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Habous M, Khattak A, Farag M, Binsaleh S, Ralph D, Aziz M, Bettocchi C, Muir G. Investigating the risk factors of penile arterial insufficiency and veno-occlusive dysfunction in patients with erectile dysfunction. BJUI Compass 2024; 5:34-41. [PMID: 38179020 PMCID: PMC10764169 DOI: 10.1002/bco2.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/20/2023] [Accepted: 07/10/2023] [Indexed: 01/06/2024] Open
Abstract
Objective To investigate the risk factors for penile arterial insufficiency (PAI), which is a known cause of erectile dysfunction (ED). Methods Patients who attended our urology clinic complaining of ED for more than 6 months were prospectively enrolled in this study over 1-year period. Patient consent was taken and ethical committee approval. Complete medical history and thorough general and local examination including body mass index (BMI), Peyronie's disease (PD) and penile size measurements (length and girth) were done for all of them. Laboratory tests included testosterone, lipid profile and glycated haemoglobin (HA1c). A penile duplex ultrasound study (PDU) was done for all patients after intracavernosal injection (ICI) with alprostadil. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured after 15 min. Statistical analysis was done using SPSS. Results A total of 440 patients were enrolled in this analysis. The mean age was 48(23-81), and the mean BMI was 30 (18-51). Older patients had lower PSV (r = -0.361, P = 0.000) and higher EDV (r = 0.174, P = 0.001), and both correlations were highly statistically significant. Diabetics had lower PSV (r = -0.318, P = 0.000) and higher EDV (r = 0.139, P = 0.008), which were also highly statistically significant. Smokers had lower PSV (r = -0.140, P = 0.008) and higher EDV (r = 0.178, P = 0.001), which were highly statistically significant. Men with larger penises measured skin to tip had lower EDV (r = -0.119, P = 0.024), which was less significant. Interestingly, there was neither a significant correlation between BMI and PSV (0.16, P = 0.745) nor a significant correlation between testosterone and PSV (0.029, P = 0.552). Also, there was no correlation between PSV and both dyslipidaemia and penile PD. Conclusions Ageing, tobacco consumption, DM and hypertension seem to have a negative impact on penile haemodynamics, which was statistically significant. In our patients, there was no statistically significant effect on penile haemodynamics in patients with increased BMI, low testosterone or PD or according to the size of the penis.
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Affiliation(s)
| | | | - Mohammed Farag
- Urology DepartmentAzhar University, Assiut BranchAssiutEgypt
| | - Saleh Binsaleh
- Division of Urology, Department of Surgery, Faculty of MedicineKing Saud UniversityRiyadhSaudi Arabia
| | - David Ralph
- St. Peters Institute of Andrology, UCLHLondonUK
| | - Mohammed Aziz
- Urology DepartmentMenofia UniversityShibin Al KawmEgypt
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2
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Zhang K, Teoh J, Laguna P, Dominguez-Escrig J, Barret E, Ramon-Borja JC, Muir G, Bohr J, Pelechano Gómez P, Ng CF, Sanchez-Salas R, de la Rosette J. Effect of Focal vs Extended Irreversible Electroporation for the Ablation of Localized Low- or Intermediate-Risk Prostate Cancer on Early Oncological Control: A Randomized Clinical Trial. JAMA Surg 2023; 158:343-349. [PMID: 36723911 PMCID: PMC10099059 DOI: 10.1001/jamasurg.2022.7516] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/09/2022] [Indexed: 02/02/2023]
Abstract
Importance Focal ablative irreversible electroporation (IRE) is a therapy that treats only the area of the tumor with the aim of achieving oncological control while reducing treatment-related functional detriment. Objective To evaluate the effect of focal vs extended IRE on early oncological control for patients with localized low- and intermediate-risk prostate cancer. Design, Setting, and Participants In this randomized clinical trial conducted at 5 centers in Europe, men with localized low- to intermediate-risk prostate cancer were randomized to receive either focal or extended IRE ablation. Data were collected at baseline and at regular intervals after the procedure from June 2015 to January 2020, and data were analyzed from September 2021 to July 2022. Main Outcomes and Measures Oncological outcome as indicated by presence of clinically significant prostate cancer (International Society of Urological Pathology grade ≥2) on transperineal template-mapping prostate biopsy at 6 months after IRE. Descriptive measures of results from that biopsy included the number and location of positive cores. Results A total of 51 and 55 patients underwent focal and extended IRE, respectively. Median (IQR) age was 64 years (58-67) in the focal ablation group and 64 years (57-68) in the extended ablation group. Median (IQR) follow-up time was 30 months (24-48). Clinically significant prostate cancer was detected in 9 patients (18.8%) in the focal ablation group and 7 patients (13.2%) in the extended ablation group. There was no significant difference in presence of clinically significant prostate cancer between the 2 groups. In the focal ablation group, 17 patients (35.4%) had positive cores outside of the treated area, 3 patients (6.3%) had positive cores in the treated area, and 5 patients (10.4%) had positive cores both in and outside of the treated area. In the extended group, 10 patients (18.9%) had positive cores outside of the treated area, 9 patients (17.0%) had positive cores in the treated area, and 2 patients (3.8%) had positive cores both in and outside of the treated area. Clinically significant cancer was found in the treated area in 5 of 48 patients (10.4%) in the focal ablation group and 5 of 53 patients (9.4%) in the extended ablation group. Conclusions and Relevance This study found that focal and extended IRE ablation achieved similar oncological outcomes in men with localized low- or intermediate-risk prostate cancer. Because some patients with intermediate-risk prostate cancer are still candidates for active surveillance, focal therapy may be a promising option for those patients with a high risk of cancer progression. Trial Registration ClinicalTrials.gov Identifier: NCT01835977.
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Affiliation(s)
- Kai Zhang
- Department of Urology, Beijing United Family Hospital and Clinics, Beijing, China
| | - Jeremy Teoh
- S.H. Ho Urology Centre, Department of Surgery, Chinese University of Hong Kong, Hong Kong, China
| | - Pilar Laguna
- Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
| | | | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Gordon Muir
- Department of Urology, King’s College Hospital, London, United Kingdom
| | - Julia Bohr
- Department of Urology, Kliniken Essen-Mitte, Ev. Huyssens-Stiftung, Essen, Germany
| | - Paula Pelechano Gómez
- Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, Chinese University of Hong Kong, Hong Kong, China
| | | | - Jean de la Rosette
- Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
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3
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Brunckhorst O, Liszka J, James C, Fanshawe JB, Hammadeh M, Thomas R, Khan S, Sheriff M, Ahmed HU, Van Hemelrijck M, Muir G, Stewart R, Dasgupta P, Ahmed K. Mental wellbeing and quality of life in prostate cancer (MIND-P): Protocol for a multi-institutional prospective cohort study. PLoS One 2023; 18:e0284727. [PMID: 37093833 PMCID: PMC10124830 DOI: 10.1371/journal.pone.0284727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/29/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND The mental wellbeing implications of a prostate cancer diagnosis are increasingly being realised. Significant mental health symptoms such as depression and anxiety, along with related constructs such as fear of cancer recurrence, body image and masculine self-esteem issues are prevalent. However, less is understood about potential prognostic factors for these outcomes in prostate cancer patients. Therefore, this study aims to primarily explore potential treatment, patient and oncological factors associated with mental wellbeing outcomes in the initial prostate cancer follow-up period. METHODS MIND-P is a multi-institutional prospective cohort study recruiting newly diagnosed prostate cancer patients for 12-month follow up. It will aim to recruit a final sample of 300 participants undergoing one of four treatment options: active surveillance, radical prostatectomy, radical radiotherapy, or hormone monotherapy. Questionnaire-based data collection consists of multiple validated mental, physical, and social wellbeing outcomes at baseline and 3-monthly intervals until study completion. Primary analysis will include evaluation of treatment undergone against multiple mental wellbeing outcomes. Secondary analysis will additionally explore multiple patient and oncological prognostic factors of potential importance, along with the cumulative incidence of these outcomes, symptom trajectory and their association with subsequent functional and social outcomes. CONCLUSION This cohort study aims to add to the existing limited literature evaluating significant prognostic factors for multiple mental wellbeing outcomes in newly diagnosed prostate cancer patients. This may be of potential use for guiding future prognosis research and of clinical use for identifying individuals potentially requiring additional surveillance or support during routine cancer follow up. STUDY REGISTRATION This study was prospectively registered on ClinicalTrials.gov (NCT04647474).
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Affiliation(s)
- Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Jaroslaw Liszka
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Callum James
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Jack B Fanshawe
- Department of Urology, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Mohamed Hammadeh
- Department of Urology, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Robert Thomas
- The Primrose Oncology Unit, Bedfordshire Hospitals NHS Foundation Trust, Bedford, United Kingdom
| | - Shahid Khan
- Department of Urology, East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, United Kingdom
| | - Matin Sheriff
- Department of Urology, Medway NHS Foundation Trust, Gillingham, United Kingdom
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Urology, Charring Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Gordon Muir
- Department of Urology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Robert Stewart
- King's College London Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
- Department of Urology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
- Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- Khalifa University, Abu Dhabi, United Arab Emirates
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Vyas N, Brunckhorst O, Fox L, Van Hemelrijck M, Muir G, Stewart R, Dasgupta P, Ahmed K. Undergoing radical treatment for prostate cancer and its impact on wellbeing: A qualitative study exploring men's experiences. PLoS One 2022; 17:e0279250. [PMID: 36525457 PMCID: PMC9757548 DOI: 10.1371/journal.pone.0279250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Quality of life in prostate cancer survivorship is becoming increasingly important, with mental and social wellbeing recognised as key components. However, limited global evaluation of psychosocial challenges experienced after treatment exists. Therefore, we aimed to explore the lived experiences of men who underwent radical treatment, and its psychosocial impact. MATERIAL AND METHODS This qualitative study was conducted using 19 men who had undergone radical treatment (prostatectomy or radiotherapy) for their cancer. Semi-structured interviews were conducted exploring lived experiences of men after treatment. A Structured thematic analysis of collected data was undertaken, with an inductive co-construction of themes through the lens of the biopsychosocial model. Themes generated were considered within a psychological, social, and physical wellbeing framework. RESULTS An initial knowledge gap meant mental wellbeing was strongly impacted initially leading to a 'Diagnostic Blow and the Search for Clarity'. Doubt over individuals' future resulted in 'An Uncertain Future' in many men. Once treatment was completed a 'Reflective journey' began, with men considering their outcomes and decisions made. Social wellbeing was also impacted with many identifying the 'Emotional Repercussions' on their relationships and the impact their diagnosis had on their partner and family. Many subsequently sought to increase their support through 'The Social Network and Advocacy', while physical changes led to an increased need for 'Social Planning'. Finally, physical wellbeing was highlighted by a continual acknowledgement of the 'Natural process of ageing' leading to a reluctancy to seek help, whilst simultaneously attempting to improve existing health via 'The Health Kick'. CONCLUSIONS Radical treatments have a considerable impact on mental and social wellbeing of individuals. Anxiety after diagnosis and significant uncertainty over individual futures exist, with physical complications of treatment leading to social repercussions. Future research should aim to identify forms of support to improve quality of life of these men.
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Affiliation(s)
- Neel Vyas
- MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, United Kingdom
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, United Kingdom
| | - Louis Fox
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Gordon Muir
- Department of Urology, King’s College Hospital, London, United Kingdom
| | - Robert Stewart
- King’s College London Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, United Kingdom
- Urology Centre, Guy’s and St. Thomas’ NHS Foundation Trust, King’s Health Partners, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, United Kingdom
- Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- Khalifa University, Abu Dhabi, United Arab Emirates
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Deacon M, Muir G. Reply to Morris et al. re: 'The medical evidence on non-therapeutic circumcision of infants and boys-setting the record straight'. Int J Impot Res 2022; 35:267-268. [PMID: 36261537 PMCID: PMC10159837 DOI: 10.1038/s41443-022-00631-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 11/09/2022]
Affiliation(s)
| | - Gordon Muir
- Urology Department, King's College Hospital, London, UK.
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6
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Muir G. 938 ‘TO DIP OR NOT TO DIP’: IMPROVING THE MANAGEMENT OF LOWER URINARY TRACT INFECTIONS IN OLDER PEOPLE. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
I completed two PDSA cycles of a Quality Improvement project, from 2019 to 2021, aimed at improving the management of lower urinary tract infections (UTIs) in older people. My interest in this subject was instilled after it was brought to my attention that Public Health England (PHE) guidelines were revised in 2018 to state that urine dipsticks tests (UDTs) should not be used as a diagnostic aid in any patient over the age of 65 years. I became concerned that geriatric patients may be misdiagnosed and mistreated with unnecessary antibiotics, given the high prevalence of asymptomatic bacteriuria in this population.
Method
I sampled patients diagnosed with a urinary tract infection in the Emergency Department of the Queen Elizabeth Hospital, Gateshead over a 7-day period. I extracted medical notes of patients prescribed one of 7 antibiotics, then excluded patients under 65-years-old and those treated for an infection outside the lower urinary tract. Next, I established whether a UDT was used as a diagnostic aid using the medical notes.
Results
Before and after intervention: my initial findings revealed that a UDT was performed in 100% patients diagnosed with a UTI (i.e. no cases were in line with best practice). My first educational intervention involved sharing the revised PHE guidelines with staff via an interactive teaching-session, following this I found that a UDT was performed in 62% patients. My next intervention was a flow-chart entitled ‘to dip or not to dip’ pasted in the ED. Following this final intervention, I found that 27% cases were in line with best practice (a UDT was used in 73% cases).
Conclusion
With this modest improvement, I concluded that my recommendations reduced the number of over 65-year-old patients undergoing unnecessary UDTs as part of their diagnostic work-up.
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Affiliation(s)
- G Muir
- Dept of Elderly Care; Queen Elizabeth Hospital , Gateshead
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7
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Burtt G, Springate C, Martin A, Woodward E, Zantek P, Al Jaafari F, Muir G, Misrai V. The Efficacy and Safety of Laser and Electrosurgical Transurethral Procedures for the Treatment of BPO in High-Risk Patients: A Systematic Review. Res Rep Urol 2022; 14:247-257. [PMID: 35757198 PMCID: PMC9215288 DOI: 10.2147/rru.s361956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/01/2022] [Indexed: 12/04/2022] Open
Abstract
Objective To compare efficacy and safety outcomes of GreenLight, Holmium and Thulium laser techniques with standard monopolar and bipolar transurethral resection of the prostate (TURP) in high-risk patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). Methods We conducted a systematic literature review of studies in patients undergoing BPO surgeries who may be considered high-risk for standard TURP, with higher risk defined as follows: large prostates (≥80 mL) and/or taking antithrombotic agents and/or urinary retention and/or age >80 years and/or significant comorbidity. Outcomes summarised included bleeding complications, re-intervention rates, hospital length of stay, and standard measures of disease and symptom severity for all available timepoints. Results A total of 276 studies of 32,722 patients reported relevant data. Studies were heterogeneous in methodology, population and outcomes reported. IPSS reduction, Qmax improvement and PVR were similar across all interventions. Mean values at baseline and after 12 months across interventions were 13.2−29 falling to 2.3−10.8 for IPSS, 0−19 mL/s increasing to 7.5−34.1 mL/s for Qmax and 41.4−954 mL falling to 5.1−138.3 mL for PVR. Laser treatments show some advantages compared with monopolar and bipolar TURP for some adverse events and safety parameters such as bleeding complications. Duration of hospital stay, reinterventions and recatheterisations were lower with GreenLight, HoLEP, Thulium lasers, and bipolar enucleation than TURP. Conclusions Laser therapies are effective and well-tolerated treatment options in high-risk patients with BPO compared with monopolar or bipolar TURP. The advantageous safety profile of laser treatments means that patients with a higher bleeding risk should be offered laser surgery preferentially to mTURP or bTURP.
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Affiliation(s)
| | | | - Alison Martin
- Reviews Department, Crystallise Ltd, Essex, UK
- Correspondence: Alison Martin, Director and Head of Reviews, Crystallise Ltd, 17 High Street, Stanford-le-Hope, Essex, SS17 0HD, United Kingdom, Tel +44 1268 543470, Email
| | | | | | | | - Gordon Muir
- King's College Hospital NHS Trust, London, UK
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8
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Muir G. P02 To dip or not to dip? Improving the management of lower urinary tract infections in older patients. JAC Antimicrob Resist 2022. [PMCID: PMC8849381 DOI: 10.1093/jacamr/dlac004.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
PHE guidelines were revised in 2018 to state that urine dipsticks tests (UDTs) should not be used as a diagnostic aid in any patient over the age of 65 years.
The high prevalence of asymptomatic bacteriuria in the elderly population is widely acknowledged however the adherence to the above guidelines is unclear.
My aim was to investigate whether geriatric patients are being misdiagnosed with urinary tract infections (UTIs) and mistreated with unnecessary antibiotics, given the high prevalence of asymptomatic bacteriuria in this population.
Methods
I sampled patients diagnosed with a UTI in the Emergency Department of the Queen Elizabeth Hospital, Gateshead over a 7 day period. I extracted medical notes of patients prescribed one of 7 antibiotics, then excluded patients under 65 years old and those treated for an infection outside the lower urinary tract. Next, I established whether a UDT was used as a diagnostic aid using the medical notes. Using this methodology, I repeated my data collection and completed two PDSA cycles of this Quality Improvement project, from 2019 to 2021.
Results
My initial findings revealed that a UDT was performed in 100% patients diagnosed with a UTI (i.e. no cases were in line with best practice). My first educational intervention involved sharing the revised PHE guidelines with staff via an interactive teaching-session. Following this step, I found that a UDT was performed in 62% patients. My next intervention was a flow chart entitled ‘to dip or not to dip’ pasted in the ED. After this second intervention, I found that 27% cases were in line with best practice (a UDT was used in 73% cases).
Conclusions
With this modest improvement, I concluded that my recommendations reduced the number of over 65-year-old patients undergoing unnecessary UDTs as part of their diagnostic work-up.
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Affiliation(s)
- G. Muir
- Senior House Officer at the Queen Elizabeth Hospital Gateshead NHS Foundation Trust, UK
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9
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Deacon M, Muir G. What is the medical evidence on non-therapeutic child circumcision? Int J Impot Res 2022; 35:256-263. [PMID: 34997197 DOI: 10.1038/s41443-021-00502-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/24/2021] [Accepted: 11/15/2021] [Indexed: 01/02/2023]
Abstract
Non-therapeutic circumcision refers to the surgical removal of part or all of the foreskin, in healthy males, where there is no medical condition requiring surgery. The arguments for and against this practice in children have been debated for many years, with conflicting and conflicted evidence presented on both sides. Here, we explore the evidence behind the claimed benefits and risks from a medical and health-related perspective. We examine the number of circumcisions which would be required to achieve each purported benefit, and set that against the reported rates of short- and long-term complications. We conclude that non-therapeutic circumcision performed on otherwise healthy infants or children has little or no high-quality medical evidence to support its overall benefit. Moreover, it is associated with rare but avoidable harm and even occasional deaths. From the perspective of the individual boy, there is no medical justification for performing a circumcision prior to an age that he can assess the known risks and potential benefits, and choose to give or withhold informed consent himself. We feel that the evidence presented in this review is essential information for all parents and practitioners considering non-therapeutic circumcisions on otherwise healthy infants and children.
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Affiliation(s)
| | - Gordon Muir
- Urology Department, King's College Hospital, London, UK.
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10
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Thomas J, Martin L, Muir G. Getting to grips with grip strength: A scoping review of patients mapped against sarcopenia consensus cut points. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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Veale D, Vaidya A, Papageorgiou A, Foks M, Giona S, Hodsoll J, Freeston M, Muir G. A preliminary investigation of a novel method to manipulate penis length to measure female sexual satisfaction: a single-case experimental design. BJU Int 2021; 128:374-385. [PMID: 33793040 DOI: 10.1111/bju.15416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate a novel methodology and explore whether artificially reducing the depth of penetration during intercourse matters to women. STUDY DESIGN AND METHODS A study with a single-case experimental design ('n of 1'), in which a heterosexual couple act as their own control and the study is then replicated in subsequent couples, was conducted. Thirty-five couples were assessed for eligibility to participate. Twenty-nine couples without any sexual problems were randomized and 12 submitted sufficient data to analyse. As a proxy for reducing penis length, we artificially reduced the depth of penetration by using different sizes of silicone rings around the base of the man's erect penis. The main outcome measures were provided by the female partner on a scale of 0-100 and comprised: degree of (i) overall sexual pleasure; (ii) sexual pleasure from intercourse alone; and (iii) emotional connection to the male partner. The female partner was also asked before the experiment began to rate the degree of positive or negative change that would be personally meaningful for her. RESULTS On average, reducing the depth of penetration led to a statistically significant 18% reduction of overall sexual pleasure with an average 15% reduction in length of the penis. The longer the erect penis, the less likely the rings were to have an impact on sexual pleasure. There was a range of individual responses, however, with a minority of women reporting that reducing the depth of penetration was more pleasurable on some occasions. CONCLUSIONS Size may matter in women in a healthy stable relationship when there is penile shortening. Because of the small number of couples and the inclusion of men with an apparently long penis, our results are preliminary, and we welcome replication in a larger sample with a more diverse range of penile lengths. Our results should not be misinterpreted as meaning that increasing penile length will increase sexual pleasure in women.
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Affiliation(s)
- David Veale
- Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust, London, UK
| | - Aashay Vaidya
- GKT School of Medical Education, King's College London, London, UK
| | - Andriani Papageorgiou
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Simone Giona
- King's College Hospital NHS Foundation Trust and Frimley Park Hospital, Camberley, UK
| | - John Hodsoll
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Gordon Muir
- King's College Hospital NHS Foundation Trust and King's College London, London, UK
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13
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Muir G, Boff J. Physician, heal thyself? Leaving healers at risk of covid-19 is unacceptable. BMJ 2021; 372:n325. [PMID: 33547055 DOI: 10.1136/bmj.n325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Jonathan Boff
- Department of History, University of Birmingham, Birmingham, UK
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De Piano M, Manuelli V, Zadra G, Loda M, Muir G, Chandra A, Morris J, Van Hemelrijck M, Wells CM. Exploring a role for fatty acid synthase in prostate cancer cell migration. Small GTPases 2020; 12:265-272. [PMID: 33043786 DOI: 10.1080/21541248.2020.1826781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Fatty acid synthase (FASN) is commonly overexpressed in prostate cancer and associated with tumour progression. FASN is responsible for de novo synthesis of the fatty acid palmitate; the building block for protein palmitoylation. A functional role for FASN in regulating cell proliferation is widely accepted. We recently reported that FASN activity can also mediate prostate cancer HGF-mediated cell motility. Moreover, we found that modulation of FASN expression specifically impacts on the palmitoylation of RhoU. Findings we will describe here. We now report that loss of FASN expression also impairs HGF-mediated cell dissociation responses. Taken together our results provide compelling evidence that FASN activity directly promotes cell migration and supports FASN as a potential therapeutic target in metastatic prostate cancer.
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Affiliation(s)
- Mario De Piano
- School of Cancer and Pharmaceutical Sciences, Kings College London, London, UK
| | - Valeria Manuelli
- School of Cancer and Pharmaceutical Sciences, Kings College London, London, UK
| | - Giorgia Zadra
- Departments of Oncologic Pathology and Pathology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Massimo Loda
- Departments of Oncologic Pathology and Pathology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Gordon Muir
- Urology, King's College Hospital, London, UK
| | - Ash Chandra
- Cellular Pathology, St. Thomas' Hospital, London, UK
| | - Jonathan Morris
- School of Cancer and Pharmaceutical Sciences, Kings College London, London, UK
| | | | - Claire M Wells
- School of Cancer and Pharmaceutical Sciences, Kings College London, London, UK
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Ahmed Khudhur H, Brunckhorst O, Muir G, Jalil R, Khan A, Ahmed K. Prostatic abscess: A systematic review of diagnosis, current treatment modalities and outcomes. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33971-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Khudhur H, Brunckhorst O, Muir G, Jalil R, Khan A, Ahmed K. Prostatic abscess: A systematic review of current diagnostic methods, treatment modalities and outcomes. Turk J Urol 2020; 46:tud.2020.19273. [PMID: 32479256 PMCID: PMC7360156 DOI: 10.5152/tud.2020.19273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/26/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Prostatic abscesses (PAs) are an uncommon urologic presentation with widely varying approaches in their diagnoses and management. This study, therefore, aims to systematically review the literature of PAs to identify common clinical presentations, evaluate currently utilized diagnostic and treatment modalities, and assess their outcomes. MATERIAL AND METHODS A systematic review of the literature was performed using the MEDLINE and EMBASE databases, from January 1968 to June 2019. Outcome measures extracted from identified articles included age, the underlying disease, identified pathogens, diagnostic tool utilized, treatment used, and various subsequent clinical outcomes. RESULTS The literature search yielded 683 articles, with a final twelve included in the review, representing a total of 210 patients. Transrectal ultrasonography (TRUS) was the most commonly used imaging tool used to identify PAs in all twelve studies. The PAs were treated with conservative antibiotic treatment in seven studies. Transurethral resection of the prostatic abscess (TURP) was utilized in eight studies with an average abscess size of 3.87 cm (3.0-4.0 cm) and with an average hospital stay of 10.22 days in those undergoing TURP. Transperineal aspiration was seen in five studies and offered a less invasive treatment modality. Finally, TRUS-guided needle aspiration was seen in seven studies with an average hospital stay of 23.25 days. This was the longest of any identified modalities with an additional high rate of abscess recurrence. CONCLUSION Diagnosis and treatment practices of PAs remain widely varied in the literature due to a lack of clear guidelines. Based on the current evidence, we provide recommendations of treatment based on abscess size, patient age, and clinical condition. While smaller abscesses may be suited to antibiotic or TRUS-guided aspiration, transurethral approaches should be considered for larger and more complex abscesses. However, the current evidence remains poor with further research required to determine the optimum treatment modalities for patients.
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Affiliation(s)
- Hasan Khudhur
- Department of Urology, King’s College Hospital, London, UK
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, UK
| | - Gordon Muir
- Department of Urology, King’s College Hospital, London, UK
| | - Rozh Jalil
- Department of Urology, King’s College Hospital, London, UK
| | - Azhar Khan
- Department of Urology, King’s College Hospital, London, UK
| | - Kamran Ahmed
- Department of Urology, King’s College Hospital, London, UK
- MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, UK
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17
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18
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Drudge-Coates L, Khati V, Ballesteros R, Martyn-Hemphill C, Brown C, Green J, Challacombe B, Muir G. A nurse practitioner model for the assessment of suspected prostate cancer referrals is safe, cost and time efficient. Ecancermedicalscience 2019; 13:994. [PMID: 32010218 PMCID: PMC6974368 DOI: 10.3332/ecancer.2019.994] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Indexed: 12/21/2022] Open
Abstract
Purpose To evaluate the outcomes from a Urology Nurse Practitioner (UNP)-led service for the initial assessment and diagnostic decision making and for suspected prostate cancer referrals. Methods Using a modified Delphi analysis approach, a panel of Urological Prostate Cancer specialists were asked to review the UNP management plans of a convenience sample of 60 randomly selected patient cases – between June 2012 and June 2015. The panel was required to establish consensus or identify divergence of clinical practice, based on five key statements. In addition, cost analysis, waiting time and patient satisfaction evaluation were made regarding the nurse-led service. Results In 87% (52/60 cases), consensus was reached by the panel that the UNP management plan was entirely appropriate and in only two cases was there discordance, where the panel felt that the management plan by the UNP was inappropriate with errors potentially and significantly affecting the patient. Over the 3 years, a modest cost saving of £11,500.38 was realised, which due to increased referrals has now realised in 1 year (2017/18) a saving of £11,335.50. Compared to the previous physician-led service, waiting times for patient appointment fell by 52% over the 3-year period; 57/63 (90%) patients reported being satisfied with seeing a UNP instead of a doctor for their first appointment; 60/63 (95%) reported that, following the initial hospital visit with the UNP, they had a clear understanding of what the next steps were in their assessment. Overall, 54/63 (86%) were ‘very satisfied’ with the UNP-led service. Conclusion Our study demonstrates that a UNP approach to the assessment and management of suspected prostate cancer referrals provides an effective approach to care in an ever-demanding healthcare arena. Through a supported training programme, urology nurses can deliver a high standard of service.
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Affiliation(s)
| | - Vitra Khati
- Department of Urology, King's College Hospital NHS Foundation Trust, SE5 9RS London, UK
| | - Randolph Ballesteros
- Department of Urology, King's College Hospital NHS Foundation Trust, SE5 9RS London, UK
| | | | - Christian Brown
- Department of Urology, King's College Hospital NHS Foundation Trust, SE5 9RS London, UK
| | - James Green
- Department of Urology, Barts Health NHS Trust, London EC1A 7BE, UK
| | - Ben Challacombe
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - Gordon Muir
- Department of Urology, King's College Hospital NHS Foundation Trust, SE5 9RS London, UK
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Brunckhorst O, Wells L, Teeling F, Muir G, Muneer A, Ahmed K. A systematic review of the long-term efficacy of low-intensity shockwave therapy for vasculogenic erectile dysfunction. Int Urol Nephrol 2019; 51:773-781. [PMID: 30903393 PMCID: PMC6499893 DOI: 10.1007/s11255-019-02127-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/07/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To look at the evidence base for LISWT as a treatment modality for vasculogenic erectile dysfunction, focusing on the long-term outcomes at over 6 months following treatment. METHODS A systematic literature search was conducted utilising MEDLINE and Scopus databases from 2010 to September 2018 by two independent reviewers. Outcome measures extracted for long-term efficacy included International Index of Erectile Function scores and Erection Hardness Scores. Subgroup analysis for LISWT effectiveness included age, PDE5i responsiveness, presence of vascular co-morbidities and smoking status. RESULTS The search identified eleven studies, representing a total of 799 patients. Nine studies found a significant improvement in erectile function after LISWT at 6-month follow-up (median IIEF-EF improvement in 5.3 at 6 months). However, of five studies assessing erectile function at 12 months; two identified a plateauing of results, with three a deterioration (IIEF-EF score changes of - 2 to 0.1 from 6 months). Erectile function did, however, remain above baseline results in all of these studies. Subgroup analysis revealed increasing age to reduce the response to LISWT treatment. Whilst ED severity, PDE5i responsiveness and co-morbidities potentially influence effectiveness, results are still inconsistent. CONCLUSIONS LISWT may be a safe and acceptable potential ED treatment with demonstrated benefits at 6 months. There is some question regarding efficacy deterioration beyond this, but there is still a demonstrated benefit seen even at 12 months post treatment. However, quality of evidence remains low with larger multiinstitutional studies required, standardising confounders such as shockwave administration and oral medication use.
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Affiliation(s)
- Oliver Brunckhorst
- MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, SE1 9RT UK
| | - Lauren Wells
- MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, SE1 9RT UK
| | - Fiona Teeling
- MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, SE1 9RT UK
| | - Gordon Muir
- MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, SE1 9RT UK
| | - Asif Muneer
- Department of Urology, University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, SE1 9RT UK
- Department of Urology, University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Urology, King’s College Hospital, London, UK
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Robert M, Marotta J, Rakotomalala E, Muir G, Grasset D. Piezoelectric Extracorporeal
Shock-Wave Lithotripsy of Lower
Pole Nephrolithiasis. Eur Urol 2019. [DOI: 10.1159/000480829] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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21
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Habous M, Malkawi I, Han E, Farag M, Muir G, Abdelwahab O, Nassar M, Mahmoud S, Santucci R, Binsaleh S. Peyronie's Disease is common in poorly controlled diabetics but is not associated with the Metabolic Syndrome. Urol Ann 2019; 11:252-256. [PMID: 31413501 PMCID: PMC6676820 DOI: 10.4103/ua.ua_164_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Purpose: The purpose of the study is to investigate if metabolic syndrome (MS) and other comorbidities are associated with Peyronie's disease (PD). Methods: A total of 1833 patients retrospectively investigated and divided into two groups: Group A – PD patients (n = 319) and Group B – non-PD patients (n = 1303). The two groups were fully evaluated for diabetes mellitus (DM) with the glycated hemoglobin (HbA1c), hypertension (HTN), dyslipidemia (DL), obesity by measuring body mass index, total testosterone (T), penile vascular circulation measuring Peak systolic velocity (PSV) as indicator of arterial supply, end-diastolic velocity (EDV) as indicator of venous output, and finally, smoking. Results: The presence of diabetes was significantly correlated with PD (P = 0.005). Patients with diabetes had a 7% higher incidence of PD. However, patients with the highest HbA1c level of >8.5 had an increased odds ratio of 1.6 (P = 0.025, confidence interval [CI] =1.061–2.459) of having PD. Increased age was significantly correlated with PD (P = 0.025). For each year of life, the likelihood of having PD increases by an odds ratio of 1.019, or 2% per year (P = 0.001, CI = 1.004–1.027). Unexpectedly, DL (P = 0.006) and smoking (P = 0.041) were associated with lower incidences of PD. Patients with DL or smoking had a 5%–7% lower incidence of PD with an odds ratio of 0.6 (P = 0.006, CI = 0.410–0.864). HTN (P = 0.621) and the total number of comorbidities (P = 0.436) were not correlated with PD. Mean serum T values were statistically (P = 0.43) but not clinically significant among patients with Peyronie's versus patients without Peyronie's (4.62 vs. 4.38 ng/ml). Neither low PSV (Fisher's exact test P = 0.912) nor abnormal EDV (Fisher's exact test P = 0.775) was correlated with the finding of PD. Conclusions: While MS was not associated with PD, diabetes, particularly poorly controlled diabetes, was associated with an increased rate. Further research into the interaction of PD and metabolic disease is warranted.
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Affiliation(s)
- Mohamad Habous
- Department of Urology and Andrology, Elaj Medical Centers, Jeddah, Saudi Arabia
| | - Ibraheem Malkawi
- Detroit Medical Center, Michigan State University, East Lansing, Michigan, USA
| | - Esther Han
- Detroit Medical Center, Michigan State University, East Lansing, Michigan, USA
| | - Mohammed Farag
- Department of Urology, Al-Azhar Faculty of Medicine, Assiut, Egypt
| | - Gordon Muir
- Department of Urology, King's College, London, UK
| | | | - Mohammed Nassar
- Department of Urology and Andrology, Elaj Medical Centers, Jeddah, Saudi Arabia
| | - Saad Mahmoud
- Department of Urology and Andrology, Elaj Medical Centers, Jeddah, Saudi Arabia
| | - Richard Santucci
- Detroit Medical Center, Michigan State University, East Lansing, Michigan, USA
| | - Saleh Binsaleh
- Division of Urology, Department of Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
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22
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Habous M, Giona S, Tealab A, Aziz M, Sherif H, Abdelwahab O, Binsaleh S, Ralph D, Bettocchi C, Mulhall JP, Muir G. Penile length is preserved after implant surgery. BJU Int 2018; 123:885-890. [DOI: 10.1111/bju.14604] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mohamad Habous
- Department of Urology and Andrology; Elaj Medical Centers; Jeddah Saudi Arabia
| | | | - Alaa Tealab
- Department of Urology; Zagazig University; Zagazig Egypt
| | - Mohammed Aziz
- Department of Urology; Menoufia University; Menoufia Egypt
| | | | | | - Saleh Binsaleh
- Division of Urology; Department of Surgery; Faculty of Medicine; King Saud University; Riyadh Saudi Arabia
| | - David Ralph
- St. Peters Institute of Andrology; University College London Hospitals; London UK
| | - Carlo Bettocchi
- Department of Urology, Andrology and Kidney Transplantation Unit; Department of Emergency and Organ Transplantation; University of Bari; Bari Italy
| | - John P. Mulhall
- Sexual and Reproductive Medicine; Memorial Sloan-Kettering Cancer Center; New York NY USA
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Habous M, Giona S, Williamson B, Mekawi Z, Abdelrahman Z, Nassar M, Binsaleh S, Muir G. 546 Assessment of predictors of abnormal peak systolic velocity and end diastolic velocity in penile doppler ultrasound. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.04.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Habous M, Giona S, Muir G, Binsaleh S, Abdelwahab O, Nassar M, Abdelrahman Z, Elserafy A, Mulhall J, Ralph D. 259 Penile prosthesis implantation preserves penile length. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.04.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Habous M, Giona S, Binsaleh S, Abdelrahman Z, Nassar M, Tealab A, Mulhall J, Muir G. 440 Serum testosterone in diabetic men is not linked to diabetic control. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.04.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Habous M, Giona S, Abdelrahman Z, Nassar M, Tealab A, Muir G, Binsaleh S. 710 Investigating the correlation between vitamin D and metabolic syndrome. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.04.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Habous M, Giona S, Tealab A, Aziz M, Williamson B, Nassar M, Abdelrahman Z, Remeah A, Abdelkader M, Binsaleh S, Muir G. Clomiphene citrate and human chorionic gonadotropin are both effective in restoring testosterone in hypogonadism: a short-course randomized study. BJU Int 2018; 122:889-897. [DOI: 10.1111/bju.14401] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Mohamad Habous
- Urology and Andrology Department; Elaj Medical Centres; Jeddah Saudi Arabia
| | | | | | - Mohammed Aziz
- Urology Department; Menoufia University; Shibin Al Kawm Egypt
| | | | - Mohammed Nassar
- Urology and Andrology Department; Elaj Medical Centres; Jeddah Saudi Arabia
| | - Zeyad Abdelrahman
- Urology and Andrology Department; Elaj Medical Centres; Jeddah Saudi Arabia
| | - Abdallah Remeah
- Urology and Andrology Department; Elaj Medical Centres; Jeddah Saudi Arabia
| | - Mohamed Abdelkader
- Urology and Andrology Department; Elaj Medical Centres; Jeddah Saudi Arabia
| | - Saleh Binsaleh
- Division of Urology; Department of Surgery; Faculty of Medicine; King Saud University; Riyadh Saudi Arabia
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Habous M, Muir G, Soliman T, Farag M, Williamson B, Binsaleh S, Elhadek W, Mahmoud S, Ibrahim H, Abdelwahab O, Abdelrahman Z, Abdelkader M, Jenkins LC, Mulhall JP. Outcomes of variation in technique and variation in accuracy of measurement in penile length measurement. Int J Impot Res 2018; 30:21-26. [DOI: 10.1038/s41443-017-0013-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 09/18/2017] [Accepted: 10/23/2017] [Indexed: 11/09/2022]
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Habous M, Giona S, Muir G, Abdelwahab O, Laban O, Mahmoud S, Nassar M, Tealab A, Binsaleh S, Mulhall J. 01 Penile Implants Preserve Penile Length Irrespective of the Type of Implant. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2017.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Riaz Agha
- Guy's, King's and St Thomas' School of Medicine, London, UK.
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31
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Marra G, Eldred-Evans D, Challacombe B, Van Hemelrijck M, Polson A, Pomplun S, Foster CS, Brown C, Cahill D, Gontero P, Popert R, Muir G. Pathological Concordance between Prostate Biopsies and Radical Prostatectomy Using Transperineal Sector Mapping Biopsies: Validation and Comparison with Transrectal Biopsies. Urol Int 2017; 99:168-176. [PMID: 28768264 DOI: 10.1159/000471491] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/15/2017] [Indexed: 11/19/2022]
Abstract
Background/Aims/Objectives: Our aim was to evaluate the accuracy of systematic transperineal sector mapping biopsy (TPSMB) in predicting Gleason score (GS) at radical prostatectomy (RP), to compare its accuracy with standard transrectal ultrasound-guided biopsies (TRUS) and to establish the clinical impact of discordance between biopsies and RP on subsequent surgical management. METHODS Two hundred fifty-five patients from 2008 to 2013 who underwent RP following TPSMB (n = 204) or TRUS (n = 51), were included in this retrospective multi-institutional study. Concordance between biopsies and RPs GS was assessed both as percentages and with Cohen's Kappa coefficient. All mismatches between biopsies and RP were assessed for significance by 3 urologists using the Delphi method. RESULTS No differences were present among the groups. Concordance between biopsy and RP GS was 75.49% for TPSMB and 64.70% for TRUS. Kappa coefficient was 0.42 and 0.39 respectively. The Delphi method showed lower clinical impact of GS discordances for TPSMB with 7.8% of patients having significant change, thus being potentially more suitable for other treatment modalities, compared to TRUS (13.7%). CONCLUSIONS TPSMB had a higher accuracy for predicting the GS grade at RP showing superior GS concordance compared with standard TRUS. TPSMB provides an effective technique for systematic prostate biopsy to evaluate overall prostate cancer GS.
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Dart AE, Worth DC, Muir G, Chandra A, Morris JD, McKee C, Verrill C, Bryant RJ, Gordon-Weeks PR. The drebrin/EB3 pathway drives invasive activity in prostate cancer. Oncogene 2017; 36:4111-4123. [PMID: 28319065 PMCID: PMC5537610 DOI: 10.1038/onc.2017.45] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/13/2017] [Accepted: 02/02/2017] [Indexed: 02/06/2023]
Abstract
Prostate cancer is the most common cancer in men and the metastatic form of the disease is incurable. We show here that the drebrin/EB3 pathway, which co-ordinates dynamic microtubule/actin filament interactions underlying cell shape changes in response to guidance cues, plays a role in prostate cancer cell invasion. Drebrin expression is restricted to basal epithelial cells in benign human prostate but is upregulated in luminal epithelial cells in foci of prostatic malignancy. Drebrin is also upregulated in human prostate cancer cell lines and co-localizes with actin filaments and dynamic microtubules in filopodia of pseudopods of invading cells under a chemotactic gradient of the chemokine CXCL12. Disruption of the drebrin/EB3 pathway using BTP2, a small molecule inhibitor of drebrin binding to actin filaments, reduced the invasion of prostate cancer cell lines in 3D in vitro assays. Furthermore, gain- or loss-of-function of drebrin or EB3 by over-expression or siRNA-mediated knockdown increases or decreases invasion of prostate cancer cell lines in 3D in vitro assays, respectively. Finally, expression of a dominant-negative construct that competes with EB3 binding to drebrin, also inhibited invasion of prostate cancer cell lines in 3D in vitro assays. Our findings show that co-ordination of dynamic microtubules and actin filaments by the drebrin/EB3 pathway drives prostate cancer cell invasion and is therefore implicated in disease progression.
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Affiliation(s)
- A E Dart
- The MRC Centre for Developmental Neurobiology, King's College London, New Hunts House, Guy's Campus, London, UK
| | - D C Worth
- The MRC Centre for Developmental Neurobiology, King's College London, New Hunts House, Guy's Campus, London, UK
| | - G Muir
- Urology, King's College Hospital, London, UK
| | - A Chandra
- Cellular Pathology, 2nd floor North Wing, St. Thomas' Hospital, London, UK
| | - J D Morris
- Division of Cancer Studies, New Hunt's House, Guy's Campus, King's College London, London, UK
| | - C McKee
- Oxford Institute for Radiation Oncology, Churchill Hospital, University of Oxford, Oxford, UK
| | - C Verrill
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - R J Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - P R Gordon-Weeks
- The MRC Centre for Developmental Neurobiology, King's College London, New Hunts House, Guy's Campus, London, UK
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Affiliation(s)
- Anish Pushkaran
- The Alan de Bolla Urology Unit, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK
| | - Victoria Stainer
- The Alan de Bolla Urology Unit, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK
| | - Gordon Muir
- The Department of Urology, Kings College, London, UK
| | - Iqbal S. Shergill
- The Alan de Bolla Urology Unit, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK
- The North Wales and North West Urological Research Centre, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK
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Muir G, Klecka J, CULKIN DJ, Barusso GH, Kums J, Brunken C, Eure G, Rioja Sanz C, Gomez Sancha F, Yildiz MM, Jean J, Rosette DL. Comparison of GreenLight laser and transurethral resection of the prostate baseline characteristics and outcomes: lessons learned from the Clinical Research Office of the Endourological Society GreenLight Laser Study. Minerva Urol Nephrol 2017; 69. [DOI: 10.23736/s0393-2249.16.02721-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Wadhwa K, Carmona-Echeveria L, Kuru T, Gaziev G, Serrao E, Parashar D, Frey J, Dimov I, Seidenader J, Acher P, Muir G, Doble A, Gnanapragasam V, Hadaschik B, Kastner C. Transperineal prostate biopsies for diagnosis of prostate cancer are well tolerated: a prospective study using patient-reported outcome measures. Asian J Androl 2017; 19:62-66. [PMID: 26924279 PMCID: PMC5227677 DOI: 10.4103/1008-682x.173453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We aimed to determine short-term patient-reported outcomes in men having general anesthetic transperineal (TP) prostate biopsies. A prospective cohort study was performed in men having a diagnostic TP biopsy. This was done using a validated and adapted questionnaire immediately post-biopsy and at follow-up of between 7 and 14 days across three tertiary referral hospitals with a response rate of 51.6%. Immediately after biopsy 43/201 (21.4%) of men felt light-headed, syncopal, or suffered syncope. Fifty-three percent of men felt discomfort after biopsy (with 95% scoring <5 in a 0-10 scale). Twelve out of 196 men (6.1%) felt pain immediately after the procedure. Despite a high incidence of symptoms (e.g., up to 75% had some hematuria, 47% suffered some pain), it was not a moderate or serious problem for most, apart from hemoejaculate which 31 men suffered. Eleven men needed catheterization (5.5%). There were no inpatient admissions due to complications (hematuria, sepsis). On repeat questioning at a later time point, only 25/199 (12.6%) of men said repeat biopsy would be a significant problem despite a significant and marked reduction in erectile function after the procedure. From this study, we conclude that TP biopsy is well tolerated with similar side effect profiles and attitudes of men to repeat biopsy to men having TRUS biopsies. These data allow informed counseling of men prior to TP biopsy and a benchmark for tolerability with local anesthetic TP biopsies being developed for clinical use.
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Affiliation(s)
- Karan Wadhwa
- Department of Urology, Addenbrookes Hospital, Cambridge, UK
| | | | - Timur Kuru
- Department of Urology, University Hospital Heidelberg, Germany
| | | | - Eva Serrao
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - Deepak Parashar
- Cancer Research Centre and Statistics and Epidemiology Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Julia Frey
- Department of Urology, Addenbrookes Hospital, Cambridge, UK
| | - Ivailo Dimov
- Department of Urology, University Hospital Heidelberg, Germany
| | | | - Pete Acher
- Department of Urology, Southend University Hospital, Southend, UK
| | - Gordon Muir
- Department of Urology, Kings College Hospital, London, UK
| | - Andrew Doble
- Department of Urology, Addenbrookes Hospital, Cambridge, UK.,CamPARI Prostate Cancer Clinic, Addenbrookes Hospital, Cambridge UK
| | - Vincent Gnanapragasam
- Department of Urology, Addenbrookes Hospital, Cambridge, UK.,CamPARI Prostate Cancer Clinic, Addenbrookes Hospital, Cambridge UK
| | - Boris Hadaschik
- Department of Urology, University Hospital Heidelberg, Germany
| | - Christof Kastner
- Department of Urology, Addenbrookes Hospital, Cambridge, UK.,CamPARI Prostate Cancer Clinic, Addenbrookes Hospital, Cambridge UK
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Thomas JA, Zantek P, Bachmann A, Barber N, Muir G, Benejam J, Stolzenberg JU, Bruyere F, Loidl W, Thorpe A, Morton R. PD24-06 PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE BY 180-W GREENLIGHT LASER VERSUS BIPOLAR TRANSURETHRAL RESECTION OF THE PROSTATE: A SUBSET ANALYSIS OF THE GOLIATH TRIAL. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Thomas JA, Tubaro A, Barber N, d’Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink H, Ameye F, Saussine C, Bruyère F, Loidl W, Larner T, Gogoi NK, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitán C, Knispel H, Bachmann A. A Multicenter Randomized Noninferiority Trial Comparing GreenLight-XPS Laser Vaporization of the Prostate and Transurethral Resection of the Prostate for the Treatment of Benign Prostatic Obstruction: Two-yr Outcomes of the GOLIATH Study. Eur Urol 2016; 69:94-102. [DOI: 10.1016/j.eururo.2015.07.054] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 07/27/2015] [Indexed: 11/29/2022]
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Veale D, Miles S, Read J, Troglia A, Carmona L, Fiorito C, Wells H, Wylie K, Muir G. Penile Dysmorphic Disorder: Development of a Screening Scale. Arch Sex Behav 2015; 44:2311-2321. [PMID: 25731908 DOI: 10.1007/s10508-015-0484-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 04/03/2014] [Accepted: 11/30/2014] [Indexed: 06/04/2023]
Abstract
Penile dysmorphic disorder (PDD) is shorthand for men diagnosed with body dysmorphic disorder, in whom the size or shape of the penis is their main, if not their exclusive, preoccupation causing significant shame or handicap. There are no specific measures for identifying men with PDD compared to men who are anxious about the size of their penis but do not have PDD. Such a measure might be helpful for treatment planning, reducing unrealistic expectations, and measuring outcome after any psychological or physical intervention. Our aim was, therefore, to validate a specific measure, termed the Cosmetic Procedure Screening Scale for PDD (COPS-P). Eighty-one male participants were divided into three groups: a PDD group (n = 21), a small penis anxiety group (n = 37), and a control group (n = 23). All participants completed the COPS-P as well as standardized measures of depression, anxiety, social phobia, body image, quality of life, and erectile function. Penis size was also measured. The final COPS-P was based on nine items. The scale had good internal reliability and significant convergent validity with measures of related constructs. It discriminated between the PDD group, the small penis anxiety group, and the control group. This is the first study to develop a scale able to discriminate between those with PDD and men anxious about their size who did not have PDD. Clinicians and researchers may use the scale as part of an assessment for men presenting with anxiety about penis size and as an audit or outcome measure after any intervention for this population.
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Affiliation(s)
- David Veale
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London and South London and Maudsley NHS Foundation Trust, London, UK.
- Centre for Anxiety Disorders, The Maudsley Hospital, Denmark Hil, London, SE5 8AZ, UK.
| | - Sarah Miles
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London and South London and Maudsley NHS Foundation Trust, London, UK
| | - Julie Read
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London and South London and Maudsley NHS Foundation Trust, London, UK
| | - Andrea Troglia
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London and South London and Maudsley NHS Foundation Trust, London, UK
| | - Lina Carmona
- Kings College Hospital NHS Foundation Trust, London, UK
| | | | - Hannah Wells
- Kings College Hospital NHS Foundation Trust, London, UK
| | | | - Gordon Muir
- Kings College Hospital NHS Foundation Trust, London, UK
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Habous M, Muir G, Tealab A, Williamson B, Elkhouly M, Elhadek W, Mahmoud S, Laban O, Binsaleh S, Abdelwahab O, Mulhall JP, Veale D. Analysis of the Interobserver Variability in Penile Length Assessment. J Sex Med 2015; 12:2031-5. [DOI: 10.1111/jsm.13005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Marra G, Sturch P, Oderda M, Tabatabaei S, Muir G, Gontero P. Systematic review of lower urinary tract symptoms/benign prostatic hyperplasia surgical treatments on men's ejaculatory function: Time for a bespoke approach? Int J Urol 2015; 23:22-35. [DOI: 10.1111/iju.12866] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/08/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Giancarlo Marra
- Urology Clinic; Città della Salute e della Scienza; University of Turin; Turin Italy
| | - Paul Sturch
- Department of Urology; King's College Hospital; London UK
| | - Marco Oderda
- Urology Clinic; Città della Salute e della Scienza; University of Turin; Turin Italy
| | - Shahin Tabatabaei
- Department of Urology; Massachusetts General Hospital; Boston MA USA
| | - Gordon Muir
- Department of Urology; King's College Hospital; London UK
| | - Paolo Gontero
- Urology Clinic; Città della Salute e della Scienza; University of Turin; Turin Italy
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Habous M, Tealab A, Williamson B, Binsaleh S, El Dawy S, Mahmoud S, Abdelwahab O, Nassar M, Mulhall JP, Veale D, Muir G. Erect Penile Dimensions in a Cohort of 778 Middle Eastern Men: Establishment of a Nomogram. J Sex Med 2015; 12:1402-6. [DOI: 10.1111/jsm.12894] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Veale D, Miles S, Read J, Troglia A, Wylie K, Muir G. Sexual Functioning and Behavior of Men with Body Dysmorphic Disorder Concerning Penis Size Compared with Men Anxious about Penis Size and with Controls: A Cohort Study. Sex Med 2015; 3:147-55. [PMID: 26468378 PMCID: PMC4599552 DOI: 10.1002/sm2.63] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction Little is known about the sexual functioning and behavior of men anxious about the size of their penis and the means that they might use to try to alter the size of their penis. Aim To compare sexual functioning and behavior in men with body dysmorphic disorder (BDD) concerning penis size and in men with small penis anxiety (SPA without BDD) and in a control group of men who do not have any concerns. Methods An opportunistic sample of 90 men from the community were recruited and divided into three groups: BDD (n = 26); SPA (n = 31) and controls (n = 33). Main Outcome Measures The Index of Erectile Function (IEF), sexual identity and history; and interventions to alter the size of their penis. Results Men with BDD compared with controls had reduced erectile dysfunction, orgasmic function, intercourse satisfaction and overall satisfaction on the IEF. Men with SPA compared with controls had reduced intercourse satisfaction. There were no differences in sexual desire, the frequency of intercourse or masturbation across any of the three groups. Men with BDD and SPA were more likely than the controls to attempt to alter the shape or size of their penis (for example jelqing, vacuum pumps or stretching devices) with poor reported success. Conclusion Men with BDD are more likely to have erectile dysfunction and less satisfaction with intercourse than controls but maintain their libido. Further research is required to develop and evaluate a psychological intervention for such men with adequate outcome measures.
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Affiliation(s)
- David Veale
- Institute of Psychiatry, Psychology and Neurosciences, Kings College London, South London and Maudsley NHS Foundation Trust London, UK
| | - Sarah Miles
- Institute of Psychiatry, Psychology and Neurosciences, Kings College London, South London and Maudsley NHS Foundation Trust London, UK
| | - Julie Read
- Institute of Psychiatry, Psychology and Neurosciences, Kings College London, South London and Maudsley NHS Foundation Trust London, UK
| | - Andrea Troglia
- Institute of Psychiatry, Psychology and Neurosciences, Kings College London, South London and Maudsley NHS Foundation Trust London, UK
| | - Kevan Wylie
- Porterbrook Clinic, Sheffield Health and Social Care NHS Foundation Trust Sheffield, UK
| | - Gordon Muir
- King's College Hospital, NHS Foundation Trust London, UK
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Thomas JA, Tubaro A, Barber N, d' Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink J, Ameye F, Saussine C, Bruyere F, Loidl W, Larner T, Gogoi N, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitan C, Knispel H, Bachmann A. PD5-10 TRANSURETHRAL RESECTION OF THE PROSTATE (GL-XPS OR TURP) DOES NOT RESULT IN SIGNIFICANT IMPAIRMENT OF ERECTILE FUNCTION. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Veale D, Miles S, Bramley S, Muir G, Hodsoll J. Am I normal? A systematic review and construction of nomograms for flaccid and erect penis length and circumference in up to 15,521 men. BJU Int 2015; 115:978-86. [PMID: 25487360 DOI: 10.1111/bju.13010] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To systematically review and create nomograms of flaccid and erect penile size measurements. METHODS Study key eligibility criteria: measurement of penis size by a health professional using a standard procedure; a minimum of 50 participants per sample. EXCLUSION CRITERIA samples with a congenital or acquired penile abnormality, previous surgery, complaint of small penis size or erectile dysfunction. Synthesis methods: calculation of a weighted mean and pooled standard deviation (SD) and simulation of 20,000 observations from the normal distribution to generate nomograms of penis size. RESULTS Nomograms for flaccid pendulous [n = 10,704, mean (SD) 9.16 (1.57) cm] and stretched length [n = 14,160, mean (SD) 13.24 (1.89) cm], erect length [n = 692, mean (SD) 13.12 (1.66) cm], flaccid circumference [n = 9407, mean (SD) 9.31 (0.90) cm], and erect circumference [n = 381, mean (SD) 11.66 (1.10) cm] were constructed. Consistent and strongest significant correlation was between flaccid stretched or erect length and height, which ranged from r = 0.2 to 0.6. LIMITATIONS relatively few erect measurements were conducted in a clinical setting and the greatest variability between studies was seen with flaccid stretched length. CONCLUSIONS Penis size nomograms may be useful in clinical and therapeutic settings to counsel men and for academic research.
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Affiliation(s)
- David Veale
- The Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Miles
- The Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Sally Bramley
- King's College London Medical School, King's College London, London, UK
| | - Gordon Muir
- King's College NHS Foundation Trust, London, UK
| | - John Hodsoll
- The Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Bachmann A, Tubaro A, Barber N, d’Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink H, Ameye F, Saussine C, Bruyère F, Loidl W, Larner T, Gogoi NK, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitán C, Knispel H, Thomas JA. A European Multicenter Randomized Noninferiority Trial Comparing 180 W GreenLight XPS Laser Vaporization and Transurethral Resection of the Prostate for the Treatment of Benign Prostatic Obstruction: 12-Month Results of the GOLIATH Study. J Urol 2015; 193:570-8. [DOI: 10.1016/j.juro.2014.09.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Alexander Bachmann
- Department of Urology Basel, University Hospital Basel, University Basel, Basel, Switzerland
| | - Andrea Tubaro
- Department of Urology, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Neil Barber
- Department of Urology, Frimley Park Hospital, Frimley, Camberley
| | - Frank d’Ancona
- Department of Urology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Gordon Muir
- Department of Urology, King’s College Hospital and King’s Health Partners, London
| | - Ulrich Witzsch
- Department of Urology and Pediatric Urology, Krankenhaus Nordwest, Frankfurt, Germany
| | | | - Joan Benejam
- Department of Urology, Hospital de Manacor, Manacor, Spain
| | | | - Antony Riddick
- Department of Urology, Lothian University Hospitals Division, Western General Hospital, Edinburgh
| | - Sascha Pahernik
- Department of Urology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Herman Roelink
- Department of Urology, Ziekenhuis Groep Twente, Almelo/Hengelo, The Netherlands
| | - Filip Ameye
- Department of Urology, AZ Maria Middelares Gent, Gent, Belgium
| | - Christian Saussine
- Department of Urology, Nouvel Hopital Civil de Strasbourg, Strasbourg University, Strasbourg, France
| | - Franck Bruyère
- Department of Urology, CHRU Bretonneau, Tours, Loire Valley and Université François Rabelais de Tours, PRES Centre- Val de Loire Université, Val de Loire, France
| | - Wolfgang Loidl
- Department of Urology, Krankenhaus der Barmherzigen Schwestern Linz, Linz, Austria
| | - Tim Larner
- Department of Urology, Brighton and Sussex University Hospitals NHS Trust, Brighton
| | - Nirjan-Kumar Gogoi
- Department of Urology, Mid Yorkshire NHS Trust, Dewsbury & District Hospital, Dewsbury
| | - Richard Hindley
- Department of Urology, Basingstoke and North Hampshire NHS Foundation Trust, Hampshire
| | - Rolf Muschter
- Department of Urology, Diakoniekrankenhaus Rotenburg, Rotenburg, Germany
| | - Andrew Thorpe
- Department of Urology, Freeman Hospital Newcastle, Newcastle upon Tyne
| | - Nitin Shrotri
- Department of Urology, Kent and Canterbury Hospital, Kent
| | - Stuart Graham
- Department of Urology, Whipps Cross University Hospital, London
| | - Moritz Hamann
- Department of Urology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Martin Schostak
- Department of Urology, University Hospital Magdeburg, Magdeburg, Germany
| | - Carlos Capitán
- Department of Urology, Hospital Universitario Fundacion Alcorcon, Madrid, Spain
| | - Helmut Knispel
- Department of Urology, Uro-Forschungs GmbH im St. Hedwig Krankenhaus, Berlin, Germany
| | - J. Andrew Thomas
- Department of Urology, ABMU LHB, Princess of Wales Hospital, Bridgend, Wales
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Aydin A, Muir G, Khan MS, Dasgupta P, Ahmed K. Evaluation of the GreenLight Simulator and development of a simulation-based training curriculum for laser PVP. Int J Surg 2014. [DOI: 10.1016/j.ijsu.2014.08.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sturch P, Woo HH, McNicholas T, Muir G. Ejaculatory dysfunction after treatment for lower urinary tract symptoms: retrograde ejaculation or retrograde thinking? BJU Int 2014; 115:186-7. [DOI: 10.1111/bju.12868] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Paul Sturch
- Department of Urology; King's College Hospital; London UK
| | - Henry H. Woo
- Sydney Adventist Hospital Clinical School; University of Sydney; Sydney Australia
| | - Tom McNicholas
- Lister Hospital and University of Hertfordshire; Stevenage UK
| | - Gordon Muir
- Department of Urology; King's College Hospital; London UK
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Ahmed K, Aydin A, Muir G, Khan MS, Dasgupta P. MP14-15 FACE, CONTENT AND CONSTRUCT VALIDATION OF THE GREENLIGHT SIMULATOR. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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49
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Bachmann A, Tubaro A, Barber N, d'Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Pahernik S, Riddick A, Roelink J, Ameye F, Thomas A. MP71-16 PROSPECTIVE RANDOMIZED CONTROLLED TRIAL COMPARING GREENLIGHT (GL) 180-W XPS PVP AND TRANSURETHRAL RESECTION OF THE PROSTATE (THE GOLIATH STUDY): ONE YEAR FOLLOW-UP BY PROSTATE SIZE. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Affiliation(s)
- Gordon Muir
- Department of Urology, Kings College Hospital, London, UK.
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