Publications by authors named "Jonathan Kam"

42 Publications

Ga-PSMA PET/CT versus CT and bone scan for investigation of PSA failure post radical prostatectomy.

Asian J Urol 2021 Apr 10;8(2):170-175. Epub 2020 Feb 10.

Nepean Urology Research Group, Nepean Hospital, Penrith New South Wales, Australia.

Objective: To evaluate the use of Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (Ga-PSMA PET/CT), compared with conventional CT abdomen/pelvis (CTAP) and whole body single photon emission CT bone scan (BS), for detection of local or distant metastasis following biochemical failure/recurrence in post-prostatectomy patients.

Methods: We conducted a review of our prospectively maintained, institutional database to identify 384 patients with post-prostatectomy biochemical failure/recurrence who underwent PSMA PET/CT, CTAP and BS from February 2015 to August 2017 in Nepean Hospital, tertiary referral centre. The results of the three imaging modalities were analysed for their ability to detect local recurrence and distant metastases. PSMA PET/CT and CTAP imaging were separately performed on the same day and the BS was performed within several days (mostly in 24 h). Difference in detection rates was determined between the modalities and the Chi square test was used to determine significance.

Results: A total of 384 patients were identified with a median prostate-specific antigen (PSA) of 0.465 ng/mL (interquartile range =0.19-2.00 ng/mL). Overall, PSMA PET/CT was positive for 245 (63.8%) patients whereas CTAP and BS were positive in 174 patients (45.3%). A total of 98 patients (25.5%) had local or distant metastasis detected on PSMA only, while 20 patients (5.2%) had recurrences detected on CTAP but not on PSMA PET/CT.

Conclusion: The use of PSMA PET/CT has a higher detection rate of predicted local or distant metastasis compared to CTAP and BS in the staging of patients with biochemical recurrences after radical prostatectomy.
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http://dx.doi.org/10.1016/j.ajur.2020.02.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099644PMC
April 2021

Unexpected case of large ureteric calculus being passed following prostatic artery embolisation.

Urol Case Rep 2021 Mar 22;35:101546. Epub 2020 Dec 22.

Nepean Urology Research Group, Kingswood, NSW, 2747, Australia.

Spontaneous passage of large ureteric calculi over 10mm is uncommon. We present a case of a 69-year-old male with a significant prostatic enlargement (150 cc) and a 13mm ureteric calculus which had not passed for 3 months following a failed attempt at ureteroscopy. His stone passed spontaneously following prostatic artery embolisation (PAE), performed for symptomatic benign prostatic hypertrophy (BPH). We consider the mechanisms by which PAE may impact on the distal ureter which allowed stone passage.
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http://dx.doi.org/10.1016/j.eucr.2020.101546DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772534PMC
March 2021

A prospective, matched comparison of ultra-low and standard-dose computed tomography for assessment of renal colic.

BJU Int 2020 09 23;126 Suppl 1:27-32. Epub 2020 Jun 23.

Nepean Urology Research Group, Kingswood, NSW, Australia.

Objective: To determine the diagnostic accuracy of ultra-low-dose computed tomography (ULDCT) compared with standard-dose CT (SDCT) in the evaluation of patients with clinically suspected renal colic, in addition to secondary features (hydroureteronephrosis, perinephric stranding) and additional pathological entities (renal masses).

Patients And Methods: A prospective, comparative cohort study was conducted amongst patients presenting to the emergency department with signs and symptoms suggestive of renal or ureteric colic. Patients underwent both SDCT and ULDCT. Single-blinded review of the image sets was performed independently by three board-certified radiologists.

Results: Among 21 patients, the effective radiation dose was lower for ULDCT [mean (SD) 1.02 (0.16) mSv] than SDCT [mean (SD) 4.97 (2.02) mSv]. Renal and/or ureteric calculi were detected in 57.1% (12/21) of patients. There were no significant differences in calculus detection and size estimation between ULDCT and SDCT. A higher concordance was observed for ureteric calculi (75%) than renal calculi (38%), mostly due to greater detection of calculi of <3 mm by SDCT. Clinically significant calculi (≥3 mm) were detected by ULDCT with high specificity (97.6%) and sensitivity (100%) compared to overall detection (specificity 91.2%, sensitivity 58.8%). ULDCT and SDCT were highly concordant for detection of secondary features, while ULDCT detected less renal cysts of <2 cm. Inter-observer agreement for the ureteric calculi detection was 93.9% for SDCT and 87.8% for ULDCT.

Conclusion: ULDCT performed similarly to SDCT for calculus detection and size estimation with reduced radiation exposure. Based on this and other studies, ULDCT should be considered as the first-line modality for evaluation of renal colic in routine practice.
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http://dx.doi.org/10.1111/bju.15116DOI Listing
September 2020

Long Pulse-Width Setting Improves Holmium-YAG Laser Lithotripsy - Enhanced Fragmentation and Retropulsion Characteristics of Renal Calculi in a Novel In-Vivo Setting.

Surg Technol Int 2020 Nov;37:168-170

Nepean Urology Research Group (NURG), Kingswood, NSW, Australia, Nepean Clinical School, University of Sydney, Kingswood, NSW, Australia.

The aim of this novel in vivo study was to characterize the effect of short pulse-width versus long pulse-width Holmium-YAG laser lithotripter settings on retropulsion and fragmentation in a real-life setting. A prospective, crossover study was conducted at a tertiary teaching hospital in NSW, Australia. Patients who underwent flexible ureteroscopy with laser lithotripsy for renal calculi in 2018 were included. All patients underwent flexible ureteroscopy using a Flexor® 10.7/12 French ureteric access sheath (Cook Medical LLC, Bloomington, IN, USA) and lithotripsy with a 30W Holmium-YAG laser (Rocamed, Monaco). Thirty-two renal calculi were subjected to 1 min of laser treatment using both short and long pulse-width settings. Using 5-point, operator-assessed Likert scales, the level of retropulsion and fragmentation efficacy were assessed. There was significantly less retropulsion and improved stone fragmentation (p<0.001) using the long pulse-width compared to the short pulse-width setting. Regardless of stone size, in vivo renal calculi lithotripsy with a long pulse-width significantly improves the efficacy of lithotripter treatment.
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November 2020

Segmental testicular infarction, a rare complication of epididymo-orchitis.

Urol Case Rep 2020 Sep 15;32:101246. Epub 2020 May 15.

Nepean Urology Research Group, Kingswood, NSW, 2747, Australia.

Segmental infarction of the testicle secondary to epididymo-orchitis is a rare condition which can be difficult to diagnose and can lead to loss of the testis. We report a case of a 72-year-old man who presented with two weeks of worsening pain of his left testis despite oral antibiotic treatment for epididymo-orchitis. A testicular ultrasound initially revealed a suspected intra-testicular abscess. Despite intravenous antibiotics, his symptoms worsened. A repeat ultrasound demonstrated an increase in size of the lesion and a decision was made to take him to theatre. Intra-operative findings instead revealed a segmental area of testicular infarction requiring debridement.
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http://dx.doi.org/10.1016/j.eucr.2020.101246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256310PMC
September 2020

Acute airway compromise and coagulopathy: a rare presentation of acquired haemophilia A.

BMJ Case Rep 2020 May 4;13(5). Epub 2020 May 4.

Department of Otolaryngology, Head & Neck Surgery, Gosford Hospital, Gosford, New South Wales, Australia.

Acquired haemophilia A is a rare but important diagnosis, carrying a mortality rate of 22%. Life-threatening sequalae of this diagnosis includes airway compromise, which can rapidly lead to demise of the patient if left untreated. Our case examines an 80-year-old man presenting with a supraglottic haematoma resulting from acquired haemophilia A causing airway compromise and necessitating definitive airway control. A review of current understanding and management of the disease is also ddiscussed.
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http://dx.doi.org/10.1136/bcr-2019-233345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222884PMC
May 2020

A Rare Case of Extensive Unilateral Ureteritis Cystica.

Urology 2020 Apr 22;138:e3-e4. Epub 2020 Jan 22.

Department of Urology, Canberra Hospital, Garran, Canberra, Australia.

Ureteritis cystica is rare, benign entity that associates with chronic urothelial irritation such as recurrent urinary tract infection or nephrolithiasis. It is often diagnosed incidentally on routine imaging or ureteroscopy in asymptomatic individuals. In this case report, we present the retrograde pyelogram and ureteroscopy images of a rare case of extensive unilateral ureteritis cystica in a 78-year-old female presenting for elective stone surgery.
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http://dx.doi.org/10.1016/j.urology.2020.01.017DOI Listing
April 2020

Australian ultrasound-guided biopsy trends: a 17-year analysis of national data.

Prostate Int 2019 Dec 21;7(4):150-155. Epub 2019 Oct 21.

Department of Urology, The Canberra Hospital, ACT, Australia.

Background: Prostate cancer diagnosis is primarily performed through ultrasound-guided biopsy. Australia has a Stage 4 aging population and as prostate cancer is a disease of middle aged to elderly patients, it would be expected that there would be an increase in the diagnosis of prostate cancer. However, several key events have occurred in the last 10 years including the introduction of multiparametric magnetic resonance imaging (mpMRI) of the prostate and publication of major prostate cancer screening trials and guidelines. We aimed to characterize the trends in prostate biopsy in Australia in the context of these changes.

Methods: Population and prostate biopsy data were obtained from the Australian Government Bureau of Statistics Census data and the Australian Department of Health Medicare Benefits Schedule between 2000 and 2017. A meta narrative review of publications, guidelines, and policy announcements regarding prostate cancer screening and diagnosis in Australia was performed. Prostate biopsy trends were analyzed from 2000 to 2017 by age-group and year.

Results: The 2016 Census data showed the male population of Australia was 11,546,638. Between 2000 and 2017, a total of 373,158 ultrasound-guided biopsies were performed in Australia. A general decline in the total number of prostate biopsies performed was observed from 2009 onwards. There was a transition of the highest prostate biopsy age-group from 55-64 to 65-74 years with the transition occurring in 2012. Biopsy numbers in the age-group 75-84 years also slowly increased from 2000 to 2009 and declined for a short period of time till 2013 and is on the rise again.The decrease in 2010 coincides with the increased uptake of mpMRI in Australia as a new tool in the screening for prostate cancer. Furthermore, this decrease also coincides with the release of the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) prostate cancer screening trials in 2009 and the policy statements developed as a result of these by Royal Australian College of General Practitioners and Urological Society of Australia and New Zealand.

Conclusion: Interesting trends have been identified through this population study. With an aging population, it would be expected that the number of prostate biopsies would be increasing. It is likely that the introduction of mpMRI in Australia and the release of prostate cancer screening guidelines have decreased the number of patients being screened for prostate cancer. Furthermore, increasing use of active surveillance may be responsible for the increase in the prostate biopsies occurring in the older age-groups.
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http://dx.doi.org/10.1016/j.prnil.2019.09.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962731PMC
December 2019

Epididymo-orchitis masquerading as an irreducible inguinal hernia.

Br J Hosp Med (Lond) 2019 Oct;80(10):616-617

Consultant Urologist, Nepean Urology Research Group, Department of Urology, Nepean Hospital, Sydney, New South Wales, Australia.

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http://dx.doi.org/10.12968/hmed.2019.80.10.616DOI Listing
October 2019

Single use versus reusable digital flexible ureteroscopes: A prospective comparative study.

Int J Urol 2019 10 25;26(10):999-1005. Epub 2019 Aug 25.

Nepean Urology Research Group, Sydney, New South Wales, Australia.

Objectives: To compare the performance and surgical outcomes of two different single-use digital flexible ureteroscopes with a reusable video flexible ureteroscope.

Methods: Patients undergoing retrograde flexible ureteroscopy at Nepean Hospital, Sydney, Australia, were included in this study. Three different flexible ureteroscopes were used in this study: (i) single-use digital LithoVue (Boston Scientific, Marlborough, MA, USA); (ii) single-use digital PU3022A (Pusen, Zhuhai, China); and (iii) reusable digital URF-V2 (Olympus, Tokyo, Japan). Visibility and maneuverability was rated on a 5-point Likert scale by the operating surgeon. Operative outcomes and complications were collected and analyzed.

Results: A total of 150 patients were included in the present study. Of these, 141 patients had ureteroscopy for stone treatment, four for endoscopic combined intrarenal surgery and five for diagnostic/tumor treatment. There were 55 patients in the LithoVue group, 31 in the PU3022A group and 64 patients in the Olympus URF-V2 group. The URF-V2 group had higher visibility scores than both the single-use scopes and higher maneuverability scores when compared with the PU3022A. The LithoVue had higher visibility and maneuverability scores when compared with the PU3022A. There were no differences in operative time, rates of relook flexible ureteroscopes, scope failure or complication rates observed.

Conclusions: Single-use digital flexible ureteroscopes have visibility and maneuverability profiles approaching that of a reusable digital flexible ureteroscope. Single-use flexible ureteroscopes achieve similar clinical outcomes to the more expensive reusable versions.
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http://dx.doi.org/10.1111/iju.14091DOI Listing
October 2019

Ocular injuries resulting from commercial cosmetic procedures.

Clin Exp Optom 2020 07 5;103(4):430-433. Epub 2019 Aug 5.

Department of Ophthalmology, The Alfred Hospital, Melbourne, Victoria, Australia.

The prevalence of potentially precarious cosmetic facial procedures appears to be on the rise. A significant amount of these cosmetic procedures are offered and performed by operators without formal medical training and anatomical knowledge, and with variable degrees of skill. Some of these procedures can result in devastating sight-threatening complications, and many of the individuals undergoing such treatments are relatively young and healthy. Patients need to be aware of the potential risks, including permanent visual loss, before embarking on any cosmetic facial procedure. Optometrists may be the first point of contact for patients with ocular complaints following these treatments. Hence, the authors present here a review on the various ocular injuries that may result from commercial cosmetic procedures.
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http://dx.doi.org/10.1111/cxo.12952DOI Listing
July 2020

Evaluation of the accuracy of multiparametric MRI for predicting prostate cancer pathology and tumour staging in the real world: an multicentre study.

BJU Int 2019 08 25;124(2):297-301. Epub 2019 Feb 25.

Gosford Hospital and Gosford Private Hospital, Gosford, NSW, Australia.

Objectives: To assess the accuracy of multiparametric magnetic resonance imaging (mpMRI) for the detection of significant prostate cancer in men undergoing radical prostatectomy (RP) in an Australian multicentre setting, and to assess concordance between mpMRI and RP for local tumour staging and index lesion locations.

Patients And Methods: Men who underwent mpMRI within 12 months of RP between January 2013 and August 2016 at three Australian sites were included (Central Coast, NSW, St Vincents Hospital, Melbourne, Vic., and Bendigo Hospital, Vic.). The results of mpMRI were compared with the final RP specimen to analyse the performance of mpMRI for significant prostate cancer detection, index lesion localization, prediction of T3 disease and lymph node metastasis. A comparison between mpMRI cases performed using the technical and reporting specifications of Prostate Imaging Reporting and Data System (PI-RADS) version 1 and version 2 was also performed. Data analysis was performed using spss 24.0.

Results: A total of 235 cases were included for analysis. mpMRI PI-RADS score ≥3 had a 91% sensitivity and 95% positive predictive value (PPV) for significant prostate cancer at RP. The overall concordance between index lesion location on mpMRI and RP specimen was 75%. The sensitivity for predication of significant prostate cancer was higher in the PI-RADS version 2 cases compared with PI-RADS version 1 (87-99%; P = 0.005). Index lesion concordance was higher in the PI-RADS version 2 group (68% vs 91%; P = 0.002). mpMRI had a 38% sensitivity, 95% specificity, 90% PPV and 57% negative predictive value for extraprostatic disease. Sensitivity for prediction of T3 disease improved from 30% to 62% (P = 0.008) with PI-RADS version 2.

Conclusions: In patients undergoing RP, an abnormal mpMRI is highly predictive (95% PPV) of significant prostate cancer, with an index lesion concordance of 75%. There has been a significant improvement in accuracy after the adoption of PI-RADS version 2 technical specifications and reporting criteria; however; further study is required to determine if this is attributable to improved experience with mpMRI or changes in the PI-RADS system.
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http://dx.doi.org/10.1111/bju.14696DOI Listing
August 2019

Post-cataract surgery endophthalmitis: The role of prophylactic antibiotic eye drops.

Clin Exp Ophthalmol 2019 05 10;47(4):555-556. Epub 2018 Dec 10.

Department of Ophthalmology, The Alfred, Melbourne, Victoria, Australia.

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http://dx.doi.org/10.1111/ceo.13444DOI Listing
May 2019

Re: Young et al.: Conservatively treated orbital blowout fractures: spontaneous radiologic improvement (Ophthalmology. 2018;125:938-944).

Ophthalmology 2018 12 19;125(12):e86-e87. Epub 2018 Oct 19.

Department of Ophthalmology, The Alfred, Melbourne, Australia.

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http://dx.doi.org/10.1016/j.ophtha.2018.06.028DOI Listing
December 2018

Fungal prostatic abscess erupting through the penis.

Br J Hosp Med (Lond) 2018 Oct;79(10):592

Consultant Urological Surgeon, Nepean Urology Research Group, Nepean Hospital, Kingswood, NSW, Australia.

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http://dx.doi.org/10.12968/hmed.2018.79.10.592DOI Listing
October 2018

Portable Video Media Versus Standard Verbal Communication in Surgical Teaching: A Prospective, Multicenter, and Randomized Controlled Crossover Trial.

J Surg Educ 2019 Mar - Apr;76(2):440-445. Epub 2018 Sep 23.

Nepean Urology Research Group (NURG), Kingswood, NSW, Australia. Electronic address:

Objective: This study aims to evaluate the effectiveness of portable video media (PVM) compared to standard verbal communication (SVC) as a novel adjunct for surgical education of junior medical officers and medical students, in terms of knowledge acquisition and participant satisfaction.

Background: The effective, continued education of final year medical students and junior doctors is the foundation of quality healthcare. The development of new media technologies and rapid internet streaming has resulted in an opportunity for the integration of PVM into medical education. PVM is an educational platform with the advantage of being standardized, efficient, and readily available.

Design: This is a multicenter, prospective, and randomized controlled crossover study. Participants completed a preintervention knowledge test and were then randomized in an allocation ratio of 1:1 to receive surgical education regarding cystoscopy and ureteric stenting for acute renal colic via either PVM or SVC. A 32-point knowledge test and a modified Client Satisfaction Questionnaire-8 were then administered and the participants were then crossed over to the other educational method. The knowledge and satisfaction tests were then readministered.

Results: Fifty-four participants were recruited for this study with 27 participants in each group. Both groups had a 18% to 20% increase in knowledge scores following the first intervention p < 0.001 and on crossover there was a further 4% increase in knowledge scores, p < 0.01. There was no significant difference between the groups in knowledge scores before intervention, p = 0.23 after first intervention p = 0.74 or following crossover p = 0.09. After first intervention, participants in the group receiving PVM education first had a significant 8% higher satisfaction score compared to the SVC group, p = 0.023.

Conclusions: Our study has shown that PVM shows similar efficacy in information uptake to traditional forms of education. Furthermore, PVM was shown to have higher satisfaction scores compared to SVC. Further studies will need to evaluate the use of PVM for education in other surgical and medical domains and assess the long-term knowledge retention.
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http://dx.doi.org/10.1016/j.jsurg.2018.08.013DOI Listing
September 2020

Does magnetic resonance imaging-guided biopsy improve prostate cancer detection? A comparison of systematic, cognitive fusion and ultrasound fusion prostate biopsy.

Prostate Int 2018 Sep 2;6(3):88-93. Epub 2017 Nov 2.

Department of Urology, Gosford District Hospital and Gosford Private Hospital, Gosford, Australia.

Background: The increase in the use of multiparametric magnetic resonance imaging for the detection of prostate cancer has led to the rapid adoption of MRI-guided biopsies (MRGBs). To date, there is limited evidence in the use of MRGB and no direct comparisons between the different types of MRGB. We aimed to assess whether multiparametric MRGBs with MRI-US transperineal fusion biopsy (FB) and cognitive biopsy (CB) improved the management of prostate cancer and to assess if there is any difference in prostate cancer detection with FB compared with CB.

Methods: Patients who underwent an MRGB and a systematic biopsy (SB) from June 2014 to August 2016 on the Central Coast, NSW, Australia, were included in the study. The results of SB were compared with MRGB. The primary outcome was prostate cancer detection and if MRGB changed patient management.

Results: A total of 121 cases were included with a mean age of 65.5 years and prostate-specific antigen 7.4 ng/mL. Seventy-five cases (62%) had a Prostate Imaging and Reporting Data System 4-5 lesions and 46 (38%) had a Prostate Imaging and Reporting Data System 3 lesions. Fifty-six cases underwent CB and 65 underwent FB.Of the 93 patients with prostate cancer detected, 19 men (20.5%) had their management changed because of the MRGB results. Eight men (9%) had prostate cancer detected on MRGB only and 12 men (13%) underwent radical prostatectomy or radiotherapy based on the MRGB results alone.There was a trend to a higher rate of change in management with FB compared with CB (29% vs. 18%).

Conclusions: This is one of the first Australian studies to assess the utility of MRGB and compare FB with CB. MRGB is a useful adjunct to SB, changing management in over 20% of our cases, with a trend toward FB having a greater impact on patient management compared with CB.
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http://dx.doi.org/10.1016/j.prnil.2017.10.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6104474PMC
September 2018

A Rare Case of Ureteral IgG4 Disease Masquerading as Urothelial Carcinoma.

Urology 2018 Aug 22;118:e1-e2. Epub 2018 May 22.

Department of Urology, Nepean Hospital, Nepean Urology Research Group, Kingswood, NSW, Australia; The University of Sydney and Macquarie University Hospital, The University of Sydney, Sydney, Australia.

The present paper described a rare case of ureteral IgG4-related disease (IgG4-RD) that mimicked urothelial carcinoma. An otherwise healthy patient presented with computed tomography, ureteroscopic, and biopsy findings that were suspicious of urothelial carcinoma. The patient received a right nephroureterectomy. Histopathology showed ureteral IgG4-RD, without evidence of urothelial carcinoma. Accurate diagnosis of this rare entity should be based on clinical, biochemical, and histopathological findings.
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http://dx.doi.org/10.1016/j.urology.2018.05.019DOI Listing
August 2018

Multi-centre, prospective evaluation of the Seldinger technique for difficult male urethral catheter insertions by non-urology trained doctors.

BJU Int 2017 11 5;120 Suppl 3:21-27. Epub 2017 Sep 5.

Department of Urology, Gosford District Hospital, Gosford, NSW, Australia.

Objective: To evaluate the safety and effectiveness of the Seldinger technique by non-urology trained (NUT) doctors for difficult male indwelling urinary catheter (IDC) insertions.

Patients And Methods: In all, 115 patients and 57 participating NUT doctors were recruited by the urologist or urology registrar, when contacted in regards to failed IDC insertion. The successful passage of an IDC by the NUT doctors using the Seldinger technique with a straight, hydrophilic guidewire was assessed in our prospective, multicentre evaluation. Instruction of this technique was via bedside teaching by the urology registrar or via video media.

Results: The 115 patients, involving 57 NUT doctors, were prospectively evaluated across four sites; 93% (107/115) of cases had successful placement of an IDC with the Seldinger technique by a NUT doctor. No complications with the Seldinger technique were recorded. In 80 patients (69.6%), the technique was successfully performed by a NUT doctor without attendance by a urologist or urology registrar, with instruction provided from video media or prior bedside teaching by the urology registrar.

Conclusions: Our study is the first to validate the safety and effectiveness of the Seldinger technique for difficult male IDC insertion performed by NUT doctors. This technique can be taught via video education and thus has important implications for health services where urological support is not readily available.
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http://dx.doi.org/10.1111/bju.13928DOI Listing
November 2017

Rare case of a massive staphylococcal prostatic abscess presenting as an ischio-rectal abscess.

ANZ J Surg 2019 Apr 27;89(4):438-440. Epub 2017 Jul 27.

Nepean Urology Research Group, Nepean Hospital, Sydney, New South Wales, Australia.

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http://dx.doi.org/10.1111/ans.14112DOI Listing
April 2019

Marking technique to improve primary success of incision and curettage of eyelid chalazia.

Clin Exp Ophthalmol 2018 01 13;46(1):89-90. Epub 2017 Jun 13.

The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.

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http://dx.doi.org/10.1111/ceo.12994DOI Listing
January 2018

Chronic peritoneal inflammation and nodules masquerading as peritoneal carcinomatosis in Birt-Hogg-Dube syndrome.

ANZ J Surg 2019 01 3;89(1-2):E37-E38. Epub 2017 May 3.

Department of Urology, Gosford District Hospital and Gosford Private Hospital, Gosford, New South Wales, Australia.

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http://dx.doi.org/10.1111/ans.13967DOI Listing
January 2019

Delayed biloma formation in a patient with blunt liver injury after low velocity trauma.

Br J Hosp Med (Lond) 2017 Feb;78(2):110-111

Head of Department, Trauma Unit, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia, and Discipline of Emergency Medicine, University of Sydney, 2006, Australia.

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http://dx.doi.org/10.12968/hmed.2017.78.2.110DOI Listing
February 2017

Post-Vitrectomy Endophthalmitis in Victoria, Australia.

Asia Pac J Ophthalmol (Phila) 2017 Jan-Feb;6(1):104

Department of Ophthalmology, Southend University Hospital, Prittlewell Chase, Southend on Sea, Essex, SS00RY, United Kingdom.

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http://dx.doi.org/10.22608/APO.2016126DOI Listing
March 2017

Retrograde Ejaculation: A Rare Presenting Symptom of Type 1 Diabetes Mellitus.

Urol Case Rep 2017 Jan 27;10:9-10. Epub 2016 Oct 27.

Northern Sydney Local Health District, Sydney, Australia; University of Sydney, Sydney, Australia.

A 19 year old presented with a progressive decline in ejaculate volume over 2 weeks, followed by a complete absence of ejaculate emission. A post-ejaculatory urine specimen demonstrated spermatozoa confirming a diagnosis of retrograde ejaculation. Investigations revealed a raised blood glucose level of 24.5 mmol/L and HbA1c >15%, with positive tests for anti-GAD antibodies and anti-IA2 antibodies consistent with a diagnosis of Type 1 diabetes mellitus. Retrograde ejaculation in diabetes is associated with autonomic neuropathy and is a late feature of the disease. This case is unique with retrograde ejaculation being the primary presenting symptom of Type 1 diabetes mellitus.
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http://dx.doi.org/10.1016/j.eucr.2016.10.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5090193PMC
January 2017

The use of portable video media vs standard verbal communication in the urological consent process: a multicentre, randomised controlled, crossover trial.

BJU Int 2016 Nov 25;118(5):823-828. Epub 2016 Aug 25.

Gosford District Hospital, Gosford, NSW, Australia.

Objectives: To determine if portable video media (PVM) improves patient's knowledge and satisfaction acquired during the consent process for cystoscopy and insertion of a ureteric stent compared to standard verbal communication (SVC), as informed consent is a crucial component of patient care and PVM is an emerging technology that may help improve the consent process.

Patients And Methods: In this multi-centre randomised controlled crossover trial, patients requiring cystoscopy and stent insertion were recruited from two major teaching hospitals in Australia over a 15-month period (July 2014-December 2015). Patient information delivery was via PVM and SVC. The PVM consisted of an audio-visual presentation with cartoon animation presented on an iPad. Patient satisfaction was assessed using the validated Client Satisfaction Questionnaire 8 (CSQ-8; maximum score 32) and knowledge was tested using a true/false questionnaire (maximum score 28). Questionnaires were completed after first intervention and after crossover. Scores were analysed using the independent samples t-test and Wilcoxon signed-rank test for the crossover analysis.

Results: In all, 88 patients were recruited. A significant 3.1 point (15.5%) increase in understanding was demonstrable favouring the use of PVM (P < 0.001). There was no difference in patient satisfaction between the groups as judged by the CSQ-8. A significant 3.6 point (17.8%) increase in knowledge score was seen when the SVC group were crossed over to the PVM arm. A total of 80.7% of patients preferred PVM and 19.3% preferred SVC. Limitations include the lack of a validated questionnaire to test knowledge acquired from the interventions.

Conclusions: This study demonstrates patients' preference towards PVM in the urological consent process of cystoscopy and ureteric stent insertion. PVM improves patient's understanding compared with SVC and is a more effective means of content delivery to patients in terms of overall preference and knowledge gained during the consent process.
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http://dx.doi.org/10.1111/bju.13595DOI Listing
November 2016

Structured Preoperative Phone Counseling by Junior Medical Staff for Improving the Consent Process for Tonsillectomy.

Otolaryngol Head Neck Surg 2016 12 23;155(6):1040-1045. Epub 2016 Aug 23.

Gosford District Hospital, Gosford, Australia.

Objective: To assess the effectiveness of preoperative phone counseling by junior medical staff for improving the standard of informed consent for tonsillectomy.

Study Design: Prospective randomized controlled trial.

Setting: District general hospital.

Subjects And Methods: A total of 43 patients undergoing tonsillectomy were randomly allocated to 2 groups. Group A (n = 25) underwent the conventional consent process by the consultant ear, nose, and throat surgeon at the time of assessment (which generally takes place 6 to 12 months prior to surgery due to wait-list times). Group B (n = 18) underwent this same consent process but received a structured preoperative phone call 2 to 3 weeks prior to the day of surgery. A preoperative questionnaire assessing the knowledge of tonsillectomy, perioperative course, and risks was completed on the day of surgery.

Results: Group B had a better recall of the risks of tonsillectomy, recalling 7.1 of the 10 most significant risks, as compared with 4.6 for group A (P = .017). Group B had a better awareness of tooth damage (78% vs 30% of patients, P ≤ .001), voice change (61 vs 19%, P = .005), and burns to lips and mouth (44% vs 8%, P = .005). Finally, 35% more patients from group B rated their understanding of tonsillectomy as good or very good (P = .017).

Conclusion: Preoperative phone counseling by junior medical staff closer to the time of surgery reinforces and clarifies the information previously provided by senior consultants at the time of initial consent for tonsillectomy.
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http://dx.doi.org/10.1177/0194599816666069DOI Listing
December 2016

Portable Video Media Versus Standard Verbal Communication in Surgical Information Delivery to Nurses: A Prospective Multicenter, Randomized Controlled Crossover Trial.

Worldviews Evid Based Nurs 2016 Oct 13;13(5):363-370. Epub 2016 May 13.

Senior Urology Registrar, Gosford District Hospital, Gosford, NSW, Australia.

Background: Continuing education of health professionals is important for delivery of quality health care. Surgical nurses are often required to understand surgical procedures. Nurses need to be aware of the expected outcomes and recognize potential complications of such procedures during their daily work. Traditional educational methods, such as conferences and tutorials or informal education at the bedside, have many drawbacks for delivery of this information in a universal, standardized, and timely manner. The rapid uptake of portable media devices makes portable video media (PVM) a potential alternative to current educational methods.

Objective: To compare PVM to standard verbal communication (SVC) for surgical information delivery and educational training for nurses and evaluate its impact on knowledge acquisition and participant satisfaction.

Design: Prospective, multicenter, randomized controlled crossover trial.

Setting: Two hospitals: Gosford District Hospital and Wyong Hospital.

Participants: Seventy-two nursing staff (36 at each site).

Intervention: Information delivery via PVM--7-minute video compared to information delivered via SVC.

Outcome Measures: Knowledge acquisition was measured by a 32-point questionnaire, and satisfaction with the method of education delivery was measured using the validated Client Satisfaction Questionnaire (CSQ-8).

Results: Knowledge acquisition was higher via PVM compared to SVC 25.9 (95% confidence interval [CI] 25.2-26.6) versus 24.3 (95% CI 23.5-25.1), p = .004. Participant satisfaction was higher with PVM 29.5 (95% CI 28.3-30.7) versus 26.5 (95% CI 25.1-27.9), p = .003. Following information delivery via SVC, participants had a 6% increase in knowledge scores, 24.3 (95% CI 23.5-25.1) versus 25.7 (95% CI 24.9-26.5) p = .001, and a 13% increase in satisfaction scores, 26.5 (95% CI 25.1-27.9) versus 29.9 (95% CI 28.8-31.0) p < .001, when they crossed-over to information delivery via PVM.

Linking Evidence To Action: PVM provides a novel method for providing education to nurses that improves knowledge retention and satisfaction with the educational process.
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http://dx.doi.org/10.1111/wvn.12162DOI Listing
October 2016

Red hot chilli pepper! Intralingual dermoid cyst: a rare cause of neck swelling.

ANZ J Surg 2018 07 8;88(7-8):797-798. Epub 2016 Apr 8.

Department of Otolaryngology, Head and Neck Surgery, Gosford District Hospital, Gosford, New South Wales, Australia.

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http://dx.doi.org/10.1111/ans.13514DOI Listing
July 2018

Rapidly growing massive pleomorphic rhabdomyosarcoma of the bladder presenting with bladder outlet obstruction.

ANZ J Surg 2018 Mar 17;88(3):E208-E209. Epub 2015 Sep 17.

Department of Urology, Gosford District Hospital, Gosford, New South Wales, Australia.

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March 2018