Urology Specialist Research Articles

Tek Çocuk Ürolojisi Uzmanı Tarafından Yapılan Hipospadias Cerrahisi Sonuçları; 3 Yıllık Deneyim

Tek Çocuk Ürolojisi Uzmanı Tarafından Yapılan Hipospadias Cerrahisi Sonuçları; 3 Yıllık Deneyim

A nurse practitioner model for the assessment of suspected prostate cancer referrals is safe, cost and time efficient.

PurposeTo evaluate the outcomes from a Urology Nurse Practitioner (UNP)-led service for the initial assessment and diagnostic decision making and for suspected prostate cancer referrals.MethodsUsing a modified Delphi analysis approach, a panel of Urological Prostate Cancer specialists were asked to review the UNP management plans of a convenience sample of 60 randomly selected patient cases – between June 2012 and June 2015. The panel was required to establish consensus or identify divergence of clinical practice, based on five key statements. In addition, cost analysis, waiting time and patient satisfaction evaluation were made regarding the nurse-led service.ResultsIn 87% (52/60 cases), consensus was reached by the panel that the UNP management plan was entirely appropriate and in only two cases was there discordance, where the panel felt that the management plan by the UNP was inappropriate with errors potentially and significantly affecting the patient. Over the 3 years, a modest cost saving of £11,500.38 was realised, which due to increased referrals has now realised in 1 year (2017/18) a saving of £11,335.50. Compared to the previous physician-led service, waiting times for patient appointment fell by 52% over the 3-year period; 57/63 (90%) patients reported being satisfied with seeing a UNP instead of a doctor for their first appointment; 60/63 (95%) reported that, following the initial hospital visit with the UNP, they had a clear understanding of what the next steps were in their assessment. Overall, 54/63 (86%) were ‘very satisfied’ with the UNP-led service.ConclusionOur study demonstrates that a UNP approach to the assessment and management of suspected prostate cancer referrals provides an effective approach to care in an ever-demanding healthcare arena.Through a supported training programme, urology nurses can deliver a high standard of service.

Evaluation of ambiguous genitalia.

To provide a framework for the evaluation of ambiguous genitalia. The most pressing evaluation of ambiguous genitalia is assessment for life-threatening causes such as salt-wasting congenital adrenal hyperplasia (CAH) or syndromes with underlying anomalies such as neurologic or cardiac malformations. A multidisciplinary team, including specialists in Gynecology, Endocrinology, Urology, Genetics, Clinical Psychology/Psychiatry, Radiology, Nursing, Neonatology, and Pediatric Surgery, should be involved. Each patient should be approached in an individualized manner to assign sex of rearing in the most expeditious yet thoughtful means possible.As knowledge on the natural history of sex preference and fertility of individuals with ambiguous genitalia increases, controversy regarding the indication for and timing of genital surgery continues. Considerations include gender identity, future fertility, malignancy risk, infection prevention, and functional anatomy for sexual activity. The evaluation of ambiguous genitalia should involve a multidisciplinary team. A combination of history taking, physical examination, laboratory evaluation, and radiologic assessment can assist with the diagnosis. Care should be taken to emphasize karyotypic sex is not equivalent to gender and to use caution with regards to irreversible medical and surgical therapies which may impact fertility and sexual function and nonconform with future sex identity.

Can the Urologists Perform Stone Analysis, Metabolic Evaluation and Metaphylaxis at Urinary Tract Stone Disease in Tekirdağ?

Objective: As the urolithiasis is an endemic situation in our country, the urologists are well-experienced about this situation. The prevention of urolithiasis recurrence is as important as the surgical treatment. For this reason metabolic evaluation and medical treatment of stone disease is extremely important. This study aimed to evaluate urological specialists' views of metabolic evaluation and medical treatment of urolithiasis. Thus, the main problems and the probable solutions about medical treatment and metabolic evaluation of urinary system stone disease can be evaluated. Methods: The urologists working at Tekirdag were invited to the study. A face-to-face questionnaire, which was composed of three parts, was performed to the participants. In the first section, the demographic characteristics of the participants were evaluated. In the second and third sections, the approach of participants to metabolic evaluation and medical treatment in urolithiasis were investigated, respectively. Results: A total of 29 urologist who routinely performed endourological surgery were included to the study. When we evaluated their endourological practice, 65.5% of the participants were performing 10-25 endourological surgery per month. When we asked the approach of participants about the metabolic evaluation, 34.5% reported that they did not perform metabolic evaluation to their adult patients and 65.5% did not perform to the children with urolithiasis. All participants believed the efficacy of medical treatment however, 66% of the participants were performing at less than half of their patients in clinical practice. Conclusions: The clinical practice about metabolic evaluation, stone analysis and metaphylaxis were lower than expected. Most of the participants were not able to make metabolic evaluation and stone analysis. Further studies are needed to resolve the problems associated with metabolic evaluation and metaphylaxis administration.

Survivorship Care Plans: Health Actions Taken and Satisfaction After Use.

To examine the use of and assess patient satisfaction with survivorship care plans (SCPs). 189 cancer survivors recruited from five cancer treatment center locations (Avera Cancer Institute in Aberdeen, Mitchell, Sioux Falls, and Yankton; Sanford Cancer Center in Sioux Falls) and one auxiliary specialty center (Urology Specialists in Sioux Falls), all in South Dakota. A written survey was completed by participants before and three months after receiving an SCP. Associations between demographics and cancer-related characteristics and use of the SCP were evaluated using chi-square tests. Logistic regression was used to determine factors associated with any use of the SCP, health actions attributable to the SCP, and satisfaction with the SCP. The most frequently reported uses of the SCP were to share with spouse or partner, inform about symptoms, and ask physician or nurse about concerns. SCP use, health actions taken, and satisfaction with the SCP were associated with gender, marital status, and main cancer type. Nurses should promote SCPs because they are valued and used by survivors for follow-up care.

A CLINICAL CASE OF UROLOGICAL REHABILITATION OF A CHILD WITH YATROGENIC COMPLICATIONS OF THE URINARY TRACT DUE TO A SPINAL CORD INJURY

The outcome both of patient recovery and spinal injury, in addition to a variety of clinical factors, is significantly affected by consequences and complications occurring during all periods of injury management. In acute, early and intermediate stages, complications of pelvic organs, according to different authors, are found in 77 - 100% of cases. The described clinical case serves as an illustration of irreversible complications had arisen because of improper management of a spinal cord injury (SCI) patient. An inadequate technique for urine diversion, underestimation of specific demands of the SCI patient, lack of proper positioning skills - all mentioned impacts caused inflammatory and trophic disorders. The article discusses an experience of urological rehabilitation specialists treated a child with iatrogenic complications of a urinary tract due to SCI at levels from Th8 to Th10. Particular attention is paid to mistakes made at the early rehabilitation stage and caused iatrogenic obliteration of the urethra in the area of penoscrotal angle and iatrogenic lysis of the bulbar urethra what inevitably worsened patient’s recovery and the quality of his and his family life.

Reduced bleeding with DRY CUT® transurethral resection of the prostate (TURP) compared to standard TURP

Objective: To compare bleeding and transfusion rate between patients who undergo standard transurethral resection of the prostate (TURP) and patients who undergo DRY CUT® TURP.Materials and methods: A retrospective comparison was made of 626 patients who underwent a standard monopolar TURP during 2004–2007 at the Karolinska University Hospital Huddinge with 620 patients who underwent monopolar DRY CUT® TURP during 2011–2014 at the same clinic. Transfusion rate, perioperative bleeding, prostate volume, resection weight, use of anticoagulation therapy, presence of prostate cancer, whether the operation was performed by a specialist doctor in urology or a resident and length of hospital stay were evaluated.Results: The median bleeding was 300 ml (IQR = 100–645 ml) in the group of patients who underwent standard TURP compared to 75 ml (IQR 30–268 ml) in the DRY CUT® TURP group. The bleeding quotient for standard TURP was 2.3-times the perioperative bleeding for DRY CUT® TURP. In a logistic regression model the patients who underwent standard TURP were more likely to undergo blood transfusion compared to DRY CUT® TURP (OR = 3.18, 95% CI = 1.72–5.88). The results were not affected by adjustment for patient age, presence of prostate cancer, anticoagulation therapy or operation performed by a specialist in urology. However, the resection weight did influence the bleeding quotient.Conclusions: The shift from standard TURP to DRY CUT® TURP has decreased the perioperative bleeding and need for blood transfusion at our hospital.

Workload, job satisfaction, Work Time Act-what is urology doing?

Due to demographic changes, the proportion of people requiring urological treatment will continue to rise. In order to better address this development, we need a well-trained and motivated urological medical community. Not only is continued education in urology an integral part of this, but it must also be embedded into future-oriented, flexible work-hour models, taking into account the German Work Time Act. Thus, in order to obtain a better assessment of the current situation of urological physicians undergoing specialist training, work -hour models currently used in urological clinics must be evaluated. This should allow conclusions to be drawn to find future-oriented solutions in order to do justice to the Future Offensive-Urology in 2025. Transparency, openness, and cooperation should be top priority between the DGU (German Association for Urology) working groups active in this field and the working groups of the BvDU (German Professional Association for Urologists).

Data from an integrated cancer prevention center screening for multiple cancer types.

e13069 Background: Cancer is the second leading cause of death globally, and was responsible for ~9.6 million deaths in 2018. Importantly, between 30–50% of cancers can be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies. Methods: We present the results of 15758 adults who came to our clinic between 2006 and 2018. Patients were counseled on reducing risk factors and screened for early detection of 11 of the most common cancer types. Patients were examined by specialists in internal medicine, surgery, plastic surgery, OBGYN, urology, oncology, oral surgery, gastroenterology, and others. Women underwent vaginal US, pap smear, mammography (40yr) and US/MRI of the breast with a clinical indication. Men underwent PSA/free PSA ( > 40yr). LDCT for moderate smokers. Colonoscopy was recommended to all subjects ( > 40yr). Results: A total of 7900 (50.1%) men and 7857 women (49.9%) mean age 46.9±11.3 years were screened. A total of 418 (2.7%) malignant lesions were detected in patients who had been screened, 245 (1.6%) of which were detected through our screening: skin 66 (0.4%), prostate 30 (0.2%), thyroid 28 (0.2%), breast 28 (0.2%), colorectal 19 (0.1%), urinary 13 (0.08%), lung 11 (0.07%), cervical 11 (0.07%), other/unknown 9 (0.06%), hematologic 8 (0.05%), ovarian 5 (0.03%), uterine 5 (0.03%), pancreas 3 (0.02%), testicular 3 (0.02%), oropharyngeal 2 (0.01%), hepatobiliary 2 (0.01%), stomach 1 (0.01%), larynx 1 (0.01%). A total of 17 (0.1%) malignant lesions were missed: breast 3 (0.02%), colorectal 3 (0.02%), skin 2 (0.01%), thyroid 2 (0.01%), hematologic 2 (0.01%), pancreas 2 (0.01%), kidney 1 (0.01%), lung 1 (0.01%), brain 1 (0.01%). A total of 147 (0.9%) malignant lesions developed > 1year after a visit. Only forty-nine of the cancer patients (12.5%) died after 18.9±17.8 months at a mean age of 66.5±12.2 years. Significantly, better than the expected cancer mortality in general. First-degree family member with cancer (HR = 1.46) and advanced age (HR = 21.8) was associated with increased cancer risk (P < 0.05). Conclusions: One stop shop cancer screening, in the setting of a multidisciplinary outpatient clinic is feasible, can detect cancer at an early stage, and can significantly improve survival.

PUK17 CYSTINURIA, A RARE RENAL CONDITION THAT IS OFTEN UNDIAGNOSED: UK STUDY USING CPRD DATABASE

Cystinuria, a rare autosomal recessive genetic disease, is characterized by high urine concentrations of cysteine, leading to cystine stones in the kidneys, ureter, and bladder. Due to associated conditions and non-specific symptoms it may be under-reported and undiagnosed. This analysis aims to estimate the prevalence of cystinuria, the use of healthcare resources and pathway of patients in the UK. A retrospective analysis was carried out using the CPRD GOLD UK database and linked HES data to identify diagnosed, potentially undiagnosed or miscoded patients. First patient records with at least one event of cystinuria recorded between January 1987 and November 2017 were obtained. This population was analysed on the following aspects: demographics, GP consultations, specialist referrals, treatment patterns, outpatient visits, hospitalisations. Then records of patients without a diagnosis of cystinuria but with associated conditions were analysed. Algorithms based on a sequence of inclusion criteria were developed and validated by clinical experts to identify suspected cystinuria cases. Prevalence rates for 2017 were calculated. 170 patients diagnosed with cystinuria were identified in the database, of whom 96 had a linkage to hospital data. Health records of diagnosed patients revealed that the most prescribed drugs other than for renal conditions were for pain management and infections, patients frequently visited specialists in urology, nephrology and general surgery and hospitalisations were on average inferior to 3 days. A total of 50 patients were identified as having suspected cystinuria via the algorithm. The prevalence of cystinuria was estimated to between 0.48 and 0.62 per 10,000. The study adds to the literature by providing a new estimate of cystinuria prevalence in the UK and further shows that there are patients being undiagnosed or miscoded. However, the clinical criteria may not be specific enough to capture all the suspected patients through algorithms.

Boosting-BoW Algorithm for Finding Kidney Diseases from Medical Test Reports

This paper introduces an approach to increase the accuracy rate of classification by employing Bag-of-Words (BoW) as a feature selection method along with machine learning algorithms to obtain a more accurate output. Because of its capability in quickly processing large sets of data and getting accurate results, this approach can be used in medical areas. Different ensemble approaches are generated by different researchers to obtain good results as mentioned in the literature review. In this study a novel algorithm is proposed to analyze medical kidney test reports, using BoW for selecting the features and analyzing them via Boosting four different machine learning classification algorithms like Sequential Minimum Optimization (SMO), k-Nearest Neighbors (k-NN), Random Forests (RF) and Naive Bayes (NB). With the help of specialists in urology, the proposed algorithm is tested against multiple datasets of different kidney tests. The accuracy of the proposed Boosting algorithms outperforms its counterpart algorithms like SMO, k-NN, RF and NB when they had showen their performances alone.

Computer Application of Ultrasound and Nuclear Magnetic Resonance Images for the Anatomical Learning of the Pelvis and the Female Pelvic Floor.

Computer applications have been incorporated as valuable components in teaching, especially thanks to the advancement and innovation of new technologies during the last decades. The implementation of these computer developments in medicine and in the field of medical teaching with different utilities has been a revolution. This is manifested with greater intensity in certain medical specialties and in different areas of medical education, for example in the study of human anatomy, especially in parts of the human body of great complexity such as the pelvis and the pelvic floor of women. New technologies are also important in the use, study and interpretation of radiological tests, including ultrasound and nuclear magnetic resonance. This implies a change in the study and learning techniques of students, resident doctors and specialists in gynecology, radiodiagnosis, urology and many other medical specialties, considering new computer developments as a good alternative or complement to existing teaching methods. For this reason, we consider that computer programs like the one we present in this work can be very useful in the future of education and more specifically in the training of specialists in medicine.

Promotion and support of successful training as aurologist by the Deutsche Gesellschaft für Urologie

The Deutsche Gesellschaft für Urologie (DGU) has set itself the task of supporting medical assistants on their way to becoming specialists in urology. At the same time, urological junior researchers have been given the opportunity to become part of the urological community at an early stage through the so-called junior membership of the DGU. The working group "Young Urologists" of the DGU addresses in particular topics such as the development of concepts for the promotion of young talent, improvement of further education, models for better compatibility of leisure/family and work as well as the compatibility of clinical and scientific work. As part of the DGU Congress, urological assistants can actively contribute by submitting abstracts for lecture or poster sessions. On the other hand, seminars and forums also address topics relevant to further education. To ensure this, representatives of the assistants are members of the scientific program commission of the DGU congress. The aim of the Junior Academy is to accompany young urologists on their way to becoming aspecialist with high-quality seminars. In addition, the Junior Academy offers personal support on the way to their targeted career goal. The Junior Academy has alarge network that makes it possible to learn from the best. The established Ferdinand-Eisenberger Research Fellowships allow young researchers in urology to be exempted from their clinical routine for one year in order to intensify independent scientific work at arenowned research institution in Germany. AuF-Symposia (working group urological research) and workshops are also aimed at young scientists. Further funding projects, such as support for DFG applications, are unique to the society.

Evaluation of urologic emergency cases applying to emergency service

Introduction: Urological emergencies constitute a significant proportion of patients presenting to emergency services. In this study demographic data, clinical diagnosis and treatment options of urological emergency cases referred to Malatya Training and Research Hospital Emergency Service were evaluated retrospectively. Materials and Methods: 18658, which were evaluated as urological emergency from 717624 patients who applied for Malatya Training and Research Hospital Emergency Service between March 2017 and March 2018 for any reason, were evaluated retrospectively. Demographic characteristics, such as age and gender of the patients, and medical treatments applied o clinics were evaluated. Findings: 47.2% of the patients were male (mean age: 43.7), 52.8% were female (mean age: 39.9), 6.7% were children, 11.3% were 70 years or above. The number of patients who were diagnosed with genitourinary system infection was 8549. There were 4536 patients with acute renal colic, 67 patients with massive macroscopic hematuria. When 74 cases with genitourinary system trauma were evaluated, minor and major renal injuries were seen most frequently. 73 of the patients were surgically operated. A total of 5 (0.02%) patients with two major renal traumas, 2 Fournier gangrene and 1 gunshot injury to the scrotum region were referred to the secondary center after the first visit to the emergency center. Conclusion: Urological emergencies that are frequently encountered in the emergency department should be evaluated quickly by the emergency physician and should be referred to a urology specialist. Having a detailed knowledge of the urological experience of the urologist and assessing the patient quickly and making the necessary intervention in the shortest time can be lifesaving.

A newly developed porcine training model for transurethral piecemeal and en bloc resection of bladder tumour

The Asian Urological Surgery Training & Education Group (AUSTEG) has been established to provide training and education to young urologists in Asia. We developed and validated a porcine bladder training model for transurethral resection of bladder tumour (TURBT). Urology residents and specialists were invited to test the training model. They were asked to complete a pre-task questionnaire, to perform piecemeal and en bloc resection of 'bladder tumours' within the training model, and to complete a post-task questionnaire afterwards. Their performances were assessed by faculty members of the AUSTEG. For the face validity, a pre-task questionnaire consisting of six statements on TURBT and the training model were set. For the content validity, a post-task questionnaire consisting of 14 items on the details of the training model were set. For the construct validity, a Global Rating Scale was used to assess the participants' performances. The participants were stratified into two groups (junior surgeons and senior surgeons groups) according to their duration of urology training. For the pre-task questionnaire, a mean score of ≥ 4.0 out of 5.0 was achieved in 5 out of 6 statements. For the post-task questionnaire, a mean score of ≥ 4.5 out of 5.0 was achieved in every item. For the Global Rating Scale, the senior surgeons group had higher scores than the junior surgeons group in 8 out of 11 items as well as the total score. A porcine TURBT training model has been developed, and its face, content and construct validity has been established.

Shared development of prostate cancer education materialElaboración compartida de material educativo sobre el cáncer de próstata

RESUMOObjetivoApresentar o processo de construção compartilhada de material educativo sobre câncer de próstata.MétodosFoi desenvolvida uma pesquisa participante com uma amostra de conveniência que incluiu, inicialmente, 15 homens e uma mulher (média de idade: 52 anos), todos trabalhadores da mesma empresa, para subsidiar a elaboração de um material educativo. A primeira versão foi avaliada por oito especialistas (cinco especialistas em detecção precoce do câncer, um em urologia e dois em comunicação social) e um grupo diferente de 21 participantes (18 homens e três mulheres; média de idade: 41 anos). O material elaborado abordou riscos e benefícios do rastreamento do câncer de próstata.ResultadosOs participantes desconheciam a orientação do Ministério da Saúde contra o rastreamento do câncer de próstata e houve debate sobre dúvidas e percepções relativas ao tema. O produto final, que gerou uma publicação do Instituto Nacional de Câncer José Alencar Gomes da Silva, foi avaliado por participantes e especialistas.ConclusõesA participação dos homens na elaboração e na avaliação do material confirmou a necessidade imperiosa de difundir informações sobre riscos e potenciais danos associados ao rastreamento desse câncer. O material educativo não deve ser visto como peça isolada, mas como recurso complementar para ações educativas em saúde de caráter participativo, crítico e criativo.

Challenges of Training General Surgery Residents to Do Urology in the Developing World

The purpose this manuscript is to describe the work of one program in Kenya, East Africa, to train general surgery residents in urology to make available the much needed service to the underserved rural population. People in developing countries continue to face the challenge of accessing surgical care with a ratio of 1 surgeon to 20,000 people. This is due, in part, to the inadequate number of trained surgeons. The availability of specialized surgical care such as urology is even more unlikely due to fewer numbers of specialists in urology. Such disciplines take many years of training before a person qualifies as a specialist. This requires highly motivated and suitable candidates who are willing to spend time in training and acquiring skills as well as proper infrastructure for training. There is an effort to train general surgical residents in enhanced skills to make available urology services to the wider population. This involves equipping them with skills in general urology, basic skills in handling endoscopic equipment, and basic endo-urology procedures such as diagnostic cystoscopy with or without biopsy and direct vision urethrotomy (DVU). The residents are also exposed to visiting faculty through international collaborations, surgical camps, and workshops to enhance their skills and knowledge. Equipping general surgical residents with urology skills will greatly reduce the shortage of these services to the people of developing countries.

20 Years of the Reference Center for Prostate Tumors of the Ministry Of Health at the Department of Urology in Sestre Milosrdnice University Hospital Center.

The Department of Urology at the Sestre milosrdnice University Hospital Center is the oldest urological institution in the Republic of Croatia and this part of Europe. Today, the Department is a modern tertiary healthcare institution, where the most complex methods of urological practice are performed using modern medical devices and highly sophisticated technology. In 2011, our urology specialist education program was certified by the European Board of Urology (EBU) as the only one of its kind in Croatia. The program was recertified in 2017. The Department runs a program for the early detection of prostate cancer and performs more than 240 radical prostatectomies annually, which is the highest number of such interventions in Croatia. The aim of this study is to present the work and the activities of the Reference Center for Prostate Tumors of the Ministry of Health at the Department of Urology in Sestre milosrdnice University Hospital Center over the last 20 years. The database of the Reference Center for Prostate Tumors of the Ministry of Health at the Department of Urology in Sestre milosrdnice University Hospital Center was reviewed. During the twenty-year period, approximately 15,000 prostate interventions were performed due to benign and malignant diseases. Of this, 7,374 transrectal ultrasound guided prostate biopsies, 2,632 radical prostatectomies with open retropubic access, 3,988 transurethral prostate resections and 1,097 open suprapubic adenomectomies were performed. With the achieved scientific and professional results in monitoring, studying and improving the prevention, diagnosis and therapy of prostate tumors, as well as with the professional conditions and personnel, the Department of Urology in Sestre milosrdnice University Hospital Center truly justifies the title of the Reference Center for Prostate Tumors of the Ministry of Health of the Republic of Croatia awarded to it in 1998.

Emergency Management of Priapism in the United Kingdom: A Survey of Current Practice

BackgroundDespite its importance, current practice in the emergency management of priapism in the United Kingdom is unknown. AimTo evaluate current practice in the emergency management of priapism in the United Kingdom. MethodsAll “full,” “associate urological specialist,” and “trainee” members of the British Association of Urological Surgeons (BAUS; leading membership-based organization for practitioners of urologic surgery in the United Kingdom) were invited to participate in an online survey. Questions related to the emergency management of priapism, access to tertiary andrology services, and use of guidelines. OutcomesKey outcome measures included frequency of encountered cases, access to specialist andrology support, confidence in key management steps, and use of current guidelines. Results213 of 1,304 (16.3%) eligible members completed the survey. Most reported managing 1 case annually (median = 1, range = 0–>10). Only 7.0% transferred patients to a tertiary center and 87.8% believed they could access specialist andrology advice if required. Respondents were less confident in performing intracavernosal phenylephrine instillation (88.7%) compared with corporal aspiration (98.1%), with confidence lowest among trainee members. Only 68.5% reported performing the distal shunt procedure. Of the 212 respondents that chose to answer questions relating to guidelines, only 155 (73.1%) were aware of their existence, with those published by the European Association of Urology being most popular (53.8%). 205 (96.2%) respondents expressed an interest in the development of a UK-specific guideline, with 162 of 212 (76.4%) stating they would use this in practice. Clinical ImplicationsUrologists in the United Kingdom support the development of UK-specific guidance on the emergency management of priapism for use within the context of the National Health Service. Strengths and LimitationsThis is the first study to assess current practice in the emergency management of priapism in the United Kingdom. Its strength is that most UK urologists were invited to participate through collaboration with the BAUS. Although the response rate of 16.3% is acceptable for a national survey of this nature, responses were self-reported, rendering them susceptible to bias. ConclusionThis study demonstrates that some UK urologists lack confidence in key steps in the emergency management of priapism and identifies a strong level of support for the development of up-to-date UK-specific guidance.Bullock N, Steggall M, Brown G. Emergency Management of Priapism in the United Kingdom: A Survey of Current Practice. J Sex Med 2018;15:476–479.

EFFICACY OF DIFFERENT THERAPEUTIC MODALITIES FOR PRIMARY MONOSYMPTOMATIC PEDIATRIC NOCTURNAL ENURESIS

EFFICACY OF DIFFERENT THERAPEUTIC MODALITIES FOR PRIMARY MONOSYMPTOMATIC PEDIATRIC NOCTURNAL ENURESIS Murtadha M Almusafer@ & Aymen Adel* @FICMS, Professor of Urology, University of Basrah, College of Medicine, Department of Surgery. *FICMS, Urology Specialist, Basrah General Hospital, Basrah, IRAQ. Abstract Primary monosymptomatic nocturnal enuresis (PMNE) is still a common bothersome complaint that makes the children and their families looking for help. Primary MNE is defined as abnormal urination that occurs involuntarily during sleep. Its incidence varies with age, with 15%-20% at 5 year old and fades with increasing age to reach 1-2% at 15 year old. Owing to its complicated pathophysiology and sharing of different body systems, multiple lines of treatment were attempted. This study aimed is to explore the efficacy of different treatment modalities for PMNE in the study patients. Ninety two patients were enrolled in this prospective randomized trial and divided into 4 groups; group A instructed to use the behavioral measures, group B given intranasal Desmopressin, group C given Oxybutynin and group D given combination of the 3 treatments. Fourteen participants were excluded because they were lost during followup and the remaining 78 patients' data were analyzed. Patients were reassessed at 4th and 12th weeks. Wet nights/week significantly reduced in all treatment groups as compared to baseline. Percentage reduction of wet nights/week for behavioral group was 38.9%, Desmopressin was 83%, Oxybutynin was 78% and for Combination was 87.8% at 12th week. According to the ICCS definitions of success there is no full response in behavioral group with partial response of 42.1%, for Desmopressin group the full response was 57.1% and partial response 28.6%, for Oxybutynin group was 50%, and 33%, for combination group 60%, 30% at 12th week of treatment. In conclusion, although behavioral therapy reduces wet nights but not reaching to a full improvement and its use is preferably combined with other treatment modalities. Desmopressin, Oxybutynin, and Combination treatment significantly decreases wet nights with high full response rate.