Publications by authors named "Mohan Arianayagam"

21 Publications

  • Page 1 of 1

Spontaneous bleeding from an unusual renal mass: A case of gestational choriocarcinoma related to previous pregnancy over a decade earlier.

Urol Case Rep 2021 Jul 17;37:101614. Epub 2021 Mar 17.

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

Gestational choriocarcinoma is an uncommon trophoblastic malignancy, occurring in females after pregnancy, which is rarely encountered by urologists. It can be rapidly progressive, however metastases to other organs can occur after a prolonged latency period. We describe a rare case of solitary metastatic gestational choriocarcinoma presenting with spontaneous bleeding from a renal mass, over a decade after the associated pregnancy with a presumed sub-clinical primary tumour. This case demonstrates the importance of recognising gestational choriocarcinoma as a potential differential diagnosis of spontaneous bleeding renal mass in females of child-bearing age as a urologist given the often-aggressive nature of the disease.
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http://dx.doi.org/10.1016/j.eucr.2021.101614DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020421PMC
July 2021

Bladder infusion versus standard catheter removal for trial of void: a systematic review and meta-analysis.

World J Urol 2020 Aug 14. Epub 2020 Aug 14.

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

Purpose: To compare the efficacy and time-to-discharge of two methods of trial of void (TOV): bladder infusion versus standard catheter removal.

Methods: Electronic searches for randomized controlled trials (RCTs) comparing bladder infusion versus standard catheter removal were performed using multiple electronic databases from dates of inception to June 2020. Participants underwent TOV after acute urinary retention or postoperatively after intraoperative indwelling catheter (IDC) placement. Quality assessment and meta-analyses were performed, with odds ratio and mean time difference used as the outcome measures.

Results: Eight studies, comprising 977 patients, were included in the final analysis. Pooled meta-analysis demonstrated that successful TOV was significantly higher in the bladder infusion group compared to standard TOV (OR 2.41, 95% CI 1.53-3.8, p = 0.0005), without significant heterogeneity (I=19%). The bladder infusion group had a significantly shorter time-to-decision in comparison to standard TOV (weighted mean difference (WMD)-148.96 min, 95% CI - 242.29, - 55.63, p = 0.002) and shorter time-to-discharge (WMD - 89.68 min, 95% CI - 160.55, - 18.88, p = 0.01). There was no significant difference in complication rates between the two groups.

Conclusion: The bladder infusion technique of TOV may be associated with a significantly increased likelihood of successful TOV and reduced time to discharge compared to standard TOV practices.
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http://dx.doi.org/10.1007/s00345-020-03408-4DOI Listing
August 2020

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

Metachronous ureteral metastasis of clear cell renal cell carcinoma in a duplex collecting system 1 year after nephrectomy.

Urol Case Rep 2020 Sep 16;32:101214. Epub 2020 Apr 16.

Nepean Urology Research Group, Nepean Hospital, PO Box 63, Penrith, NSW, 2751, Australia.

While renal cell carcinoma is known to metastasise in an unpredictable pattern, even after resection of a primary tumour, delayed ureteric metastasis is a very rarely reported phenomenon. In this case report, we describe a case of ipsilateral metachronous ureteric metastasis in a patient with a complete duplex collecting system. This case demonstrates some useful strategies in the diagnosis and treatment of renal cell carcinoma in this context. To our knowledge, this is the first case report of delayed ureteric metastasis of a renal clear cell carcinoma in a patient with a duplex collecting system.
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http://dx.doi.org/10.1016/j.eucr.2020.101214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184155PMC
September 2020

A Systematic Review and Meta-Analysis of Pelvic Drain Insertion After Robot-Assisted Radical Prostatectomy.

J Endourol 2020 04 23;34(4):401-408. Epub 2020 Mar 23.

Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia.

To perform a systematic review and meta-analysis and to assess the clinical benefit of prophylactic pelvic drain (PD) placement after robot-assisted laparoscopic prostatectomy (RALP) with pelvic lymph node dissection (PLND) in patients with localized prostate cancer. An electronic search of databases, including Scopus, Medline, and EMbase, was conducted for articles that considered postoperative outcomes with PD placement and without PD (no drain) placement after RALP. The primary outcome was rate of symptomatic lymphocele (requiring intervention) and secondary outcomes were complications as described by the Clavien-Dindo classification system. Quality assessment was performed using the Modified Cochrane Risk of Bias Tool for Quality Assessment. Six relevant articles comprising 1783 patients (PD = 1253; ND = 530) were included. Use of PD conferred no difference in symptomatic lymphocoele rate (risk difference 0.01; 95% confidence interval [CI] -0.007 to 0.027), with an overall incidence of 2.2% (95% CI 0.013-0.032). No difference in low-grade (I-II; risk difference 0.035, 95% CI -0.065 to 0.148) or high-grade (III-V; risk difference -0.003, 95% CI -0.05 to 0.044) complications was observed between PD and ND groups. Low-grade (I-II) complications were 11.8% (95% CI 0-0.42) and 7.3% (95% CI 0-0.26), with similar rates of high-grade (III-V) complications, being 4.1% (95% CI 0.008-0.084) and 4.3% (95% CI 0.007-0.067) for PD and ND groups, respectively. PD insertion after RALP with extended PLND did not confer significant benefits in prevention of symptomatic lymphocoele or postoperative complications. Based on these results, PD insertion may be safely omitted in uncomplicated cases after consideration of clinical factors.
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http://dx.doi.org/10.1089/end.2019.0554DOI Listing
April 2020

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

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

The current status of MRI in 
prostate cancer.

Aust Fam Physician 2015 Apr;44(4):225-30

MBBS FRACS (Urol), Urology Fellow, Nepean Hospital, Kingswood, NSW.

Background: The diagnosis and treatment of prostate cancer is a controversial topic. Until recently there has not been a reliable imaging mo-dality for identification of cancer within the prostate. New evidence suggests that multiparametric magngenetic resonance im-aging (MRI) has the potential to improve the diagnosis and treatment of prostate cancer.

Objective: This article explains the potential roles for multiparametric MRI in the diagnosis and treatment of prostate cancer.

Discussion: Multiparametric MRI can help identify regions which may represent clinically significant prostate cancer. MRI may also be used to guide varying prostate cancer treatment modalities. An experienced radiologist and adequately powered MRI scanner are es-sential. Multiparametric MRI in the hands of an experienced uroradiology team is emerging as a useful tool in the diagnosis and treatment of prostate cancer however this technology is still in its infancy and requires further evaluation. At this time prostate MRI should only be ordered by the treating urologist.
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April 2015

The effect of the modified Z trendelenburg position on intraocular pressure during robotic assisted laparoscopic radical prostatectomy: a randomized, controlled study.

J Urol 2015 Apr 23;193(4):1213-9. Epub 2014 Oct 23.

Department of Urology, Macquarie University Hospital, Australian School of Advanced Medicine, Sydney, New South Wales, Australia.

Purpose: The Trendelenburg position has a dramatic effect on circulation, consequently increasing cerebral and intraocular pressure. We evaluated whether modifying the Trendelenburg position would minimize the increase in intraocular pressure.

Materials And Methods: In this prospective, randomized, controlled study we compared intraocular pressure in patients undergoing robot-assisted laparoscopic radical prostatectomy while in the Trendelenburg position or the modified Z Trendelenburg position. In group 1 intraocular pressure, blood pressure and endotracheal CO2 were measured in the patient at anesthesia induction (time 1), before positioning (time 2), and while in the Trendelenburg position (time 3) and in the modified Z Trendelenburg position (time 4). They were also measured after pneumoperitoneum (time 5), every 30 minutes (times 6 to 16), while supine at the end of pneumoperitoneum (time 17) and before awakening (time 18). We modified the Trendelenburg position by placing the head and shoulders horizontally.

Results: Group 1 included 29 patients in the modified Z Trendelenburg position. Group 2 included 21 patients in the Trendelenburg position. No difference was found in patient demographics or surgical outcomes. Median intraocular pressure was in the low normal range at times 1 and 2, and increased in time 3 in each group. From time 4 intraocular pressure decreased and at all time points it was significantly lower in group 1 by a mean of 4.61 mm Hg (95% CI -6.90-2.30, p <0.001). At time 17 mean intraocular pressure decreased to normal (19.6 mm Hg) in group 1 but remained in the hypertensive range (24.9 mm Hg) in group 2. At time 18 mean intraocular pressure was 17 mm Hg in each group. Blood pressure was significantly lower in group 1 with a mean reduction in systolic and diastolic pressure of 6.3 and 4.3 mm Hg, respectively.

Conclusions: Our results suggest that modifying the Trendelenburg position during robot-assisted laparoscopic radical prostatectomy has a significant positive effect on patient neuro-ocular safety by lowering intraocular pressure and accelerating its recovery to the normal range without affecting the operation.
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http://dx.doi.org/10.1016/j.juro.2014.10.094DOI Listing
April 2015

Invasive renal cell carcinoma with inferior vena cava tumor thrombus: cardiac anesthesia in liver transplant settings.

J Cardiothorac Vasc Anesth 2014 Jun 17;28(3):640-6. Epub 2013 Sep 17.

Department of Surgery, Preoperative and Pain Management, University of Miami, Leonard Miller School of Medicine and Jackson Memorial Hospital, Miami, FL.

Objectives: Resection of renal cell carcinomas (RCC) with tumor thrombus invasion into the inferior vena cava (IVC) is associated with significant perioperative morbidity and mortality. This study examined the intra- and inter-departmental collaboration among cardiac, liver transplantation, and urologic surgeons and anesthesiologists in caring for these patients.

Design: After IRB approval, medical records of patients who underwent resection of RCC tumor thrombus level III and IV, from 1997 to 2010 in this institution, were reviewed. Data were collected and analyzed by one way-ANOVA and chi-square test.

Setting: Major academic institution, tertiary referral center.

Participants: This was a retrospective study based on the medical records of patients who underwent resection of RCC tumor thrombus level III and IV, from 1997 to 2010.

Interventions: None.

Measurements And Main Results: Fifty-eight patients (82.9%) with level III thrombus and 12 patients (17.1%) with level IV thrombus were analyzed. Sixty-five (92.9%) did not require any extracorporeal circulatory support; 5 (2 with level III and 3 with level IV; 7.1%) required cardiopulmonary bypass. No patients required veno-venous bypass. Compared to patients with level III thrombus extension, patients with level IV had higher estimated blood loss (6978±2968 mL v 1540±206, p<0.001) and hospital stays (18.8±1.6 days v 8.1±0.7, p<0.001). Intraoperative transesophageal echocardiography (TEE) was utilized in 77.6% of patients with level III thrombus extension and in 100% of patients with level IV thrombus extension. Intraoperative TEE guidance resulted in a significant surgical plan modification in 3 cases (5.2%). Short-term mortality was low (n = 3, 4.3%).

Conclusions: Utilization of specialized liver transplantation and cardiac surgical techniques in the resection of RCC with extension into the IVC calls for a close intra-and interdepartmental collaboration between surgeons and anesthesiologists. The transabdominal approach to suprahepatic segments of the IVC allowed avoidance of extracorporeal circulatory support in most of these patients. Perioperative management of these patients reflected the critical importance of TEE-proficient practitioners experienced in liver transplantation and cardiac anesthesia.
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http://dx.doi.org/10.1053/j.jvca.2013.04.002DOI Listing
June 2014

Prostate sampling by 12-core biopsy: comparison of the biopsy results with tumor location in prostatectomy specimens.

Urology 2012 Jan 4;79(1):37-42. Epub 2011 Nov 4.

Department of Urology, Miller School of Medicine, University of Miami, Miami, FL 33101, USA.

Objective: To analyze the diagnostic performance of individual prostate biopsy cores. The 12-core transrectal prostate biopsy scheme has emerged as a standard of care. However, quality of sampling may vary in different areas of the prostate included in this procedure.

Material And Methods: Two-hundred fifty men underwent radical prostatectomy at our institution. All participants had a systematic 12-core transrectal prostate biopsy containing lateral and medial cores from each side of the apical, medial and basal thirds of the prostate. Biopsy results were matched with histologic maps of the prostatectomy specimens. Sensitivity, negative predictive value (NPV), and overall accuracy were calculated for each biopsy core location and compared between different groups of cores. In addition, patients in the upper quartile of prostate weight were compared with the rest of the cohort.

Results: Sensitivity, NPV, and overall accuracy were significantly lower for apical cores. Average NPV and overall accuracy of basal and mid-lateral biopsies were inferior to those of medial biopsies on the same levels. However, sensitivity of these lateral cores was similar to that of the medial cores. Sensitivities of apical and mid cores were significantly lower in patients with larger prostates.

Conclusion: Decreased accuracy in lateral mid- and basal cores results from higher frequencies of cancer in corresponding prostate areas, and therefore additional samples should be taken at these locations. In addition, diagnostic accuracy of apical cores may be improved through better targeting of the prostatic apex. This may be particularly important in patients with larger prostates.
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http://dx.doi.org/10.1016/j.urology.2011.09.011DOI Listing
January 2012

Lower urinary tract symptoms - current management in older men.

Aust Fam Physician 2011 Oct;40(10):758-67

Department of Urology, The University of Miami Miller School of Medicine, Florida, USA.

Background: Lower urinary tract symptoms are a common problem in men and the incidence of these symptoms increases with age.

Objective: This article provides an update on the evaluation and treatment of lower urinary tract symptoms in older men. In particular, we describe current nomenclature, diagnosis, the International Prostate Symptom Score, and currently available medical and surgical treatments as well as indications for referral to a urologist.

Discussion: Lower urinary tract symptoms may be divided into voiding and storage, and men may present with a combination of the two symptom groups. Voiding symptoms include weak stream, hesitancy, and incomplete emptying or straining and are usually due to enlargement of the prostate gland. Storage symptoms include frequency, urgency and nocturia and may be due to detrusor overactivity. In elderly men who present with lower urinary tract symptoms, indications for early referral to a urologist include haematuria, recurrent infections, bladder stones, urinary retention and renal impairment. In uncomplicated cases, medical therapy can be instituted in the primary care setting. Options for medical therapy include alpha blockers to relax the smooth muscle of the prostate, 5 alpha reductase inhibitors to shrink the prostate, and antimuscarinics to relax the bladder. The International Prostate Symptom Score is beneficial in assessing symptoms and response to treatment. If symptoms progress despite medical therapy or the patient is unable to tolerate medical therapy, urological referral is warranted.
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October 2011

Bladder cancer--current management.

Aust Fam Physician 2011 Apr;40(4):209-13

Royal North Shore Hospital, Sydney, New South Wales.

Background: Over 2000 cases of bladder cancer were diagnosed in Australia in 2005. Bladder cancer is a relatively common disease with high morbidity if left untreated. Bladder cancer is categorised as either 'nonmuscle invasive bladder cancer' or 'muscle invasive bladder cancer'. Treatment varies significantly for each type.

Objective: This article provides an update on the presentation of bladder cancer, its risk factors, investigations and treatment, and discusses the role of chemotherapy as a neoadjuvant and adjuvant treatment.

Discussion: Bladder cancer most commonly presents with microscopic or macroscopic haematuria. Evaluation is required of all patients with macroscopic haematuria, patients with persistent microscopic haematuria, and at risk patients with a single episode of microscopic haematuria. Evaluation consists of imaging, urine cytology and cystoscopy. Nonmuscle invasive bladder cancer patients can undergo tumour resection with adjuvant intravesical treatments, while muscle invasive bladder cancer patients are optimally treated with cystectomy and urinary diversion.
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April 2011

Anomalies of the inferior vena cava and renal veins and implications for renal surgery.

Cent European J Urol 2011 18;64(1):4-8. Epub 2011 Mar 18.

Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA.

Abnormalities of the inferior vena cava (IVC) and renal veins are extremely rare. However, with the increasing use of computed tomography (CT), these anomalies are more frequently diagnosed. The majority of venous anomalies are asymptomatic and they include left sided IVC, duplicated IVC, absent IVC as well as retro-aortic and circumaortic renal veins. The embryological development of the IVC is complex and involves the development and regression of three sets of paired veins. During renal surgery, undiagnosed venous anomalies may lead to major complications. There may be significant hemorrhage or damage to vascular structures. In addition, aberrant vessels may be mistaken for lymphadenopathy and may be biopsied. In this review we discuss the embryology of the IVC and the possible anomalies of IVC and its tributaries paying particular attention to diagnosis and implications for renal surgery.
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http://dx.doi.org/10.5173/ceju.2011.01.art1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921701PMC
June 2014

Point. Routine use of postoperative intravesical chemotherapy after TURBT-should it be done?

Urology 2010 Oct;76(4):794-6

Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA.

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http://dx.doi.org/10.1016/j.urology.2010.04.069DOI Listing
October 2010

Androgen deficiency in the aging man.

Aust Fam Physician 2010 Oct;39(10):752-5

Royal North Shore Hospital, Sydney, New South Wales.

Background: Androgen deficiency in the aging man is an area of considerable debate because a gradual decline in testosterone may simply be part of the normal aging process. However, there is an alternative view that androgen deficiency in the aging man may constitute a valid and underdiagnosed disorder.

Objective: To discuss the aetiology, clinical features, diagnosis and management of androgen deficiency in the aging man.

Discussion: Late onset hypogonadism has clinical features that overlap with both normal aging and some pathological conditions. It can only be diagnosed on the basis of both suggestive clinical features and clear biochemical evidence of testosterone deficiency. In this group of patients medication may play a role.
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October 2010

Bacterial cystitis in women.

Aust Fam Physician 2010 May;39(5):295-8

Department of Urology, Royal Prince Alfred Hospital, New South Wales, Australia.

Background: A woman presenting with symptoms suggestive of bacterial cystitis is a frequent occurrence in the general practice setting. One in three women develop a urinary tract infection (UTI) during their lifetime (compared to 1 in 20 men).

Objective: In this article we provide an outline of the aetiology, pathogenesis and treatment of bacterial cystitis in the primary care setting. We suggest measures that may assist before urological referral and work through a common clinical scenario.

Discussion: Bacterial cystitis in unlikely if the urine is both nitrite and leuco-esterase negative. Empirical antibiotics are justified if symptoms are present with positive urinary dipstick, but microscopy, culture and sensitivity of urine is warranted to ensure appropriate empirical therapy and identification of the causative organism. Risk factors for UTI in women include sexual intercourse, use of contraceptive diaphragms and, in postmenopausal women, mechanical and/or physiologic factors that affect bladder emptying such as cystocoele or atrophic vaginitis. Discussion regarding risk factors and UTI prevention is important. Women with recurrent UTIs (defined as three or more episodes in 12 months or two or more episodes in 6 months) should be screened for an underlying urinary tract abnormality (ultrasound) and may benefit from prophylactic therapy. Patients with complex or recurrent UTIs, persistent haematuria, persistent asymptomatic bacteriuria, or urinary tract abnormalities on imaging may benefit from referral to a urologist.
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May 2010

Urinary incontinence-pathophysiology and management outline.

Aust Fam Physician 2008 Mar;37(3):106-10

Department of Urology, Port Macquarie Base Hospital, Port Macquarie, New South Wales.

Background: Urinary incontinence is common in the community and may impact significantly on quality of life; yet only one-third of sufferers seek medical attention. There are many treatment options for patients suffering with urinary incontinence.

Objective: This article aims to aid general practitioners in the management urinary incontinence. We outline the pathophysiology of urinary incontinence in women and provide a primary care treatment paradigm. Suggestions for when specialist referral would be of benefit are also discussed.

Discussion: Most urinary incontinence can be evaluated and treated in the primary care setting after careful history and simple clinical assessment. Initial treatment, for both urge urinary incontinence and stress urinary incontinence, is lifestyle modification and pelvic floor muscle treatment. Urinary urgency responds to bladder training and pharmacotherapy with anticholinergic medication. Pharmacotherapy has a limited place in stress incontinence. If there is complex symptomatology or primary management fails, then referral to a specialist is suggested.
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March 2008

Symptomatic urinary stone disease in pregnancy.

Aust N Z J Obstet Gynaecol 2008 Feb;48(1):34-9

Department of Urology, Port Macquarie Base Hospital, New South Wales, Australia.

Background: Symptomatic urinary calculi are rare in pregnancy with an incidence of one per 1500 pregnant women. Calculi may cause ureteric obstruction that can be further complicated by sepsis. This may have a significant morbidity for mother and fetus.

Objective: To provide an update on the current investigations and management options for pregnant patients with symptomatic urinary calculi.

Discussion: We discuss the different imaging modalities available to investigate the renal tract in pregnant women and propose a management pathway. This topic is particularly pertinent to obstetricians in their roles as coordinators of prenatal care.
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http://dx.doi.org/10.1111/j.1479-828X.2007.00798.xDOI Listing
February 2008

Chemotherapy in the treatment of prostate cancer--is there a role?

Aust Fam Physician 2007 Sep;36(9):737-9

Department of Urology, Port Macquarie Base Hospital, and University of New South Wales, Australia.

Background: Prostate cancer is a common cancer in men. Traditional therapies are effective except in patients who progress to hormone refractory disease. Historically, chemotherapy has had a limited role in the treatment of prostate cancer. However, new agents are showing promise in patients with advanced disease.

Objective: This article reviews and presents current evidence on the use of chemotherapy in the treatment of prostate cancer and attempts to aid general practitioners in their role in the multidisciplinary environment of current cancer care.

Discussion: Analysis of the literature suggests there is no clear role for chemotherapy in the neoadjuvant or adjuvant setting. Chemotherapy may provide a short survival benefit in men with androgen independent prostate cancer but more importantly, can improve quality of life, and reduce pain and prostate specific antigen thus providing effective palliation.
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September 2007