No abstract

Objectives To assess the satisfaction of men with their testicular implants after undergoing orchidectomy for testicular cancer, and to determine their reasons for accepting or declining a prosthesis. Patients and methods In all, 424 men who had undergone radical orchidectomy and were part of the testicular cancer follow-up programme were sent an anonymous questionnaire comprising 10 questions covering two main areas. First, the reasons for accepting or declining an implant and second (if they received an implant) their satisfaction with the size, position, feel, shape and overall comfort; 234 men (55%) responded. Results About a third (71 men) accepted an implant, a third declined and a third were not offered the choice. Of the men who replied 91% felt that it was extremely important to be offered an implant at the time of surgery. Of the 71 who received an implant, 19 (27%) were dissatis®ed and felt that they had an average or poor cosmetic result. The reasons for this dissatisfaction are presented and discussed. Conclusions All men undergoing orchidectomy should be offered a testicular implant, irrespective of age.Sample implants in all sizes should be available in the outpatient department. This will give men realistic expectations and allow them to choose a suitable size of implant. The dimensions of the available implants should be improved to create a more elliptical prosthesis, to avoid dissatisfaction with the shape. Adequate ®xation to the base of the scrotum is important to avoid the`high riding' implant.

Iversen Symptom Score (MSS), uroflowmetry, filling cystometry and pressure-flow, in three successive studies. RESULTSIn men with LUTS, a significant decrease in the number and pressure of involuntary detrusor contractions (IDCs) in consecutive cystometries resulted in a reduction of observed detrusor overactivity from 72% to 63% and 48%, in the three studies. Urgency scores were significantly lower in men who became 'stable' than in those who remained 'unstable' throughout the three studies. In men with SCI, cystometric variables and detrusor overactivity remained consistent over sequential studies. CONCLUSIONUrodynamic detrusor overactivity is affected by repeated cystometry. In men with LUTS, two populations with detrusor overactivity were identified; one group adapted to repeated filling while another had persistent IDCs and greater urgency scores. The latter group had bladder behaviour similar to that of men with neurogenic bladders secondary to SCI. These findings might be important in explaining the cause of symptoms, initiating further investigation, and predicting the outcome of therapy. KEYWORDS bladder, urodynamics, neurogenic bladder disorder OBJECTIVETo investigate the variation in urodynamic variables during repeated filling cystometry and the impact that the variability had on the observed incidence of detrusor overactivity, to evaluate the correlation of detrusor overactivity with the symptoms of urge in men with lower urinary tract symptoms (LUTS), and to compare the variability of detrusor overactivity in men with LUTS to that in men with spinal cord injury (SCI). PATIENTS AND METHODSSixty men with LUTS and 35 with neurogenic bladders after SCI were assessed. Investigations included the International Prostate Symptom Score (IPSS), Madsen-

Objective To evaluate the effect on quality of life of being discharged home with a catheter before de®nitive treatment in patients with acute urinary retention (AUR). Patients and methods Patients attending the emergency department with AUR were assessed and discharged home with a catheter if they ful®lled predetermined criteria. They were admitted to the day-care unit for urological assessment and completed a disease-speci®c quality-of-life questionnaire. Results Of 101 patients presenting to the emergency department in AUR, 84 were sent home after catheterization (83%); 78 (93%) patients completed the questionnaire. The major side-effects reported were urinary leak (46%), mild haematuria (44%), urgency (42%), pain around the penis (42%), painful erection (31%) and catheter blockage (26%). Only 12% of patients felt having a catheter was very inconvenient and 93% would ®nd it acceptable to have a catheter in future. Conclusion A signi®cant minority of patients discharged home with a catheter had side-effects related to their catheter but were not greatly inconvenienced, and their capacity to carry out normal daily activities was not impaired. The immediate discharge of patients in AUR and planned treatment will enable better use of inpatient urology resources. Keywords Acute urinary retention, catheterization, quality of life IntroductionAcute urinary retention (AUR) is a common urological emergency and frequently results in TURP. The National Prostatectomy Audit (NPA) reported that 23% of all patients underwent TURP for this condition [1]. A subgroup analysis examined this patient population, particularly in relation to the practice of immediate discharge from hospital with a catheter compared with admission for investigation and treatment [2]. Of such patients, 52% were discharged immediately and 48% were admitted, highlighting the lack of consensus on whether it is safe or appropriate to discharge patients directly from the emergency department. The NPA con®rmed that the overall morbidity of these two patient groups was similar after TURP, except for an increased rate of urinary infection in those with prolonged catheterization. A reduction in the length of hospital stay bene®ts both the patient and the hospital, with potential cost savings. However, this has to be weighed against the potential morbidity and adverse impact on daily activities of having to manage a catheter at home. It has been the practice in our department, within established guidelines, to discharge patients from casualty after catheterization. This prospective study addressed the disease-speci®c quality of life of these patients to assess whether this is acceptable practice. Patients and methodsData were obtained prospectively over a 13-month period on all patients presenting with their ®rst episode of AUR. Criteria for immediate discharge were established and approved. These included normal renal function, absence of macroscopic haematuria and/or clot retention, lack of concomitant medical condition warranting hospital admission, and ade...

The expression of PAX2 in prostate cancer compared to nonmalignant prostates is statistically significant (Fisher's exact test p = 0.0004). These results suggest a possible role for PAX2 in prostate cancer. Although previous studies have suggested a role for PAX2 for supporting proliferation in undifferentiated cells, no correlation of PAX2 expression with Gleason score was found in prostate cancer.