partly due to a loss of proximal urethral sphincter tone, which causes bladder neck incompetence. In addition, the function of the striated component of the urethral sphincter is impaired. Individual motor units recorded from this muscle were clearly abnormal when compared with controls and suggested that reinnervation had occurred. We suggest that this is the result of degeneration of a specific group of sacral anterior horn cells known as Onuf's nucleus. The evidence that these particular motor units are affected, while others are spared, poses fundamental questions about the nature of selective vulnerability in degenerative diseases of the nervous system.
  • University of Birmingham So Much Cost, Such Little Progress

    University of Birmingham So Much Cost, Such Little Progress

    University of Birmingham So Much Cost, Such Little Progress Bryan, Richard T; Kirby, Roger; O'Brien, Tim; Mostafid, Hugh DOI: 10.1016/j.eururo.2014.02.031 License: Creative Commons: Attribution-NonCommercial-NoDerivs (CC BY-NC-ND) Document Version Peer reviewed version Citation for published version (Harvard): Bryan, RT, Kirby, R, O'Brien, T & Mostafid, H 2014, 'So Much Cost, Such Little Progress', European urology, vol. 66, no. 2. https://doi.org/10.1016/j.eururo.2014.02.031 Link to publication on Research at Birmingham portal Publisher Rights Statement: Checked October 2015 General rights Unless a licence is specified above, all rights (including copyright and moral rights) in this document are retained by the authors and/or the copyright holders. The express permission of the copyright holder must be obtained for any use of this material other than for purposes permitted by law. •Users may freely distribute the URL that is used to identify this publication. •Users may download and/or print one copy of the publication from the University of Birmingham research portal for the purpose of private study or non-commercial research. •User may use extracts from the document in line with the concept of ‘fair dealing’ under the Copyright, Designs and Patents Act 1988 (?) •Users may not further distribute the material nor use it for the purposes of commercial gain. Where a licence is displayed above, please note the terms and conditions of the licence govern your use of this document. When citing, please reference the published version. Take down policy While the University of Birmingham exercises care and attention in making items available there are rare occasions when an item has been uploaded in error or has been deemed to be commercially or otherwise sensitive.
  • Queen Square Alumnus Association

    Queen Square Alumnus Association

    QUEEN SQUARE ALUMNUS ASSOCIATION Issue 4 December 2012 Editor Mr David Blundred Teaching and E-Learning Administrator [email protected] Editorial Leads Professor Simon Shorvon Professor Andrew Lees Miss Jean Reynolds Ms Daniela Warr Schori Miss Pat Harris Professor Ian McDonald dŚĞ ŽƉŝŶŝŽŶƐ ĞdžƉƌĞƐƐĞĚ ŝŶ ƚŚĞ ŶĞǁ ƐůĞƩ Ğƌ ďLJ authors and interviewees do not necessarily reflect the opinion of the Editor or the UCL /ŶƐƟƚƵƚĞŽĨE ĞƵƌŽůŽŐLJĂŶĚE ĂƟŽŶĂů, ŽƐƉŝƚĂůĨŽƌ Neurology and Neurosurgery. All photographs have been kindly provided by D ĞĚŝĐĂů/ůůƵƐƚƌĂƟŽŶ͕ Y ƵĞĞŶ^ƋƵĂƌĞ>ŝďƌĂƌLJĂŶĚ ƚŚĞĚŝƚŽƌƐƉƌŝǀ ĂƚĞĐŽůůĞĐƟŽŶ͘ Contents Editorial 02 News 03 Queen Square Alumnus A round-up of the latest news Association meeting 2013 from Queen Square Alumni News 09 Queen Square Alumnus Association Meeting 11 News, views and recollections from Programme details your fellow alumni Upcoming Events 12 Queen Square Interview 13 A sample of events on offer The Editor interviews Professor Clare over the next few months Fowler on her career at Queen Square Alumni Interview 18 The Editors Travels 20 Dr Andreas Moustris talks about his time at Queen Square An update on the Editors Travels Focus on the Dominican Republic 21 Wilsons Disease Centenary Symposium 23 Professor Jose Puello updates us on developments Professor Niall Quinn and Dr Ted Reynolds in the Dominican Republic speak about this event Out of the Archives 26 Photos from our Archives 28 Christmas recollections from 1906 A look at some of our photos from our archives Belfast Neurology 30 Front Cover Explained 33 Dr Stanley Hawkins talks about Neurology in the Nineteenth and A look at the front cover Early Twentieth Century 1 EDITORIAL The Queen square Alumnus Association Meeting July 2013 I am delighted to announce that we will be holding a two day Alumnus meeting on the 8th and 9th July 2013.
  • Nerve Advancement with End-To-End Reconstruction After Partial Neurovascular Bundle Resection:A Feasibility Study

    Nerve Advancement with End-To-End Reconstruction After Partial Neurovascular Bundle Resection:A Feasibility Study

    JOURNAL OF ENDOUROLOGY Volume 21, Number 8, August 2007 © Mary Ann Liebert, Inc. DOI: 10.1089/end.2007.9946 New Technology Nerve Advancement with End-to-End Reconstruction after Partial Neurovascular Bundle Resection:A Feasibility Study JUAN I. MARTINEZ-SALAMANCA, M.D.,1 SANDHYA RAO, M.D.,1 RAJAN RAMANATHAN, M.D.,1 JAVIER GONZALEZ, M.D.,2 ANIL MANDHANI, M.D.,1 XIMING YANG, M.D.,1 JIANGLING TU,1 E. DARRACOTT VAUGHAN, M.D.,1 and ASHUTOSH TEWARI, M.D.1 ABSTRACT Background and Purpose: It is clear that some patients with prostate cancer require a total or partial neu- rovascular bundle (NVB) resection for oncologic safety to be guaranteed. Nerve grafting is an alternative for these patients to maintain erectile function; however, we report on a feasible option where the NVB is re- leased, and both terminal nerve fibers are approximated; this is the “nerve advancement technique (NAT).” Patients and Methods: Since 2005, a total of 215 men aged 48 to 70 years (mean 59 years) with a Sexual Health Inventory for Men (SHIM) score of 22 have undergone robotic radical prostatectomy for cancer. We selected prospectively seven men to have NAT performed because of clinical high-risk criteria (serum prostate specific antigen [PSA] concentration Ͼ20 mg/dL, Gleason score ϭ 8, and stage cT2c or higher), intraopera- tive criteria (difficulty separating the tissues around the prostate), and evidence of extracapsular extension (ECE) on magnetic resonance imaging. We performed unilateral partial resection, nerve advancement, and, finally, end-to-end anastomosis in six patients, whereas in one patient, we did a bilateral partial excision.

  • Prostate Cancer and Diet Update Study Conclusion

    prostate matters Newsletter of the Prostate Cancer Support Federation Issue 7 February 2010 Contents New Year, new layout Page 2 Report of the Great PSA Debate and a sponsor for our Page 3 PSA Debate continued Page 4 Prostate Cancer and new all colour newsletter! Diet Update Page 5 Diet and Lifestyle The Prostate Cancer Support Federation Changes Page 6 RADICALS Annual Conference & AGM Clinical Trial Page 7 The Great PSA Debate Questionnaire Analysis Report Living well with Page 8 National Cancer Patient Information Prostate Cancer Prescriptions Worried or concerned Saturday 24th April 2010 about prostate cancer? 11.00 to 4.45pm National Help at the Line 0845 601 0766 Penny Brohn Cancer Centre Chapel Pill Lane PM Editor: Roger Bacon email: [email protected] Pill, Bristol You can download this newsletter direct from our website. Go to: BS20 0HH www.prostatecancerfederation.org.uk/ ProstateMatters_latest.pdf Book by phone: 01243 572990 or online The Federation e mail address is: Full programme of speakers will be sent out to member groups [email protected] and published on our website when available It is intended to publish this www.prostatecancerfederation.org.uk/agm_2010.htm newsletter 4 times a year Newsletter Sponsored by Mediwatch “Providing the complete diagnostic solution for Urologists” The Great PSA Debate – November 10th 2009, Leamington Spa Over a hundred representatives of Invited speakers that attach to its use, in particular prostate cancer patient support Before the debate proper, the scene automatic biopsy and treatment of groups went to Leamington Spa was set by Dr Dennis Brennan, a men with a PSA above a notional th on 10 November 2009 to join with recently retired company doctor, threshold.

  • A Comprehensive Review of Overactive Bladder Pathophysiology: on the Way to Tailored Treatment

    EUROPEAN UROLOGY 75 (2019) 988– 1000 available at www.sciencedirect.com journal homepage: www.europeanurology.com Review – Female Urology – Incontinence – Editor’s Choice A Comprehensive Review of Overactive Bladder Pathophysiology: On the Way to Tailored Treatment Benoit Peyronnet a,*, Emma Mironska b, Christopher Chapple b, Linda Cardozo c, Matthias Oelke d, Roger Dmochowski e,Ge´rard Amarenco f, Xavier Game´ g, Roger Kirby h, Frank Van Der Aa i, Jean-Nicolas Cornu j a Department of Urology, University Hospital of Rennes, Rennes, France; b Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK; c Department of Urology, St. Antonius Hospital, Gronau, Germany; d Department of Urology, Vanderbilt University, Nashville, TN, USA; e Department of Neurourology, Tenon Hospital, Paris, France; f Department of Urogynaecology, King’s College Hospital, London, UK; g Department of Urology, University Hospital of Toulouse, Toulouse, France; h The Prostate Centre, London, UK; i Department of Urology, University of Leuven, Leuven, Belgium; j Department of Urology, University Hospital of Rouen, Rouen, France Article info Abstract Article history: Context: Current literature suggests that several pathophysiological factors and mechanisms might Accepted February 28, 2019 be responsible for the nonspecific symptom complex of overactive bladder (OAB). Objective: To provide a comprehensive analysis of the potential pathophysiology underlying Associate Editor: detrusor overactivity (DO) and OAB. Evidence acquisition: A PubMed-based literature

  • Achieving Effective Risk-Factor Modification in Men

    Risk Factor Modification v2_Layout 1 20/05/2011 15:05 Page 1 TALKING POINTS 13 Achieving effective risk-factor modification in men MICHAEL KIRBY AND ROGER KIRBY Urological complaints in men provide healthcare professionals with an opportunity to modify risk factors, thus not only averting the progression of prostate cancer and benign prostatic hyperplasia, but also reducing the hazards of cardiovascular events in men presenting with erectile dysfunction. he concept of ‘risk’ is not well will translate into Tappreciated by most men. In the premature business world, risk, when adroitly judged, morbidity and can lead to significant rewards. By mortality. contrast, most men tend to be somewhat risk averse, not only financially, but also Risk prediction more importantly in terms of approaching has become a hot their health. Attitudes between the sexes topic, not only in vary, as does their willingness to seek cardiovascular medical help and advice. Women tend to disease, but also in localised prostate Figure 1. Helping seek help earlier and are much more likely cancer, benign prostatic hyperplasia (BPH) patients counter obesity to confide in friends and relatives. and erectile dysfunction (ED), and there are by encouraging lifestyle modification major opportunities to advise corrective (patient handout available from When men eventually do present to us treatment and/or lifestyle modification www.trendsinurology.com) in the surgery or clinic, we need to take accordingly. the opportunity to think about their future risk and modify those things that PROSTATE CANCER are modifiable. A subgroup of patients presenting with localised prostate cancer can certainly be From middle age onwards we all carry stratified as high risk.
  • TUF Matters Issue 12 Read More

    TUF Matters Issue 12 Read More

    ISSUE 12 TUF SPRING NEWS AND VIEWSmatters FROM THE UROLOGY FOUNDATION 2021 Bringing follow-up to the forefront Creating a lasting legacy Ending the suffering caused by urology disease theurologyfoundation.org TUFmatters ISSUE 12 | theurologyfoundation.org contents welcome to 03 Big Bake Recipe TUF matters Swap 04 Improving care and well-being across all Hello and welcome to urology TUF matters. 06 Save the Ball First I very much hope that you are keeping safe and well. We continue to live in uncertain times. When 08 Creating a lasting the pandemic first began last year we initially had legacy hopes of it being over by summer, and then by the end of the year. Now it is becoming apparent that 10 Bringing follow up Covid is something we might have to learn to live to the forefront with on an ongoing basis. Hospitals and GP practices have worked hard to make Covid-secure spaces and 12 Ticket to ride the message from urologists is clear: if you have any worries or symptoms please do not delay to seek 14 Supporting the next help or advice. Good outcomes and quality of life generation depend upon early diagnosis so don’t hesitate if you have any health concerns. 15 TUF Nuts Tuesday In the meantime, despite the stresses and strains of 2020, TUF continued to support the urology TUF Heroes 16 community and made a number of research and training awards last year, funding 10 research projects Dates for your diary 18 and supporting over 100 trainees to take part in online lectures and tutorials via the RSM.
  • Urologic Robotic Surgery in Clinical Practice Prokar Dasgupta Editor

    Urologic Robotic Surgery in Clinical Practice Prokar Dasgupta Editor

    Urologic Robotic Surgery in Clinical Practice Prokar Dasgupta Editor Urologic Robotic Surgery in Clinical Practice Foreword by James O. Peabody and Mani Menon 123 Editor Prokar Dasgupta Department of Urology Guy’s Hospital London UK [email protected] ISBN: 978-1-84800-242-5 e-ISBN: 978-1-84800-243-2 DOI: 10.1007/978-1-84800-243-2 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Control Number: 2008936130 c Springer-Verlag London Limited 2008 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licenses issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. The use of registered names, trademarks, etc., in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore free for general use. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book.