Publications by authors named "Nicholas Bullock"

13 Publications

  • Page 1 of 1

Top 100 most influential manuscripts in erectile dysfunction.

Urologia 2021 Feb 25:391560321993559. Epub 2021 Feb 25.

Cwm Taf Morgannwg University Health Board, Abercynon, UK.

Erectile dysfunction (ED) is a common condition encountered by an array of subspecialists and is the most cited research topic within the field of andrology. This bibliometric analysis aims to identify the most influential papers that inform current clinical practice and likely shape future research. The Thompson Reuters Web of Science citation database was interrogated using search terms to cover the breadth of erectile dysfunction. Results were ranked according to citation number with country of origin, journal, topic, year of publication, author and institution also analysed. The search criteria matched 12,570 manuscripts. The top 100 highest citation ranged from 3013 to 161 (median 229.5). The most cited manuscript reports the prevalence and risk factors of ED within the Massachusetts Male Aging Study. The most manuscripts were published by the ( = 15) with a total of 7913 citations. Institutions from the USA contributed the majority ( = 55) with the UK ( = 14) second. The most common theme represented was epidemiology ( = 46) followed by treatment ( = 27). This analysis provides a list of the most influential manuscripts within ED and illustrates what can be considered a 'highly citable' paper. The most influential papers in Erectile Dysfunction remain seminal works from the end of the last century. The most cited manuscript has been cited 194 times in the last 17 months showing its continued value. Only one paper published within the last decade has reached the top twenty exemplifying the relative lack of novel influential publications.
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http://dx.doi.org/10.1177/0391560321993559DOI Listing
February 2021

The PTEN Conundrum: How to Target PTEN-Deficient Prostate Cancer.

Cells 2020 10 22;9(11). Epub 2020 Oct 22.

The European Cancer Stem Cell Research Institute, School of Biosciences, Cardiff University, Hadyn Ellis Building, Cardiff CF24 4HQ, UK.

Loss of the tumor suppressor phosphatase and tensin homologue deleted on chromosome 10 (PTEN), which negatively regulates the PI3K-AKT-mTOR pathway, is strongly linked to advanced prostate cancer progression and poor clinical outcome. Accordingly, several therapeutic approaches are currently being explored to combat PTEN-deficient tumors. These include classical inhibition of the PI3K-AKT-mTOR signaling network, as well as new approaches that restore PTEN function, or target PTEN regulation of chromosome stability, DNA damage repair and the tumor microenvironment. While targeting PTEN-deficient prostate cancer remains a clinical challenge, new advances in the field of precision medicine indicate that PTEN loss provides a valuable biomarker to stratify prostate cancer patients for treatments, which may improve overall outcome. Here, we discuss the clinical implications of PTEN loss in the management of prostate cancer and review recent therapeutic advances in targeting PTEN-deficient prostate cancer. Deepening our understanding of how PTEN loss contributes to prostate cancer growth and therapeutic resistance will inform the design of future clinical studies and precision-medicine strategies that will ultimately improve patient care.
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http://dx.doi.org/10.3390/cells9112342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690430PMC
October 2020

Intravesical injection of botulinum toxin A for treatment of overactive bladder in anticoagulated patients: Is it safe?

Turk J Urol 2020 Nov 9;46(6):481-487. Epub 2020 Oct 9.

Department of Urology, Morriston Hospital, Swansea, Wales.

Objective: This study aimed to identify the complication rate, specifically bleeding, in patients who received anticoagulation undergoing intravesical botulinum toxin A injections.

Material And Methods: This study included all patients (n=430) undergoing intravesical injection of botulinum toxin A in a single secondary care center between January 2013 and December 2018. We recorded the use of anticoagulants/antiplatelets and complications. Logistic regression was used to investigate the association between anticoagulant/antiplatelet use and the complications arising, while controlling for age and sex.

Results: We identified 430 procedures in 94 men and 336 women (mean age, 60 years). A total of 79 patients received anticoagulants (18%). Aspirin was the most common anticoagulant (52%). Complication rate in anticoagulated patients was 6% (n=5), and it was 2% in those not on anticoagulants/antiplatelets (n=7). Complications were over 3 times more likely in patients who received anticoagulants/antiplatelets (odds ratio=3.233; 95% confidence interval=0.873, 11.38; p=0.067). There was no difference in the complications between patients with idiopathic symptoms and those with neuropathic overactive bladder. No patients required further surgical intervention, and all except 1 were Clavien-Dindo grade I-II with no mortalities.

Conclusion: Anticoagulated patients undergoing intravesical injections have higher complication risks; however, the treatment outcome is unaffected with no significant morbidity/mortality. This is the first study to demonstrate safe outcomes for this subgroup and can assist in decision making and consenting.
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http://dx.doi.org/10.5152/tud.2020.20256DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7608530PMC
November 2020

Establishing a national high fidelity cadaveric emergency urology simulation course to increase trainee preparedness for independent on-call practice: a prospective observational study.

BMC Med Educ 2020 Oct 7;20(1):349. Epub 2020 Oct 7.

Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK.

Background: Whilst competence in the management of a wide range of urological emergencies is a requirement for certification in urology, many conditions are uncommon and exposure during training may be limited. This prospective observational study sought to evaluate the feasibility and effectiveness of a standardised cadaveric emergency urology simulation course aimed at improving operative confidence and competence prior to independent on-call practice in the United Kingdom.

Methods: A two-day cadaveric emergency urology simulation course supported by the British Association of Urological Surgeons (BAUS) was implemented at two pilot centres. All delegates that undertook one of the initial series of courses were invited to complete online pre- and post-course questionnaires relating to prior operative experience, documented competence and perceived confidence in being able to perform specific emergency procedures independently. Primary outcome was a self-reported 'confidence score' selected from a linear numeric scale ranging from 1 (not at all confident to perform a given procedure independently) to 10 (fully confident). Statistical analysis was undertaken using SPSS Statistics for Mac Version 25 and the paired student's t-test used to compare mean pre- and post-course scores.

Results: One hundred and four delegates undertook the course during the study period. Of these, 85 (81.7%) completed the pre-course survey and 67 (64.4%) completed the post-course survey, with 61 (58.7%) completing both. The greatest proportion of respondents were Speciality Trainees in Urology of ST5 level or higher (equivalent of Resident/Fellows with 4 or more years of surgical training; n = 31, 36.5%). Delegates reported variable pre-course exposure, with most experience reported in loin approach to the kidney (median 10) and least in exploration and packing of a transurethral resection cavity and emergency nephrectomy (median 0). Following course completion, a statistically significant increase in confidence score was observed for each procedure, with the greatest increases seen for shunt for priapism (4.87 to 8.80, p < 0.001), ureteric reimplantation (3.52 to 7.33, p < 0.001) and primary ureteric anastomosis (3.90 to 7.49, p < 0.001).

Conclusions: A standardised high fidelity cadaveric simulation course is feasible and significantly improves the confidence of trainees in performing a wide range of emergency procedures to which exposure is currently limited.
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http://dx.doi.org/10.1186/s12909-020-02268-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540436PMC
October 2020

Asymptomatic bilateral obstructing ureteric calculi resulting in Lactobacillaemia and endocarditis requiring emergency aortic valve replacement.

Urol Case Rep 2020 Sep 22;32:101218. Epub 2020 Apr 22.

Department of Urology, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK.

Ureteric calculi are a common cause of emergency presentation to hospitals in the United Kingdom and worldwide. A significant and life threatening complication of those stones that obstruct the ureter is pyonephrosis, bacteraemia and resulting sepsis. Whilst the majority of such cases present with the typical symptoms of loin pain and fever, here we describe the case of a 57 year old patient with asymptomatic bilateral obstructing ureteric calculi that led to bacteraemia from a rare bacterial pathogen, Lactobacillus jensenii, and subsequent severe bacterial endocarditis requiring emergency aortic valve replacement.
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http://dx.doi.org/10.1016/j.eucr.2020.101218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191579PMC
September 2020

Pathological upgrading in prostate cancer treated with surgery in the United Kingdom: trends and risk factors from the British Association of Urological Surgeons Radical Prostatectomy Registry.

BMC Urol 2019 Oct 17;19(1):94. Epub 2019 Oct 17.

Department of Urology, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK.

Background: Accurate grading at the time of diagnosis if fundamental to risk stratification and treatment decision making in patients with prostate cancer. Whilst previous studies have demonstrated significant pathological upgrading and downgrading following radical prostatectomy (RP), these were based on historical cohorts and do not reflect contemporary patient selection and management practices. The aim of this national, multicentre observational study was to characterise contemporary rates and risk factors for pathological upgrading after RP in the United Kingdom (UK).

Methods: All RP entries on the British Association of Urological Surgeons (BAUS) Radical Prostatectomy Registry database of prospectively entered cases undertaken between January 2011 and December 2016 were extracted. Those patients with full preoperative PSA, clinical stage, needle biopsy and subsequent RP pathological grade information were included. Upgrade was defined as any increase in Gleason grade from initial needle biopsy to pathological assessment of the entire surgical specimen. Statistical analysis and multivariate logistic regression were undertaken using R version 3.5 (R Foundation for Statistical Computing, Vienna, Austria).

Results: A total of 17,598 patients met full inclusion criteria. Absolute concordance between initial biopsy and pathological grade was 58.9% (n = 10,364), whilst upgrade and downgrade rates were 25.5% (n = 4489) and 15.6% (n = 2745) respectively. Upgrade rate was highest in those with D'Amico low risk compared with intermediate and high-risk disease (55.7% versus 19.1 and 24.3% respectively, P < 0.001). Although rates varied between year of surgery and geographical regions, these differences were not significant after adjusting for other preoperative diagnostic variables using multivariate logistic regression.

Conclusions: Pathological upgrading after RP in the UK is lower than expected when compared with other large contemporary series, despite operating on a generally higher risk patient cohort. As new diagnostic techniques that may reduce rates of pathological upgrading become more widely utilised, this study provides an important benchmark against which to measure future performance.
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http://dx.doi.org/10.1186/s12894-019-0526-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6798468PMC
October 2019

Reply letter to: Emergency general surgery - is there any value in a '100 most cited' list?

Int J Surg 2019 04 10;64:54-55. Epub 2019 Feb 10.

Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.

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http://dx.doi.org/10.1016/j.ijsu.2019.02.003DOI Listing
April 2019

The 100 most influential manuscripts in andrology: a bibliometric analysis.

Basic Clin Androl 2018 12;28:15. Epub 2018 Dec 12.

2Department of Urology, Cwm Taf University Health Board, Royal Glamorgan Hospital, Llantrisant, CF72 8XR UK.

Background: As the specialty of Andrology expands it is important to establish the most important studies that have shaped, and continue to shape, current research and clinical practice. Bibliometric analysis involving a citation rank list is an established means by which to identify the published material within a given field that has greatest intellectual influence. This bibliometric analysis sought to identify the 100 most influential manuscripts in Andrology, as well as the key research themes that have shaped contemporary understanding and management of andrological conditions.

Methods: The Thompson Reuters Web of Science citation indexing database was interrogated using a number of search terms chosen to reflect the full spectrum of andrological practice. Results were ranked according to citation number and further analysed according to subject, first and senior author, journal, year of publication, institution and country of origin.

Results: The Web of Science search returned a total of 24,128 manuscripts. Citation number of the top 100 articles ranged from 2819 to 218 (median 320). The most cited manuscript (by Feldman et al., The Journal of Urology 1994; 2819 citations) reported the prevalence and risk factors for erectile dysfunction (ED) in the Massachusetts Male Ageing Study. The Journal of Urology published the highest number of manuscripts ( = 11), followed by the New England Journal of Medicine ( = 10). The most common theme represented within the top 100 manuscripts was erectile dysfunction ( = 46), followed jointly by hypogonadism and male factor infertility ( = 24 respectively).

Conclusion: Erectile dysfunction should be considered the most widely researched, published and cited field within andrological practice. This study provides a list of the most influential manuscripts in andrology and serves as a reference of what comprises a 'highly citable' paper for both researchers and clinicians.
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http://dx.doi.org/10.1186/s12610-018-0080-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6290538PMC
December 2018

Implementation of medication-related indicators of potentially preventable hospitalizations in a national chronic disease management program for older patients with multimorbidity.

Int J Qual Health Care 2019 Mar;31(2):133-139

School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.

Initial Assessment: Older people are at increased risk of medication-related potentially preventable hospitalizations (MR-PPH) due to the presence of multiple chronic conditions (multimorbidity) and subsequent polypharmacy.

Choice Of Solution: A pilot study was conducted, using evidence-based indicators to detect older patients in a chronic disease management program (CDMP) at risk of hospitalization due to sub-optimal medication use.

Implementation: Previously validated indicators for MR-PPH were applied to patients with multimorbidity, aged 65 years or older and who were enrolled in a national community-based CDMP. Nurse-led telephone interviews and case note abstraction were used as data sources.

Evaluation: Nineteen patients triggered the MR-PPH indicators 85 times with a median of four per patient. Sub-optimal medication management was identified 34 times (40%) with a median of two per patient. The most common reasons for sub-optimal medication management were exposure to medications associated with falls, underuse of angiotensin-converting enzyme inhibitor/angiotensin-2 receptor blocker medications for cardiovascular disease and low rates of hemoglobin A1c and renal monitoring in patients with diabetes.

Lessons Learned: This study has shown the utility of MR-PPH indicators within a CDMP to identify and monitor sub-optimal medication-related care. Implementation and ongoing monitoring of these types of indicators can support the development of targeted programs to reduce the ongoing risk of adverse events in the older population and improve the overall quality of life.
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http://dx.doi.org/10.1093/intqhc/mzy133DOI Listing
March 2019

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

J Sex Med 2018 Apr 14;15(4):476-479. Epub 2018 Feb 14.

Department of Urology, Cwm Taf University Health Board, Royal Glamorgan Hospital, Llantrisant, UK; Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK.

Background: Despite its importance, current practice in the emergency management of priapism in the United Kingdom is unknown.

Aim: To evaluate current practice in the emergency management of priapism in the United Kingdom.

Methods: All "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.

Outcomes: Key outcome measures included frequency of encountered cases, access to specialist andrology support, confidence in key management steps, and use of current guidelines.

Results: 213 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 Implications: Urologists 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 Limitations: This 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.

Conclusion: This 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.
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http://dx.doi.org/10.1016/j.jsxm.2018.01.013DOI Listing
April 2018

The 100 most cited manuscripts in emergency abdominal surgery: A bibliometric analysis.

Int J Surg 2017 Jan 5;37:29-35. Epub 2016 Dec 5.

Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK; Cardiff University School of Medicine, University Hospital of Wales, Health Park, Cardiff, CF14 4XN, UK. Electronic address:

Background: The number of citations a scientific article receives provides a good indication of its impact within any given field. This bibliometric analysis aimed to identify the 100 most cited articles in Emergency Abdominal Surgery (EAS), to highlight key areas of interest and identify those that have most significantly shaped contemporary clinical practice in this newly evolving surgical specialty. This is of increasing relevance as concerns grow regarding the variable and suboptimal outcomes in Emergency General Surgery.

Materials And Methods: The Thomson Reuters Web of Science database was used to search using the terms [Emergency AND Abdom* AND Surg*] to identify all English language, full manuscripts. Results were ranked according to citation number. The top 100 articles were further analysed by subject, author, journal, year of publication, institution, and country of origin.

Results: The median (range) citation number of the top 100 out of 7433 eligible papers was 131 (1569-97). The most cited paper (by Goldman et al., Massachusetts General Hospital, New England Journal of Medicine; 1569 citations) focused on cardiac risk stratification in non-cardiac surgery. The Journal of Trauma, Injury, Infection and Critical Care published the most papers and received most citations (n = 19; 2954 citations. The majority of papers were published by centres in the USA (n = 52; 9422 citations), followed by the UK (n = 13; 1816 citations). The most common topics of publication concerned abdominal aneurysm management (n = 26) and emergency gastrointestinal surgery (n = 26).

Conclusion: Vascular surgery, risk assessment and gastrointestinal surgery were the areas of focus for 59% of the contemporary most cited emergency abdominal surgery manuscripts. By providing the most influential references this work serves as a guide to what makes a citable emergency surgery paper.
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http://dx.doi.org/10.1016/j.ijsu.2016.12.006DOI Listing
January 2017

The many faces of SRPK1.

J Pathol 2017 03 1;241(4):437-440. Epub 2017 Feb 1.

School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.

Serine-arginine protein kinase 1 (SRPK1) phosphorylates proteins involved in the regulation of several mRNA-processing pathways, including alternative splicing. SRPK1 has been recently reported to be overexpressed in multiple cancers, including prostate cancer, breast cancer, lung cancer, and glioma. Several studies have shown that inhibition of SRPK1 has anti-tumoural effects, and SRPK1 has therefore become a new candidate for targeted therapies. Interestingly, in terms of molecular mechanism, SRPK1 seems to act heterogeneously, and has been reported to affect several processes in different cancers, e.g. angiogenesis in prostate and colon cancer, apoptosis in breast and colon cancer, and migration in breast cancer. A recent report adds to this puzzle, showing that the main effect of SRPK1 overexpression in non-small-cell lung carcinoma is to stimulate a stem cell-like phenotype. This pleiotropy might be related to preferential activation of different downstream signalling pathways by SRPK1 in various cancers. © 2016 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
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http://dx.doi.org/10.1002/path.4846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5324686PMC
March 2017

Serine-arginine protein kinase 1 (SRPK1), a determinant of angiogenesis, is upregulated in prostate cancer and correlates with disease stage and invasion.

J Clin Pathol 2016 Feb 23;69(2):171-5. Epub 2015 Oct 23.

School of Physiology and Pharmacology, University of Bristol, Bristol, UK.

Vascular endothelial growth factor (VEGF) undergoes alternative splicing to produce both proangiogenic and antiangiogenic isoforms. Preferential splicing of proangiogenic VEGF is determined by serine-arginine protein kinase 1 (SRPK1), which is upregulated in a number of cancers. In the present study, we aimed to investigate SRPK1 expression in prostate cancer (PCa) and its association with cancer progression. SRPK1 expression was assessed using immunohistochemistry of PCa tissue extracted from radical prostatectomy specimens of 110 patients. SRPK1 expression was significantly higher in tumour compared with benign tissue (p<0.00001) and correlated with higher pT stage (p=0.004), extracapsular extension (p=0.003) and extracapsular perineural invasion (p=0.008). Interestingly, the expression did not correlate with Gleason grade (p=0.21), suggesting that SRPK1 facilitates the development of a tumour microenvironment that favours growth and invasion (possibly through stimulating angiogenesis) while having little bearing on the morphology or function of the tumour cells themselves.
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http://dx.doi.org/10.1136/jclinpath-2015-203125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4752636PMC
February 2016