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McLeod K, Woodward-Kron R, Rashid P, Archer J, Nestel D. "I'm on an island": A qualitative study of underperforming surgical trainee perspectives on remediation. Am J Surg 2024:S0002-9610(24)00035-7. [PMID: 38350749 DOI: 10.1016/j.amjsurg.2024.01.033] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/14/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND There is a significant gap in the literature regarding trainees' perceptions of remediation. This study aims to explore surgical trainees' experiences and perspectives of remediation. METHODS This qualitative study used semi-structured interviews with 11 doctors who have experienced formal remediation as a surgical trainee. Reflexive thematic analysis was used for data analysis. RESULTS In this study, trainees perceived remediation as a harrowing and isolating experience, with long-lasting emotions. There was a perceived lack of clarity regarding explanations of underperformance and subjective goals. Remediation was viewed as a 'performance' and tick-box exercise with superficial plans, with challenging trainee/supervisor dynamics. CONCLUSIONS These findings about trainees' perspectives on remediation show a need for trainees to be better emotionally supported during remediation and that remediation plans must be improved to address deficits. Integrating the perspectives and experiences of surgical trainees who have undergone remediation should help improve remediation outcomes and patient care.
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Affiliation(s)
- Kathryn McLeod
- Department of Urological Surgery, Barwon Health, University Hospital, Geelong, Australia; School of Medicine, Deakin University, Geelong, Australia; Department of Surgery (Austin), University of Melbourne, Heidelberg, Australia.
| | - Robyn Woodward-Kron
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
| | - Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School, The University of New South Wales, Port Macquarie, Australia
| | - Julian Archer
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Debra Nestel
- Department of Surgery (Austin), University of Melbourne, Heidelberg, Australia
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2
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Cole-Clark D, Rashid P. Costs and challenges of the curriculum vitae for SET Urology training positions: a qualitative analysis. ANZ J Surg 2024; 94:57-62. [PMID: 38174656 DOI: 10.1111/ans.18844] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Surgical training programs within Australia and Aotearoa New Zealand have become more competitive. Applicants are required to build a strong application over curriculum vitae (CV), references and interview. The building of the CV often comes at significant financial and time cost with challenges. This study explores successful applicants' experiences of the costs and challenges to build a successful CV for acceptance onto the Urology training program within Australia and New Zealand. METHODS Qualitative content analysis (QCA) was undertaken of semi-structured interviews conducted with 11 nSET Urology trainees. QCA focused on the identification and evaluation of costs and challenges experienced. Analysis was reviewed over the domain of CV components. RESULTS Costs of building each domain differed significantly between trainees as they focussed on various domains. Challenges encountered were identified with four themes were identified with associated subthemes: Passion/Commitment (two subthemes); Researching Pathways (six subthemes); Challenges (two subthemes) and Acceptance Success (two subthemes). CONCLUSIONS The commitment to a surgical specialty begins before acceptance onto a training program. A high-level CV is an integral component of acceptance onto the Urology training program. Each trainee had a different journey, including time and financial sacrifices, to obtain acceptance whilst demonstrating a strong motivation for success. The average cost of each trainee who gained acceptance was $50 779 over 3 years. Consideration should be given to making the CV component less onerous.
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Affiliation(s)
- Dane Cole-Clark
- Department of Urology, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
- Department of Urology, Rural Clinical School, The University of New South Wales, Port Macquarie, New South Wales, Australia
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3
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Pattenden TA, Thangasamy IA, Ong WL, Samaranayke D, Morton A, Murphy DG, Evans S, Millar J, Chalasani V, Rashid P, Winter M, Vela I, Pryor D, Mark S, Loeb S, Lawrentschuk N, Pritchard E. Barriers and enablers of active surveillance for prostate cancer: a qualitive study of clinicians. BJU Int 2024; 133 Suppl 3:48-56. [PMID: 37696615 DOI: 10.1111/bju.16176] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
OBJECTIVES To identify and explore barriers to, and enablers of, active surveillance (AS) in men with low-risk prostate cancer (LRPCa), as perceived by PCa clinicians. PATIENTS AND METHODS Urologists and radiation oncologists in Australia and New Zealand were purposively sampled for a cross-section on gender and practice setting (metropolitan/regional; public/private). Using a grounded theory approach, semi-structed interviews were conducted with participants. Interviews were coded independently by two researchers using open, axial, and selective coding. A constant comparative approach was used to analyse data as it was collected. Thematic saturation was reached after 18 interviews, and a detailed model of barriers to, and enablers of, AS for LRPCa, as perceived by clinicians was developed. RESULTS A model explaining what affects clinician decision making regarding AS in LRPCa emerged. It was underpinned by three broad themes: (i) clinician perception of patients' barriers and enablers; (ii) clinician perception of their own barriers and enablers; and (iii) engagement with healthcare team and resource availability. CONCLUSIONS Clinicians unanimously agree that AS is an evidence-based approach for managing LRPCa. Despite this many men do not undergo AS for LRPCa, which is due to the interplay of patient and clinician factors, and their interaction with the wider healthcare system. This study identifies strategies to mitigate barriers and enhance enablers, which could increase access to AS by patients with LRPCa.
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Affiliation(s)
- Trent A Pattenden
- Department of Urology, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Isaac A Thangasamy
- Nepean Urology Research Group, Nepean Hospital, Kingswood, New South Wales, Australia
- School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Wee Loon Ong
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Dhanika Samaranayke
- Department of Urology, Ipswich Hospital, Ipswich, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Andrew Morton
- Department of Urology, Ipswich Hospital, Ipswich, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sue Evans
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeremy Millar
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Venu Chalasani
- School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Prem Rashid
- Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Matthew Winter
- Nepean Urology Research Group, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Ian Vela
- Australian Prostate Cancer Research Centre - Queensland, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Urology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - David Pryor
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Stephen Mark
- Department of Urology, Christchurch Hospital, Christchurch, New Zealand
| | - Stacy Loeb
- New York University, New York City, NY, USA
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- EJ Whitten Prostate Cancer Research Centre, Epworth, Melbourne, Victoria, Australia
| | - Elizabeth Pritchard
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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4
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Cameron JK, Chandrasiri U, Millar J, Aitken JF, Cramb S, Dunn J, Frydenberg M, Rashid P, Mengersen K, Chambers SK, Baade PD, Smith DP. Disease mapping: Geographic differences in population rates of interventional treatment for prostate cancer in Australia. PLoS One 2023; 18:e0293954. [PMID: 37956143 PMCID: PMC10642787 DOI: 10.1371/journal.pone.0293954] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Treatment decisions for men diagnosed with prostate cancer depend on a range of clinical and patient characteristics such as disease stage, age, general health, risk of side effects and access. Associations between treatment patterns and area-level factors such as remoteness and socioeconomic disadvantage have been observed in many countries. OBJECTIVE To model spatial differences in interventional treatment rates for prostate cancer at high spatial resolution to inform policy and decision-making. METHODS Hospital separations data for interventional treatments for prostate cancer (radical prostatectomy, low dose rate and high dose rate brachytherapy) for men aged 40 years and over were modelled using spatial models, generalised linear mixed models, maximised excess events tests and k-means statistical clustering. RESULTS Geographic differences in population rates of interventional treatments were found (p<0.001). Separation rates for radical prostatectomy were lower in remote areas (12.2 per 10 000 person-years compared with 15.0-15.9 in regional and major city areas). Rates for all treatments decreased with increasing socioeconomic disadvantage (radical prostatectomy 19.1 /10 000 person-years in the most advantaged areas compared with 12.9 in the most disadvantaged areas). Three groups of similar areas were identified: those with higher rates of radical prostatectomy, those with higher rates of low dose brachytherapy, and those with low interventional treatment rates but higher rates of excess deaths. The most disadvantaged areas and remote areas tended to be in the latter group. CONCLUSIONS The geographic differences in treatment rates may partly reflect differences in patients' physical and financial access to treatments. Treatment rates also depend on diagnosis rates and thus reflect variation in investigation rates for prostate cancer and presentation of disease. Spatial variation in interventional treatments may aid identification of areas of under-treatment or over-treatment.
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Affiliation(s)
- Jessica K. Cameron
- Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia
- Cancer Council Queensland, Spring Hill, Queensland, Australia
| | | | - Jeremy Millar
- Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Joanne F. Aitken
- Cancer Council Queensland, Spring Hill, Queensland, Australia
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Susanna Cramb
- Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Jeff Dunn
- Prostate Cancer Foundation Australia, St Leonards, New South Wales, Australia
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia
| | - Mark Frydenberg
- Department of Surgery, Monash University, Clayton, Victoria, Australia
| | - Prem Rashid
- Medicine & Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Kerrie Mengersen
- Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Suzanne K. Chambers
- Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Peter D. Baade
- Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia
- Cancer Council Queensland, Spring Hill, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - David P. Smith
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, New South Wales (NSW), Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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5
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Rashid P, Zargar-Shoshtari K, Ranasinghe W. Prostate-specific antigen testing for prostate cancer: Time to reconsider the approach to screening. Aust J Gen Pract 2023; 52:91-95. [PMID: 36872083 DOI: 10.31128/ajgp-08-22-6509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Prostate cancer is now the most common cancer in men in Australia. Men should be aware of the potential risk of significant prostate cancer despite the lack of symptoms. Screening for prostate cancer using prostate-specific antigen (PSA) has been controversial. General practice guidelines can be confusing leading to men not being tested for prostate cancer. Reasons cited include overdiagnosis and overtreatment with associated morbidity. OBJECTIVE This article aims to highlight the current evidence for PSA testing and advocate for updating outdated guidelines and resources. DISCUSSION Current evidence shows that a risk-stratified approach to PSA screening helps to assess that risk. Recent studies show improved survival rates with early intervention compared with observation/delayed treatment. Imaging, including magnetic resonance imaging and prostate-specific membrane antigen positron emission tomography, have made a significant difference in the management pathway. Biopsy techniques have progressed to minimise sepsis risk. Quality and patient-reported outcomes registry data highlight the increased use of active surveillance in patients with low to intermediate risk of prostate cancer, reducing treatment-associated harms in men with low risk of progression. There have also been improvements in medical therapeutics for advanced disease.
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Affiliation(s)
- Prem Rashid
- PhD, DClinSurg, FRACS (Urol), Urological Surgeon, Conjoint Associate Professor, Rural Clinical School, Faculty of Medicine and Health, UNSW, Sydney, NSW
| | - Kamran Zargar-Shoshtari
- MBChB, MD, FRACS (Urol), Associate Professor, University of Auckland, Auckland; Consultant Urologist, Te Whatu Ora, Counties Manukau, Otahuhu, Auckland
| | - Weranja Ranasinghe
- MBChB, PhD, MRCS, FRACS (Urol), Urological Surgeon, Monash Health @ Monash University, Melbourne, Vic
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Pattenden TA, Samaranayke D, Morton A, Ong WL, Murphy DG, Pritchard E, Evans S, Millar J, Chalasani V, Rashid P, Winter M, Vela I, Pryor D, Mark S, Lawrentschuk N, Thangasamy IA. Modern Active Surveillance in Prostate Cancer: A Narrative Review. Clin Genitourin Cancer 2023; 21:115-123. [PMID: 36443163 DOI: 10.1016/j.clgc.2022.09.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/29/2022] [Accepted: 09/03/2022] [Indexed: 02/01/2023]
Abstract
The use of PSA screening has led to downstaging and downgrading of prostate cancer at diagnosis, increasing detection of indolent disease. Active surveillance aims to reduce over-treatment by delaying or avoiding radical treatment and its associated morbidity. However, there is not a consensus on the selection criteria and monitoring schedules that should be used. This article aims to summarize the evidence supporting the safety of active surveillance, the current selection criteria recommended and in use, the incidence of active surveillance, barriers existing to its uptake and future developments in patient selection.
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Affiliation(s)
| | - Dhanika Samaranayke
- Department of Urology, Ipswich Hospital, QLD, Australia; Faculty of Medicine, University of Queensland, QLD, Australia
| | - Andrew Morton
- Department of Urology, Ipswich Hospital, QLD, Australia; Faculty of Medicine, University of Queensland, QLD, Australia
| | - Wee Loon Ong
- Alfred Health Radiation Oncology Service, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia; School of Clinical Medicine, University of Cambridge, UK
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, VIC, Australia
| | - Elizabeth Pritchard
- Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia
| | - Susan Evans
- Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia
| | - Jeremy Millar
- Alfred Health Radiation Oncology Service, VIC, Australia; Central Clinical School, Monash University, VIC, Australia
| | - Venu Chalasani
- Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Prem Rashid
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Australia
| | - Matthew Winter
- Nepean Urology Research Group, Nepean Hospital, NSW, Australia
| | - Ian Vela
- Department of Urology, Princess Alexandra Hospital, QLD, Australia; Australian Prostate Cancer Research Centre, Queensland and The Queensland Bladder Cancer Initiative, School of Biomedical Science, Faculty of Health, Queensland University of Technology, QLD, Australia
| | - David Pryor
- Department of Radiation Oncology, Princess Alexandra Hospital, QLD, Australia
| | - Stephen Mark
- Department of Urology, Christchurch Hospital, New Zealand
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, VIC, Australia; EJ Whitten Prostate Cancer Research Centre, Epworth, VIC, Australia
| | - Isaac A Thangasamy
- Faculty of Medicine, University of Queensland, QLD, Australia; Nepean Urology Research Group, Nepean Hospital, NSW, Australia
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7
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Ong WL, Thangasamy I, Murphy D, Pritchard E, Evans S, Millar J, Chalasani V, Rashid P, Winter M, Vela I, Pryor D, Mark S, Lawrentschuk N. Large variation in conservative management for low‐risk prostate cancer in Australia and New Zealand. BJU Int 2022; 130 Suppl 1:17-19. [PMID: 35076135 PMCID: PMC9303782 DOI: 10.1111/bju.15698] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 01/06/2022] [Accepted: 01/17/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Wee Loon Ong
- Alfred Health Radiation Oncology Melbourne VIC Australia
- Department of Radiation Oncology Olivia Newton‐John Cancer Wellness and Research Centre Austin Health VIC Australia
- Department of Radiation Oncology Peter MacCallum Cancer Centre VIC Australia
- Department of Epidemiology and Preventive Medicine Monash University VIC Australia
- School of Clinical Medicine University of Cambridge UK
| | - Isaac Thangasamy
- Department of Cancer Surgery Peter MacCallum Cancer Centre VIC Australia
| | - Declan Murphy
- Department of Cancer Surgery Peter MacCallum Cancer Centre VIC Australia
| | - Elizabeth Pritchard
- Department of Epidemiology and Preventive Medicine Monash University VIC Australia
| | - Susan Evans
- Department of Epidemiology and Preventive Medicine Monash University VIC Australia
| | - Jeremy Millar
- Alfred Health Radiation Oncology Melbourne VIC Australia
- Central Clinical School Monash University VIC Australia
| | | | | | | | - Ian Vela
- Department of Urology Princess Alexandra Hospital QLD Australia
- Australian Prostate Cancer Research Centre Queensland University of Technology QLD Australia
| | - David Pryor
- Department of Radiation Oncology Princess Alexandra Hospital QLD Australia
| | - Stephen Mark
- Department of Urology Christchurch Hospital New Zealand
| | - Nathan Lawrentschuk
- Department of Cancer Surgery Peter MacCallum Cancer Centre VIC Australia
- EJ Whitten Prostate Cancer Research Centre Epworth Hospital VIC Australia
- Department of Surgery University of Melbourne, Royal Melbourne Hospital VIC Australia
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Affiliation(s)
- Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, The University of New South Wales, Port Macquarie, New South Wales, Australia.,Rural Clinical School, Faculty of Medicine, The University of New South Wales, Port Macquarie, NSW, 2444, Australia
| | - Maxine Ronald
- Department of General Surgery, Whangarei Hospital, Aotearoa, New Zealand
| | - Kelvin Kong
- Department of Otolaryngology, Head & Neck Surgery, John Hunter Hospital, Newcastle, NSW, Australia.,Department of Linguistics, Faculty of Medicine, Health and Health Sciences, Macquarie University, Sydney, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Hearing For Learning Initiative, Menzies School of Health Research, Casuarina, NT, Australia
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9
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Mark S, Rashid P, Heathcote P, Zargar Shoshtari K. Differences in treatment choices for localised prostate cancer diagnosed in private and public health services. Med J Aust 2021; 214:485-485.e1. [PMID: 33977532 DOI: 10.5694/mja2.51081] [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: 11/17/2022]
Affiliation(s)
- Stephen Mark
- Christchurch Hospital, Christchurch, New Zealand
| | | | - Peter Heathcote
- Australian Prostate Cancer Research Centre Queensland, Queensland University of Technology, Brisbane, QLD
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10
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Kwok M, Shugg N, Siriwardana A, Calopedos R, Richards K, Bandi S, Hempenstall J, Rashid P, Desai D. Prevalence and sequelae of penile lichen sclerosus in males presenting for circumcision in regional Australia: a multicentre retrospective cohort study. Transl Androl Urol 2021; 11:780-785. [PMID: 35812204 PMCID: PMC9262734 DOI: 10.21037/tau-22-29] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/13/2022] [Accepted: 04/17/2022] [Indexed: 11/22/2022] Open
Abstract
Background Lichen sclerosus (LS) in men commonly involves the external genitalia, with up to 20% of these patients developing urethral stricture disease, and a small group developing malignant transformation to penile squamous cell carcinoma (SCC). The objective of this study was to determine the prevalence of LS and its sequelae in males presenting for circumcision. Methods A multicentre retrospective cohort study was conducted at 8 hospitals within 3 Australian regional centres. We identified males who underwent circumcision between January 2004 and November 2018 and obtained histological and clinical data. Histopathological confirmation of LS was the primary outcome. Development of urethral stricture disease and penile cancer were secondary outcomes. Results Six hundred and eleven patients underwent circumcision, of which 313 (51.2%) had a specimen sent for histology. Of these, 199 (63.6%) had confirmed LS where the median age at diagnosis was 65 years [interquartile range (IQR), 40–77]. Even if the remainder of unsent specimens were free of LS, the prevalence would still be 32.6%. Amongst the patients with LS, 44 (22.1%) developed urethral strictures, 1 penile SCC (0.5%), and 1 penile intraepithelial neoplasia (0.5%). Conclusions The prevalence of LS in patients undergoing circumcision where the foreskin was sent for histopathological review was 63.6%. In those with LS, the prevalence of urethral stricture disease was 22.1%.
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Affiliation(s)
- Michael Kwok
- Department of Urology, Toowoomba Hospital, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Nathan Shugg
- Department of Urology, Toowoomba Hospital, Queensland, Australia
| | | | - Ross Calopedos
- Department of Urology, Port Macquarie Base Hospital, New South Wales, Australia
| | | | - Sanjeev Bandi
- Department of Urology, Mater Misericordiae Hospital, Mackay, Queensland, Australia
| | - John Hempenstall
- Department of Urology, Toowoomba Hospital, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- St Andrew’s Toowoomba Hospital, Queensland, Australia
- St Vincent’s Private Hospital Toowoomba, Queensland, Australia
| | - Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, New South Wales, Australia
- Rural Clinical School, University of New South Wales, Sydney, Australia
- Port Macquarie Private Hospital, New South Wales, Australia
- Wauchope District Memorial Hospital, New South Wales, Australia
- Kempsey District Hospital, New South Wales, Australia
| | - Devang Desai
- Department of Urology, Toowoomba Hospital, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- St Andrew’s Toowoomba Hospital, Queensland, Australia
- St Vincent’s Private Hospital Toowoomba, Queensland, Australia
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11
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Rashid P. Struggling trainee, underperformance and the role of the surgical supervisor. ANZ J Surg 2020; 90:949. [DOI: 10.1111/ans.15996] [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: 04/14/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Prem Rashid
- Rural Clinical School, Faculty of MedicineThe University of New South Wales Sydney New South Wales Australia
- Urological Society of Australia and New Zealand Sydney New South Wales Australia
- Urology Centre Port Macquarie New South Wales Australia
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12
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Imran A, Calopedos R, Habashy D, Rashid P. Acknowledging and addressing surgeon burnout. ANZ J Surg 2018; 88:1100-1101. [DOI: 10.1111/ans.14817] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/27/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Aalya Imran
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School; The University of New South Wales; Port Macquarie New South Wales Australia
| | - Ross Calopedos
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School; The University of New South Wales; Port Macquarie New South Wales Australia
| | - David Habashy
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School; The University of New South Wales; Port Macquarie New South Wales Australia
| | - Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School; The University of New South Wales; Port Macquarie New South Wales Australia
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13
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Rashid P, Habashy D, Calopedos R. Trainees at risk: the need for support and compassion. ANZ J Surg 2018; 88:1106-1107. [DOI: 10.1111/ans.14756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 05/23/2018] [Accepted: 06/06/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School; The University of New South Wales; Port Macquarie New South Wales Australia
| | - David Habashy
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School; The University of New South Wales; Port Macquarie New South Wales Australia
| | - Ross Calopedos
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School; The University of New South Wales; Port Macquarie New South Wales Australia
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Valenzuela R, Roehrborn C, Gange S, Bolton D, Chin P, Rashid P, Rukstalis D, McVary K. 192 Five Year Sexual Function Results of the Multi-Center, Prospective, Randomized Study of the Prostatic Urethral Lift (PUL). J Sex Med 2018. [DOI: 10.1016/j.jsxm.2017.11.151] [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: 10/18/2022]
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Kevric J, Papa N, Perera M, Rashid P, Toshniwal S. Poor Employment Conditions Adversely Affect Mental Health Outcomes Among Surgical Trainees. J Surg Educ 2018; 75:156-163. [PMID: 28729187 DOI: 10.1016/j.jsurg.2017.06.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 03/16/2017] [Revised: 05/17/2017] [Accepted: 06/25/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Poor mental health in junior clinicians is prevalent and may lead to poor productivity and significant medical errors. We aimed to provide contemporary data on the mental health of surgical trainees and identify risk factors relating to poorer mental health outcomes. METHODS A detailed questionnaire was developed comprising questions based on the 36-item short-form health survey (SF-36) and Physical Activity Questionnaire. Each of the questionnaires has proven validity and reliability in the clinical context. Ethics approval was obtained from the Royal Australasian College of Surgeons. The questionnaire was aimed at surgical registrars. We used Physical Activity Questionnaire, SF-36 scores and linear regression to evaluate the effect of putative predictors on mental health. RESULT A total of 83 responses were collected during the study period, of which 49 (59%) were from men and 34 (41%) were from women. The mean Mental Component Summary (MCS) score for both sexes was significantly lower than the population mean at ages 25-34 (p < 0.001). Poor satisfaction with one's work culture and a feeling of a lack of support at work were extremely strong predictors of a lower MCS score (p < 0.001). Hours of overtime worked, particularly unpaid overtime, were also strong predictors of a poorer score. CONCLUSIONS Australian surgical trainees reported lower MCS scores from the SF-36 questionnaire compared to the general population. Increasing working hours, unpaid overtime, poor job security, and job satisfaction were associated with poorer scores among trainees. Interventions providing improved working conditions need to be considered by professional training bodies and employers.
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Affiliation(s)
- Jasmina Kevric
- Department of Surgery, Monash Health, Monash University, Melbourne, Victoria, Australia.
| | - Nathan Papa
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia; Division of Surgery, Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia; Division of Surgery, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marlon Perera
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School, The University of New South Wales, Port Macquarie, New South Wales, Australia
| | - Sumeet Toshniwal
- Department of Surgery, Angliss Hospital, Eastern Health, Melbourne, Victoria, Australia
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Rashid P, Churchill JA, Gendy R. Improving clinical teaching for busy clinicians: integration of the one-minute preceptor into mini-clinical examination. ANZ J Surg 2017; 87:535-536. [PMID: 28768386 DOI: 10.1111/ans.14038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School, The University of New South Wales, Port Macquarie, New South Wales, Australia
| | - James A Churchill
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School, The University of New South Wales, Port Macquarie, New South Wales, Australia
| | - Rasha Gendy
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School, The University of New South Wales, Port Macquarie, New South Wales, Australia
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Churchill JA, Rashid P. Challenges and next steps in teaching professionalism in surgical training. ANZ J Surg 2017; 87:430-431. [PMID: 28585758 DOI: 10.1111/ans.14016] [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] [Received: 01/22/2017] [Accepted: 03/07/2017] [Indexed: 11/27/2022]
Affiliation(s)
- James A Churchill
- Department of Urology, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School, The University of New South Wales, Port Macquarie, New South Wales, Australia
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Gendy R, Rashid P. Incidental adrenal masses - A primary care approach. Aust Fam Physician 2017; 46:385-390. [PMID: 28609594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The common use of cross-sectional imaging for the investigation of abdominal and thoracic illness has resulted in the rise of the incidentally identified adrenal mass, or incidentaloma, which presents a diagnostic and management dilemma for the primary care physician. OBJECTIVE This article provides a framework for the investigation and management of incidental adrenal masses. DISCUSSION Adrenal incidentalomas are found in approximately 3-4% of abdominal computed tomography (CT) scans. It is important to evaluate these incidental adrenal lesions to determine what treatment, if any, is needed and when specialist referral may be necessary. In particular, incidentalomas must be evaluated in regard to their functional status and malignant potential, as lesions can range from being indolent, benign and non-functioning tumours that can simply be observed, to aggressive and hormonally active malignant lesions that require urgent surgical intervention.
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Calopedos RJS, Garcia C, Rashid P, Murphy DG, Lawrentschuk N, Woo HH. Citation indices for social media articles in urology. BJU Int 2017; 119 Suppl 5:47-52. [DOI: 10.1111/bju.13872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - Cindy Garcia
- Department of Urology; Wollongong Hospital; Wollongong NSW Australia
| | - Prem Rashid
- Department of Urology; Port Macquarie Base Hospital; Port Macquarie NSW Australia
- Rural Clinical School; University of NSW; Port Macquarie NSW Australia
| | - Declan G. Murphy
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Vic. Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
- Department of Surgery; University of Melbourne; Melbourne Vic. Australia
- Olivia Newton John Cancer Research Institute; Austin Hospital; Melbourne Vic. Australia
| | - Henry H. Woo
- Sydney Adventist Hospital Clinical School; University of Sydney; Sydney NSW Australia
- Department of Uro-Oncology; Chris O'Brien Lifehouse; Camperdown NSW Australia
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Woo H, Barkin J, Bolton D, Rashid P, Cantwell A, Bogache W, Richardson S, Tutrone R, Fagelson J, Chin P. MP27-18 CROSSOVER STUDY ON THE PROSTATIC URETHRAL LIFT (PUL): 4 YEAR RESULTS. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.810] [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: 11/30/2022]
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Roehrborn C, Gange S, Shore N, Giddens J, Bolton D, Cowan B, Cantwell A, McVary K, Chin P, Te A, Gholami S, Rashid P, Moseley W, Tutrone R, Freedman S, Incze P, Coffield K, Borges F, Rukstalis D. Long term (5 year) results from the largest, prospective, randomized, controlled study of the minimally invasive prostatic urethral lift (PUL). ACTA ACUST UNITED AC 2017. [DOI: 10.1016/s1569-9056(17)30258-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Surgical education continues to evolve from the master-apprentice model. Newer methods of the process need to be used to manage the dual challenges of educating while providing safe surgical care. This requires integrating adult learning concepts into delivery of practical training and education in busy clinical environments. A narrative review aimed at outlining and integrating adult learning and surgical education theory was undertaken. Additionally, this information was used to relate the practical delivery of surgical training and education in day-to-day surgical practice. Concepts were sourced from reference material. Additional material was found using a PubMed search of the words: 'surgical education theory' and 'adult learning theory medical'. This yielded 1351 abstracts, of which 43 articles with a focus on key concepts in adult education theory were used. Key papers were used to formulate structure and additional cross-referenced papers were included where appropriate. Current concepts within adult learning have a lot to offer when considering how to better deliver surgical education and training. Better integration of adult learning theory can be fruitful. Individual teaching surgical units need to rethink their paradigms and consider how each individual can contribute to the education experience. Up skilling courses for trainers can do much to improve the delivery of surgical education. Understanding adult learning concepts and integrating these into day-to-day teaching can be valuable.
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Affiliation(s)
- Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School, The University of New South Wales, Port Macquarie, NSW, 2444, Australia
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Pirpiris A, Chung ASJ, Rashid P. From humble beginnings … the evolution of the FRACS (Urology). ANZ J Surg 2017; 87:619-623. [PMID: 28147436 DOI: 10.1111/ans.13881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/13/2016] [Revised: 11/09/2016] [Accepted: 11/12/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgery has a rich and colourful history dating as far back as, at least, the Neolithic period. There have been many advances in knowledge and technology, as well as changes to working conditions and public perception and expectations. The urology training programme is jointly managed by the Royal Australasian College of Surgeons and the Urological Society of Australia and New Zealand. Urological training in Australia and New Zealand has undergone a number of changes over the years. METHODS A PubMed search was performed to find articles related to surgical training and, more specifically, urological training in Australia and New Zealand. The search terms that were used included 'urology training', 'surgical training', 'Australian urology history' and 'New Zealand urology history'. RESULTS This narrative review outlines the origin and history of this training programme and describes the changes that have led to the current model of urology training. It also relates some of the current and future challenges faced as the training programme continues to evolve in order to improve its ability to train future urologists to meet the needs of the community and to ensure public safety. CONCLUSION The urological training programme has evolved a number of times in order to tackle the challenges presented by evolving technology, community expectation and the needs of the trainee.
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Affiliation(s)
- Athina Pirpiris
- Department of Urology, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Amanda S J Chung
- Department of Urology, Concord Repatriation General Hospital Concord, Sydney, New South Wales, Australia
| | - Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School, The University of New South Wales, Port Macquarie, New South Wales, Australia
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Baba Sheikh M, Rashid P, Marouf A, Raheem Z, Manjunath S, Janga S. Molecular typing of canine parvovirus from Sulaimani, Iraq and phylogenetic analysis using partial VP2 gene. BJVM 2017. [DOI: 10.15547/bjvm.1032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Affiliation(s)
- Prem Rashid
- Department of Urology; Port Macquarie Base Hospital and Rural Clinical School; University of New South Wales; Port Macquarie NSW Australia
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Affiliation(s)
- Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School, The University of New South Wales, Port Macquarie, New South Wales, Australia
| | - Bernadine McNamara
- General Counsel, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
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27
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Rukstalis D, Rashid P, Bogache WK, Tutrone RF, Barkin J, Chin PT, Woo HH, Cantwell AL, Cowan BE, Bolton DM. 24-month durability after crossover to the prostatic urethral lift from randomised, blinded sham. BJU Int 2016; 118 Suppl 3:14-22. [DOI: 10.1111/bju.13666] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Prem Rashid
- Urology Centre; Port Macquarie NSW Australia
| | | | | | - Jack Barkin
- Toronto Urology Clinical Study Group; Toronto ON Canada
| | | | - Henry H. Woo
- Sydney Adventist Hospital Clinical School; Wahroonga NSW Australia
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Gianduzzo TR, Gardiner RA, Rashid P, Young R, Frydenberg M, Kelly S. Impact of branding on public awareness of healthcare-related governing bodies: a pilot study of the Urological Society of Australia and New Zealand brand. BJU Int 2016; 118 Suppl 3:23-29. [DOI: 10.1111/bju.13469] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Troy R.J. Gianduzzo
- School of Medicine; The University of Queensland; Brisbane Qld Australia
- Department of Urology; The Royal Brisbane and Women's Hospital; Brisbane Qld Australia
- Department of Urology; The Wesley Hospital; Brisbane Qld Australia
- School of Business; The University of Queensland; Brisbane Qld Australia
| | - Robert A. Gardiner
- School of Medicine; The University of Queensland; Brisbane Qld Australia
- Department of Urology; The Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - Prem Rashid
- Department of Urology; Port Macquarie Base Hospital; Port Macquarie NSW Australia
| | - Rhys Young
- School of Medicine; The University of Queensland; Brisbane Qld Australia
| | - Mark Frydenberg
- Department of Surgery; Monash University; Melbourne Vic. Australia
| | - Sarah Kelly
- School of Business; The University of Queensland; Brisbane Qld Australia
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Liu S, Lee S, Rashid P, Bangash H, Hamid A, Lau J, Cohen R. Active surveillance is suitable for intermediate term follow-up of renal oncocytoma diagnosed by percutaneous core biopsy. BJU Int 2016; 118 Suppl 3:30-34. [PMID: 27457972 DOI: 10.1111/bju.13538] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Shuo Liu
- Royal Perth Hospital; Perth WA Australia
- Port Macquarie Base Hospital; Port Macquarie NSW Australia
| | - Stephen Lee
- Uropath Pty Ltd; West Leederville WA Australia
- Faculty of Medicine and Dentistry; School of Pathology and Laboratory Medicine; University of Western Australia; Crawley WA Australia
| | - Prem Rashid
- Port Macquarie Base Hospital; Port Macquarie NSW Australia
- Faculty of Medicine; Rural Clinical School; University of New South Wales; Sydney NSW Australia
| | - Haider Bangash
- Royal Perth Hospital; Perth WA Australia
- Fiona Stanley Hospital; Perth WA Australia
| | - Akhlil Hamid
- Royal Perth Hospital; Perth WA Australia
- Fiona Stanley Hospital; Perth WA Australia
| | - Jason Lau
- Uropath Pty Ltd; West Leederville WA Australia
| | - Ronald Cohen
- Uropath Pty Ltd; West Leederville WA Australia
- Faculty of Medicine and Dentistry; School of Pathology and Laboratory Medicine; University of Western Australia; Crawley WA Australia
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Rashid P, Stacey MC, Hoskin SE, Pearce CA. The Effect of Probe Position, Calf Muscle Function and Lipodermatosclerosis on Photoplethysmographic Venous Refilling Time. Phlebology 2016. [DOI: 10.1177/026835559601100402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To assess the influence of probe position, lipodermatosclerosis and method of calf muscle emptying on the venous refilling time as measured by photoplethysmography in both normal limbs and limbs with chronic venous disease. Design: Prospective evaluation of age- and sex-matched control and study groups. Setting: University Department of Surgery, Vascular Research Laboratory, Fremantle Hospital, Western Australia. Patients: There were 38 controls and 31 patients with venous ulceration. Interventions: Venous refilling times were measured in six positions on the leg in all subjects: the foot, 5 cm below medial tibial condyle in the upper calf, and in the gaiter region on the medial, lateral, anterior and posterior positions at 7.5 cm above the medial malleolus. Measurements were undertaken on active exercise and after bimanual calf compression in the medial gaiter region. Measurements were also undertaken in areas of lipodermatosclerotic skin and in normal-appearing adjacent skin. Results: In normal legs, the lowest refilling times were in the anterior and lateral gaiter positions. Venous patients had a shorter refilling time in the dorsal foot, medial gaiter, posterior gaiter and medial below-knee positions, when compared with controls (Mann–Whitney U-test, p<0.01). The shortest refilling time in patients with venous disease was in the medial gaiter region. Refilling time was slightly prolonged over Hpodermatosclerotic skin compared with adjacent normal-looking skin. Refilling time measured after passive emptying of the calf muscle by external compression was significantly prolonged compared with calf emptying by active calf compression ( p<0.01). This change was similar for both groups. Conclusions: When using venous refilling time on photoplethysmography to distinguish venous from normal limbs, the best separation is in the medial gaiter position. If other probe sites or methods of calf emptying are to be employed, it is imperative that individual laboratory normal ranges be established for the particular method being employed.
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Affiliation(s)
- P. Rashid
- University Department of Surgery, Fremantle Hospital, Fremantle, Western Australia
| | - M. C. Stacey
- University Department of Surgery, Fremantle Hospital, Fremantle, Western Australia
| | - S. E. Hoskin
- University Department of Surgery, Fremantle Hospital, Fremantle, Western Australia
| | - C. A. Pearce
- University Department of Surgery, Fremantle Hospital, Fremantle, Western Australia
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Affiliation(s)
- Prem Rashid
- Department of Urology; Rural Clinical School; The University of New South Wales; Port Macquarie Base Hospital; Port Macquarie NSW Australia
| | - Troy R.J. Gianduzzo
- Department of Urology; School of Medicine; The University of Queensland; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
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Arianayagam R, Rashid P. Bullying among urology trainees in Australia and New Zealand: lessons from a cross-sectional survey. ANZ J Surg 2015; 85:499-500. [DOI: 10.1111/ans.13167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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)
- Ranjan Arianayagam
- Department of Urology; Port Macquarie Base Hospital; Rural Clinical School; The University of New South Wales; Port Macquarie New South Wales Australia
| | - Prem Rashid
- Department of Urology; Port Macquarie Base Hospital; Rural Clinical School; The University of New South Wales; Port Macquarie New South Wales Australia
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Roehrborn CG, Rukstalis DB, Barkin J, Gange SN, Shore ND, Giddens JL, Bolton DM, Cowan BE, Cantwell AL, McVary KT, Te AE, Gholami SS, Moseley WG, Chin PT, Dowling WT, Freedman SJ, Incze PF, Coffield KS, Borges FD, Rashid P. Three year results of the prostatic urethral L.I.F.T. study. Can J Urol 2015; 22:7772-7782. [PMID: 26068624] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION To report the three year results of a multi-center, randomized, patient and outcome assessor blinded trial of the Prostatic Urethral Lift (PUL) in men with bothersome lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). MATERIALS AND METHODS At 19 centers in North America and Australia, 206 subjects = 50 years old with International Prostate Symptom Score (IPSS) ≥ 13, peak flow rate (Qmax) ≤ 12 mL/s, and prostate volume between 30 cc-80 cc were randomized 2:1 to the PUL procedure or sham control. PUL involved placing permanent UroLift implants into the lateral lobes of the prostate to enlarge the urethral lumen. After randomized comparison at 3 months, PUL patients were followed to 3 years. LUTS severity (IPSS), quality of life, Qmax, sexual function, and adverse events were assessed throughout follow up. RESULTS The therapeutic effect of PUL regarding IPSS was 88% greater than sham at 3 months. Average improvements from baseline through 3 years were significant for total IPSS (41.1%), quality of life (48.8%), Qmax (53.1%), and individual IPSS symptoms. Symptomatic improvement was independent of prostate size. There were no de novo, sustained ejaculatory or erectile dysfunction events and all sexual function assessments showed average stability or improvement after PUL. Fifteen of the 140 patients originally randomized to PUL required surgical reintervention for treatment failure within the first 3 years. CONCLUSIONS PUL offers rapid improvement in voiding and storage symptoms, quality of life and flow rate that is durable to 3 years. Patients demonstrated a level of symptom relief that is associated with significant patient satisfaction. PUL, a minimally invasive procedure, is very effective in treating bothersome LUTS secondary to benign prostatic obstruction (BPO) and is unique in its ability to preserve total sexual function while offering a rapid return to normal physical activities.
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Chopra S, Rashid P. Management of castration-resistant (advanced) prostate cancer (CRPC): rationale, progress and future directions. Aust Fam Physician 2015; 44:302-305. [PMID: 26042402] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Prostate cancer is the most common solid organ cancer and the second most common cause of cancer-related deaths in Australian men. OBJECTIVE The aim of our review is to provide general practitioners with up-to-date information about castration resistance and hormonal dependence in prostate cancer. We summarise the current ongoing and completed clinical trials targeting hormonal pathways in metastatic prostate cancer. DISCUSSION The treatment paradigm of metastatic castration-resistant prostate cancer has changed markedly in the past decade and new agents targeting androgen receptor pathways have been introduced. However, the biggest challenge for clinicians is to develop guidelines to integrate these agents into clinical practice.
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Affiliation(s)
- Sam Chopra
- MBBS, MRCS (Edin), MS, Urology Advanced Trainee, Prince of Wales Hospital, Sydney, Port Macquarie, NSW
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Affiliation(s)
- Prem Rashid
- Department of Urology; Port Macquarie Base Hospital; Rural Clinical School; University of New South Wales; Port Macquarie New South Wales Australia
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Woo H, Cantwell A, Bogache W, Richardson S, Tutrone R, Rashid P, Barkin J, Fagelson J, Chin P. MP3-02 CROSSOVER STUDY OF THE PROSTATIC URETHRAL LIFT FOR LUTS SECONDARY TO BPH: 2 YEAR RESULTS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.105] [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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Garcia C, Chin P, Rashid P, Woo HH. Prostatic urethral lift: A minimally invasive treatment for benign prostatic hyperplasia. Prostate Int 2015; 3:1-5. [PMID: 26157759 PMCID: PMC4494639 DOI: 10.1016/j.prnil.2015.02.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 08/23/2014] [Accepted: 10/01/2014] [Indexed: 12/02/2022] Open
Abstract
Prostatic urethral lift (PUL) is a minimally invasive procedure for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia. The procedure may be performed under local, spinal, or general anesthesia. The PUL procedure involves the delivery of implants that retract obstructing prostate lobes. Unlike other benign prostatic hyperplasia treatment options including pharmacological therapy, and the current invasive gold-standard transurethral resection of the prostate, the PUL procedure achieves quantifiable improvements in functional outcomes and quality of life, in the absence of major adverse events. Furthermore, improvement in LUTS may be attained while preserving erectile and ejaculatory function. Adverse effects associated with the PUL procedure are mild to moderate, and are transient in nature. The PUL procedure provides an alternative for men seeking treatment for bothersome LUTS, with fewer side-effects.
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Affiliation(s)
- Cindy Garcia
- Sydney Adventist Hospital Clinical School, University of Sydney, NSW, Australia
| | - Peter Chin
- Department of Urology, The Wollongong Hospital, Wollongong, NSW, Australia ; Graduate School of Medicine, University of Wollongong, NSW, Australia ; Figtree Private Hospital, Figtree, NSW, Australia
| | - Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, NSW, Australia ; Rural Clinical School, The University of New South Wales, Port Macquarie, NSW, Australia
| | - Henry H Woo
- Sydney Adventist Hospital Clinical School, University of Sydney, NSW, Australia
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Affiliation(s)
- Prem Rashid
- Department of Urology; Port Macquarie Base Hospital; Rural Clinical School; The University of New South Wales; Sydney New South Wales Australia
| | - Maruthi Narra
- Department of Surgery; Albury Wodonga Health; Albury New South Wales Australia
| | - Henry Woo
- Department of Urology; Sydney Adventist Hospital Clinical School; The University of Sydney; Sydney New South Wales Australia
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Rashid P, Liu M, Pirpiris A. Advances in radiotherapy: Ensuring balance in the discussion. Aust Fam Physician 2015; 44:777-778. [PMID: 26915168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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41
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Roehrborn CG, Gange SN, Shore ND, Giddens JL, Bolton DM, Cowan BE, Cantwell AL, McVary KT, Te AE, Gholami SS, Rashid P, Moseley WG, Chin PT, Dowling WT, Freedman SJ, Incze PF, Coffield KS, Borges FD, Rukstalis DB. Durability of the Prostatic Urethral Lift: 2-Year Results of the L.I.F.T. Study. Urol Pract 2015; 2:26-32. [PMID: 37537806 DOI: 10.1016/j.urpr.2014.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 10/24/2022]
Abstract
INTRODUCTION For a therapy to become an important part of a provider armamentarium it must be safer or better than existing therapies and be durable. The prostatic urethral lift offers rapid improvement in lower urinary tract symptoms associated with benign prostatic hyperplasia with minimal side effects. We report 2-year results of a multicenter, randomized, blinded trial of the prostatic urethral lift. METHODS A total of 206 men 50 years old or older with an AUA-SI of 13 or greater, a peak flow rate of 12 ml per second or less and a 30 to 80 cc prostate were randomized 2:1 between the prostatic urethral lift and sham treatment. The prostatic urethral lift is performed by placing permanent transprostatic implants to lift apart the prostate lobes and reduce urethral obstruction. Sham treatment entailed rigid cystoscopy, a blinding screen and sounds that mimicked those of the prostatic urethral lift procedure. Patients were assessed for lower urinary tract symptoms, peak flow rate, quality of life and sexual function. RESULTS The prostatic urethral lift reduced the AUA-SI 88% more than sham treatment (-11.1 vs -5.9, p = 0.003). Patients with the prostatic urethral lift experienced an AUA-SI reduction from 22.1 at baseline to 18.0 (-17%), 11.1 (-50%), 11.4 (-48%) and 12.5 (-42%) at 2 weeks, 3 months, and 1 and 2 years, respectively (p <0.0001). The peak flow rate was increased 4.2 ml per second at 3 months and 2 years (p <0.0001). By 2 years only 7.5% of patients required additional intervention for lower urinary tract symptoms. Adverse events were typically mild and transient. Encrustation did not develop on implants properly placed in the prostate. There was no occurrence of de novo sustained ejaculatory or erectile dysfunction. CONCLUSIONS The prostatic urethral lift preserves sexual function and provides rapid improvement in symptoms, flow and quality of life that are sustained to 2 years.
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Affiliation(s)
- Claus G Roehrborn
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, Ontario, Canada
- The Austin Hospital, Melbourne, Victoria, Australia
- Urology Associates of Denver, Denver, Colorado
- Atlantic Urological Associates, Daytona Beach, Florida
- Southern Illinois University, Springfield, Illinois
- Weill Cornell Medical Center, New York, New York
- Urology Associates of Silicon Valley, San Jose, California
- Port Macquarie Hospital, Port Macquarie, New South Wales, Australia
- SD Uro-Research, San Diego, California
- Figtree Private Hospital, Figtree, New South Wales, Australia
- Chesapeake Urology, Baltimore, Maryland
- Freedman, MD, LTD, Las Vegas, Nevada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
- Scott and White Healthcare, Temple, Texas
- Pinellas Urology, St Petersburg, Florida
- Wake Forest University, Winston-Salem, North Carolina
| | - Steven N Gange
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, Ontario, Canada
- The Austin Hospital, Melbourne, Victoria, Australia
- Urology Associates of Denver, Denver, Colorado
- Atlantic Urological Associates, Daytona Beach, Florida
- Southern Illinois University, Springfield, Illinois
- Weill Cornell Medical Center, New York, New York
- Urology Associates of Silicon Valley, San Jose, California
- Port Macquarie Hospital, Port Macquarie, New South Wales, Australia
- SD Uro-Research, San Diego, California
- Figtree Private Hospital, Figtree, New South Wales, Australia
- Chesapeake Urology, Baltimore, Maryland
- Freedman, MD, LTD, Las Vegas, Nevada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
- Scott and White Healthcare, Temple, Texas
- Pinellas Urology, St Petersburg, Florida
- Wake Forest University, Winston-Salem, North Carolina
| | - Neal D Shore
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, Ontario, Canada
- The Austin Hospital, Melbourne, Victoria, Australia
- Urology Associates of Denver, Denver, Colorado
- Atlantic Urological Associates, Daytona Beach, Florida
- Southern Illinois University, Springfield, Illinois
- Weill Cornell Medical Center, New York, New York
- Urology Associates of Silicon Valley, San Jose, California
- Port Macquarie Hospital, Port Macquarie, New South Wales, Australia
- SD Uro-Research, San Diego, California
- Figtree Private Hospital, Figtree, New South Wales, Australia
- Chesapeake Urology, Baltimore, Maryland
- Freedman, MD, LTD, Las Vegas, Nevada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
- Scott and White Healthcare, Temple, Texas
- Pinellas Urology, St Petersburg, Florida
- Wake Forest University, Winston-Salem, North Carolina
| | - Jonathan L Giddens
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, Ontario, Canada
- The Austin Hospital, Melbourne, Victoria, Australia
- Urology Associates of Denver, Denver, Colorado
- Atlantic Urological Associates, Daytona Beach, Florida
- Southern Illinois University, Springfield, Illinois
- Weill Cornell Medical Center, New York, New York
- Urology Associates of Silicon Valley, San Jose, California
- Port Macquarie Hospital, Port Macquarie, New South Wales, Australia
- SD Uro-Research, San Diego, California
- Figtree Private Hospital, Figtree, New South Wales, Australia
- Chesapeake Urology, Baltimore, Maryland
- Freedman, MD, LTD, Las Vegas, Nevada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
- Scott and White Healthcare, Temple, Texas
- Pinellas Urology, St Petersburg, Florida
- Wake Forest University, Winston-Salem, North Carolina
| | - Damien M Bolton
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, Ontario, Canada
- The Austin Hospital, Melbourne, Victoria, Australia
- Urology Associates of Denver, Denver, Colorado
- Atlantic Urological Associates, Daytona Beach, Florida
- Southern Illinois University, Springfield, Illinois
- Weill Cornell Medical Center, New York, New York
- Urology Associates of Silicon Valley, San Jose, California
- Port Macquarie Hospital, Port Macquarie, New South Wales, Australia
- SD Uro-Research, San Diego, California
- Figtree Private Hospital, Figtree, New South Wales, Australia
- Chesapeake Urology, Baltimore, Maryland
- Freedman, MD, LTD, Las Vegas, Nevada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
- Scott and White Healthcare, Temple, Texas
- Pinellas Urology, St Petersburg, Florida
- Wake Forest University, Winston-Salem, North Carolina
| | - Barrett E Cowan
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, Ontario, Canada
- The Austin Hospital, Melbourne, Victoria, Australia
- Urology Associates of Denver, Denver, Colorado
- Atlantic Urological Associates, Daytona Beach, Florida
- Southern Illinois University, Springfield, Illinois
- Weill Cornell Medical Center, New York, New York
- Urology Associates of Silicon Valley, San Jose, California
- Port Macquarie Hospital, Port Macquarie, New South Wales, Australia
- SD Uro-Research, San Diego, California
- Figtree Private Hospital, Figtree, New South Wales, Australia
- Chesapeake Urology, Baltimore, Maryland
- Freedman, MD, LTD, Las Vegas, Nevada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
- Scott and White Healthcare, Temple, Texas
- Pinellas Urology, St Petersburg, Florida
- Wake Forest University, Winston-Salem, North Carolina
| | - Anthony L Cantwell
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, Ontario, Canada
- The Austin Hospital, Melbourne, Victoria, Australia
- Urology Associates of Denver, Denver, Colorado
- Atlantic Urological Associates, Daytona Beach, Florida
- Southern Illinois University, Springfield, Illinois
- Weill Cornell Medical Center, New York, New York
- Urology Associates of Silicon Valley, San Jose, California
- Port Macquarie Hospital, Port Macquarie, New South Wales, Australia
- SD Uro-Research, San Diego, California
- Figtree Private Hospital, Figtree, New South Wales, Australia
- Chesapeake Urology, Baltimore, Maryland
- Freedman, MD, LTD, Las Vegas, Nevada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
- Scott and White Healthcare, Temple, Texas
- Pinellas Urology, St Petersburg, Florida
- Wake Forest University, Winston-Salem, North Carolina
| | - Kevin T McVary
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, Ontario, Canada
- The Austin Hospital, Melbourne, Victoria, Australia
- Urology Associates of Denver, Denver, Colorado
- Atlantic Urological Associates, Daytona Beach, Florida
- Southern Illinois University, Springfield, Illinois
- Weill Cornell Medical Center, New York, New York
- Urology Associates of Silicon Valley, San Jose, California
- Port Macquarie Hospital, Port Macquarie, New South Wales, Australia
- SD Uro-Research, San Diego, California
- Figtree Private Hospital, Figtree, New South Wales, Australia
- Chesapeake Urology, Baltimore, Maryland
- Freedman, MD, LTD, Las Vegas, Nevada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
- Scott and White Healthcare, Temple, Texas
- Pinellas Urology, St Petersburg, Florida
- Wake Forest University, Winston-Salem, North Carolina
| | - Alexis E Te
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, Ontario, Canada
- The Austin Hospital, Melbourne, Victoria, Australia
- Urology Associates of Denver, Denver, Colorado
- Atlantic Urological Associates, Daytona Beach, Florida
- Southern Illinois University, Springfield, Illinois
- Weill Cornell Medical Center, New York, New York
- Urology Associates of Silicon Valley, San Jose, California
- Port Macquarie Hospital, Port Macquarie, New South Wales, Australia
- SD Uro-Research, San Diego, California
- Figtree Private Hospital, Figtree, New South Wales, Australia
- Chesapeake Urology, Baltimore, Maryland
- Freedman, MD, LTD, Las Vegas, Nevada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
- Scott and White Healthcare, Temple, Texas
- Pinellas Urology, St Petersburg, Florida
- Wake Forest University, Winston-Salem, North Carolina
| | - Shahram S Gholami
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, Ontario, Canada
- The Austin Hospital, Melbourne, Victoria, Australia
- Urology Associates of Denver, Denver, Colorado
- Atlantic Urological Associates, Daytona Beach, Florida
- Southern Illinois University, Springfield, Illinois
- Weill Cornell Medical Center, New York, New York
- Urology Associates of Silicon Valley, San Jose, California
- Port Macquarie Hospital, Port Macquarie, New South Wales, Australia
- SD Uro-Research, San Diego, California
- Figtree Private Hospital, Figtree, New South Wales, Australia
- Chesapeake Urology, Baltimore, Maryland
- Freedman, MD, LTD, Las Vegas, Nevada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
- Scott and White Healthcare, Temple, Texas
- Pinellas Urology, St Petersburg, Florida
- Wake Forest University, Winston-Salem, North Carolina
| | - Prem Rashid
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, Ontario, Canada
- The Austin Hospital, Melbourne, Victoria, Australia
- Urology Associates of Denver, Denver, Colorado
- Atlantic Urological Associates, Daytona Beach, Florida
- Southern Illinois University, Springfield, Illinois
- Weill Cornell Medical Center, New York, New York
- Urology Associates of Silicon Valley, San Jose, California
- Port Macquarie Hospital, Port Macquarie, New South Wales, Australia
- SD Uro-Research, San Diego, California
- Figtree Private Hospital, Figtree, New South Wales, Australia
- Chesapeake Urology, Baltimore, Maryland
- Freedman, MD, LTD, Las Vegas, Nevada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
- Scott and White Healthcare, Temple, Texas
- Pinellas Urology, St Petersburg, Florida
- Wake Forest University, Winston-Salem, North Carolina
| | - William G Moseley
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, Ontario, Canada
- The Austin Hospital, Melbourne, Victoria, Australia
- Urology Associates of Denver, Denver, Colorado
- Atlantic Urological Associates, Daytona Beach, Florida
- Southern Illinois University, Springfield, Illinois
- Weill Cornell Medical Center, New York, New York
- Urology Associates of Silicon Valley, San Jose, California
- Port Macquarie Hospital, Port Macquarie, New South Wales, Australia
- SD Uro-Research, San Diego, California
- Figtree Private Hospital, Figtree, New South Wales, Australia
- Chesapeake Urology, Baltimore, Maryland
- Freedman, MD, LTD, Las Vegas, Nevada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
- Scott and White Healthcare, Temple, Texas
- Pinellas Urology, St Petersburg, Florida
- Wake Forest University, Winston-Salem, North Carolina
| | - Peter T Chin
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, Ontario, Canada
- The Austin Hospital, Melbourne, Victoria, Australia
- Urology Associates of Denver, Denver, Colorado
- Atlantic Urological Associates, Daytona Beach, Florida
- Southern Illinois University, Springfield, Illinois
- Weill Cornell Medical Center, New York, New York
- Urology Associates of Silicon Valley, San Jose, California
- Port Macquarie Hospital, Port Macquarie, New South Wales, Australia
- SD Uro-Research, San Diego, California
- Figtree Private Hospital, Figtree, New South Wales, Australia
- Chesapeake Urology, Baltimore, Maryland
- Freedman, MD, LTD, Las Vegas, Nevada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
- Scott and White Healthcare, Temple, Texas
- Pinellas Urology, St Petersburg, Florida
- Wake Forest University, Winston-Salem, North Carolina
| | - William T Dowling
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, Ontario, Canada
- The Austin Hospital, Melbourne, Victoria, Australia
- Urology Associates of Denver, Denver, Colorado
- Atlantic Urological Associates, Daytona Beach, Florida
- Southern Illinois University, Springfield, Illinois
- Weill Cornell Medical Center, New York, New York
- Urology Associates of Silicon Valley, San Jose, California
- Port Macquarie Hospital, Port Macquarie, New South Wales, Australia
- SD Uro-Research, San Diego, California
- Figtree Private Hospital, Figtree, New South Wales, Australia
- Chesapeake Urology, Baltimore, Maryland
- Freedman, MD, LTD, Las Vegas, Nevada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
- Scott and White Healthcare, Temple, Texas
- Pinellas Urology, St Petersburg, Florida
- Wake Forest University, Winston-Salem, North Carolina
| | - Sheldon J Freedman
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, Ontario, Canada
- The Austin Hospital, Melbourne, Victoria, Australia
- Urology Associates of Denver, Denver, Colorado
- Atlantic Urological Associates, Daytona Beach, Florida
- Southern Illinois University, Springfield, Illinois
- Weill Cornell Medical Center, New York, New York
- Urology Associates of Silicon Valley, San Jose, California
- Port Macquarie Hospital, Port Macquarie, New South Wales, Australia
- SD Uro-Research, San Diego, California
- Figtree Private Hospital, Figtree, New South Wales, Australia
- Chesapeake Urology, Baltimore, Maryland
- Freedman, MD, LTD, Las Vegas, Nevada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
- Scott and White Healthcare, Temple, Texas
- Pinellas Urology, St Petersburg, Florida
- Wake Forest University, Winston-Salem, North Carolina
| | - Peter F Incze
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, Ontario, Canada
- The Austin Hospital, Melbourne, Victoria, Australia
- Urology Associates of Denver, Denver, Colorado
- Atlantic Urological Associates, Daytona Beach, Florida
- Southern Illinois University, Springfield, Illinois
- Weill Cornell Medical Center, New York, New York
- Urology Associates of Silicon Valley, San Jose, California
- Port Macquarie Hospital, Port Macquarie, New South Wales, Australia
- SD Uro-Research, San Diego, California
- Figtree Private Hospital, Figtree, New South Wales, Australia
- Chesapeake Urology, Baltimore, Maryland
- Freedman, MD, LTD, Las Vegas, Nevada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
- Scott and White Healthcare, Temple, Texas
- Pinellas Urology, St Petersburg, Florida
- Wake Forest University, Winston-Salem, North Carolina
| | - K Scott Coffield
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, Ontario, Canada
- The Austin Hospital, Melbourne, Victoria, Australia
- Urology Associates of Denver, Denver, Colorado
- Atlantic Urological Associates, Daytona Beach, Florida
- Southern Illinois University, Springfield, Illinois
- Weill Cornell Medical Center, New York, New York
- Urology Associates of Silicon Valley, San Jose, California
- Port Macquarie Hospital, Port Macquarie, New South Wales, Australia
- SD Uro-Research, San Diego, California
- Figtree Private Hospital, Figtree, New South Wales, Australia
- Chesapeake Urology, Baltimore, Maryland
- Freedman, MD, LTD, Las Vegas, Nevada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
- Scott and White Healthcare, Temple, Texas
- Pinellas Urology, St Petersburg, Florida
- Wake Forest University, Winston-Salem, North Carolina
| | - Fernando D Borges
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, Ontario, Canada
- The Austin Hospital, Melbourne, Victoria, Australia
- Urology Associates of Denver, Denver, Colorado
- Atlantic Urological Associates, Daytona Beach, Florida
- Southern Illinois University, Springfield, Illinois
- Weill Cornell Medical Center, New York, New York
- Urology Associates of Silicon Valley, San Jose, California
- Port Macquarie Hospital, Port Macquarie, New South Wales, Australia
- SD Uro-Research, San Diego, California
- Figtree Private Hospital, Figtree, New South Wales, Australia
- Chesapeake Urology, Baltimore, Maryland
- Freedman, MD, LTD, Las Vegas, Nevada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
- Scott and White Healthcare, Temple, Texas
- Pinellas Urology, St Petersburg, Florida
- Wake Forest University, Winston-Salem, North Carolina
| | - Daniel B Rukstalis
- The University of Texas Southwestern Medical Center, Dallas, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, Ontario, Canada
- The Austin Hospital, Melbourne, Victoria, Australia
- Urology Associates of Denver, Denver, Colorado
- Atlantic Urological Associates, Daytona Beach, Florida
- Southern Illinois University, Springfield, Illinois
- Weill Cornell Medical Center, New York, New York
- Urology Associates of Silicon Valley, San Jose, California
- Port Macquarie Hospital, Port Macquarie, New South Wales, Australia
- SD Uro-Research, San Diego, California
- Figtree Private Hospital, Figtree, New South Wales, Australia
- Chesapeake Urology, Baltimore, Maryland
- Freedman, MD, LTD, Las Vegas, Nevada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
- Scott and White Healthcare, Temple, Texas
- Pinellas Urology, St Petersburg, Florida
- Wake Forest University, Winston-Salem, North Carolina
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Affiliation(s)
- Prem Rashid
- Department of Urology; Port Macquarie Base Hospital; Rural Clinical School; University of New South Wales; Port Macquarie New South Wales Australia
| | - Richard Grills
- Department of Urology; Geelong Hospital and Deakin University; Geelong Victoria Australia
| | - Melvyn Kuan
- Department of Urology; Fremantle Hospital; Perth Western Australia Australia
| | - Deborah Klein
- Department of Education and Training; Urological Society of Australia and New Zealand; Sydney New South Wales Australia
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Roehrborn CG, Rukstalis DB, Giddens JL, Gange SN, Shore ND, Bolton DM, Cowan BE, Brown BT, McVary KT, Te AE, Gholami SS, Rashid P, Moseley WG, Dowling WT, Freedman SJ, Incze PF, Coffield KS, Borgess FD, Chin PT. MP71-08 TWO YEAR DURABILITY OF THE PROSTATIC URETHRAL LIFT: MULTI-CENTER PROSPECTIVE STUDY. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2167] [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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Roehrborn CG, Gange SN, Shore ND, Giddens JL, Bolton DM, Cowan BE, Brown BT, McVary KT, Te AE, Gholami SS, Rashid P, Moseley WG, Chin PT, Dowling WT, Freedman SJ, Incze PF, Coffield KS, Borges FD, Rukstalis DB. The Prostatic Urethral Lift for the Treatment of Lower Urinary Tract Symptoms Associated with Prostate Enlargement Due to Benign Prostatic Hyperplasia: The L.I.F.T. Study. J Urol 2013; 190:2161-7. [DOI: 10.1016/j.juro.2013.05.116] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Claus G. Roehrborn
- University of Texas Southwestern Medical Center, Dallas, Texas
- Scott and White Healthcare, Temple, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, and Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Steven N. Gange
- University of Texas Southwestern Medical Center, Dallas, Texas
- Scott and White Healthcare, Temple, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, and Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Neal D. Shore
- University of Texas Southwestern Medical Center, Dallas, Texas
- Scott and White Healthcare, Temple, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, and Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Jonathan L. Giddens
- University of Texas Southwestern Medical Center, Dallas, Texas
- Scott and White Healthcare, Temple, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, and Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Damien M. Bolton
- University of Texas Southwestern Medical Center, Dallas, Texas
- Scott and White Healthcare, Temple, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, and Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Barrett E. Cowan
- University of Texas Southwestern Medical Center, Dallas, Texas
- Scott and White Healthcare, Temple, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, and Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - B. Thomas Brown
- University of Texas Southwestern Medical Center, Dallas, Texas
- Scott and White Healthcare, Temple, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, and Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Kevin T. McVary
- University of Texas Southwestern Medical Center, Dallas, Texas
- Scott and White Healthcare, Temple, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, and Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Alexis E. Te
- University of Texas Southwestern Medical Center, Dallas, Texas
- Scott and White Healthcare, Temple, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, and Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Shahram S. Gholami
- University of Texas Southwestern Medical Center, Dallas, Texas
- Scott and White Healthcare, Temple, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, and Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Prem Rashid
- University of Texas Southwestern Medical Center, Dallas, Texas
- Scott and White Healthcare, Temple, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, and Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - William G. Moseley
- University of Texas Southwestern Medical Center, Dallas, Texas
- Scott and White Healthcare, Temple, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, and Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Peter T. Chin
- University of Texas Southwestern Medical Center, Dallas, Texas
- Scott and White Healthcare, Temple, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, and Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - William T. Dowling
- University of Texas Southwestern Medical Center, Dallas, Texas
- Scott and White Healthcare, Temple, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, and Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Sheldon J. Freedman
- University of Texas Southwestern Medical Center, Dallas, Texas
- Scott and White Healthcare, Temple, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, and Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Peter F. Incze
- University of Texas Southwestern Medical Center, Dallas, Texas
- Scott and White Healthcare, Temple, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, and Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - K. Scott Coffield
- University of Texas Southwestern Medical Center, Dallas, Texas
- Scott and White Healthcare, Temple, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, and Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Fernando D. Borges
- University of Texas Southwestern Medical Center, Dallas, Texas
- Scott and White Healthcare, Temple, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, and Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Daniel B. Rukstalis
- University of Texas Southwestern Medical Center, Dallas, Texas
- Scott and White Healthcare, Temple, Texas
- Western Urological Clinic, Salt Lake City, Utah
- Carolina Urological Research Center, Myrtle Beach, South Carolina
- Cosmetic Surgery Hospital, Brampton, and Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
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Arnold J, McLeod N, Thani-Gasalam R, Rashid P. Overactive bladder syndrome - management and treatment options. Aust Fam Physician 2012; 41:878-883. [PMID: 23145420] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Overactive bladder syndrome is a symptom-based clinical diagnosis. It is characterised by urinary urgency, frequency and nocturia, with or without urge urinary incontinence. These symptoms can often be managed in the primary care setting. OBJECTIVE This article provides a review on overactive bladder syndrome and provides advice on management for the general practitioner. DISCUSSION Overactive bladder syndrome can have a significant effect on quality of life, and affects 12-17% of the population. Prevalence increases with age. The management of overactive bladder syndrome involves exclusion of underlying pathology. First line treatment includes lifestyle interventions, pelvic floor exercises, bladder training and antimuscarinic agents. Failure of conservative management necessitates urology referral. Second line therapies are more invasive, and include botulinum toxin, neuromodulation or surgical interventions such as augmentation cystoplasty or urinary diversion.
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Prince D, Pedler K, Rashid P. Nocturia--a guide to assessment and management. Aust Fam Physician 2012; 41:399-402. [PMID: 22675680] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Nocturia is a common cause of sleep disturbance affecting up to 40% of the adult population. OBJECTIVE This article provides a framework for the management of nocturia. Based on the frequency volume chart, nocturia can be divided into three categories: global polyuria, nocturnal polyuria and bladder storage disorders. Differentiating between these categories enables effective targeting of treatment. DISCUSSION Although nocturia is one of the most bothersome urinary symptoms, it has generally been poorly understood and managed. Aetiology is often multifactorial and includes systemic medical disease, lower urinary tract pathology, sleep disorders and behavioural and environmental factors.
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Affiliation(s)
- David Prince
- University of New South Wales Rural Clinical School, Port Macquarie, New South Wales, Australia.
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Chung ASJ, Chabert C, Yap HW, Lam J, Awad N, Nuwayhid F, Redwig F, Rashid P, Woo HH. Photoselective vaporization of the prostate using the 180W lithium triborate laser. ANZ J Surg 2012; 82:334-7. [DOI: 10.1111/j.1445-2197.2012.06038.x] [Citation(s) in RCA: 13] [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: 10/28/2022]
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Woo HH, Bolton DM, Laborde E, Jack G, Chin PT, Rashid P, Thavaseelan J, McVary KT. Preservation of Sexual Function with the Prostatic Urethral Lift: A Novel Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. J Sex Med 2012; 9:568-75. [DOI: 10.1111/j.1743-6109.2011.02568.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [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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Chin PT, Bolton DM, Jack G, Rashid P, Thavaseelan J, Yu RJ, Roehrborn CG, Woo HH. Prostatic Urethral Lift: Two-year Results After Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. Urology 2012; 79:5-11. [DOI: 10.1016/j.urology.2011.10.021] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 10/07/2011] [Accepted: 10/07/2011] [Indexed: 10/14/2022]
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50
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Arianayagam M, Arianayagam R, Rashid P. Lower urinary tract symptoms - current management in older men. Aust Fam Physician 2011; 40:758-767. [PMID: 22003476] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Lower urinary tract symptoms are a common problem in men and the incidence of these symptoms increases with age. OBJECTIVE This article provides an update on the evaluation and treatment of lower urinary tract symptoms in older men. In particular, we describe current nomenclature, diagnosis, the International Prostate Symptom Score, and currently available medical and surgical treatments as well as indications for referral to a urologist. DISCUSSION Lower urinary tract symptoms may be divided into voiding and storage, and men may present with a combination of the two symptom groups. Voiding symptoms include weak stream, hesitancy, and incomplete emptying or straining and are usually due to enlargement of the prostate gland. Storage symptoms include frequency, urgency and nocturia and may be due to detrusor overactivity. In elderly men who present with lower urinary tract symptoms, indications for early referral to a urologist include haematuria, recurrent infections, bladder stones, urinary retention and renal impairment. In uncomplicated cases, medical therapy can be instituted in the primary care setting. Options for medical therapy include alpha blockers to relax the smooth muscle of the prostate, 5 alpha reductase inhibitors to shrink the prostate, and antimuscarinics to relax the bladder. The International Prostate Symptom Score is beneficial in assessing symptoms and response to treatment. If symptoms progress despite medical therapy or the patient is unable to tolerate medical therapy, urological referral is warranted.
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Affiliation(s)
- Mohan Arianayagam
- Department of Urology, The University of Miami Miller School of Medicine, Florida, USA.
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