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Turo R, Horsu S, Broome J, Das S, Gulur DM, Pettersson B, Doyle G, Awsare N. Complications of percutaneous nephrostomy in a district general hospital. Turk J Urol 2018; 44:478-483. [PMID: 30395796 DOI: 10.5152/tud.2018.37336] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 06/18/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Percutaneous nephrostomy (PCN) is one of the commonest procedures performed. There are currently no European recommendations on the accepted rate of complications. The aim of the present study is to report the complication rate of PCN with the specific emphasis on sepsis and septic shock, the causative organisms, sensitivities to antibiotics, and associated risk factors. MATERIAL AND METHODS Retrospectively collected data on patients undergoing acute or elective PCN at the Department of Radiology, Countess of Chester Hospital (COCH), in the UK between January 2014 and December 2016 were analyzed after the study was approved by Local Audit Department at COCH. RESULTS A total of 66 patients underwent 90 acute or elective PCNs. Three patients developed major post-PCN complication (two patients developed septic shock and the third suffered a hemorrhagic episode requiring blood transfusion). Nephrostomy tube complications (blockage, leaking, fracturing and kinking of the catheter) occurred in 4 patients. Complications were more common when the PCN was performed out of working hours (71.4% [10/14], and 17.3% [9/52] for PCNs performed within, and out of working hours, respectively: p<0.001). The age of the patients did not seem to correlate with the development of complications (p<0.001). Of all 25 patients, in whom septicemia was diagnosed prior to PCN tube insertion, 12 developed septic shock and 13 had signs of sepsis for longer than 24 h. Fifteen patients had positive urine cultures. The most common organism isolated was Escherichia coli. Blood culture isolates included: Escherichia coli, Eggerthella lenta, Enterococcus, Proteus mirabilis, Pseudomonas aeruginosa and Streptococcus pneumonia. CONCLUSION Our complication rates were within United States proposed target ranges. Our data may help to serve as a baseline for outcome targets in the European centres.
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Affiliation(s)
- Rafal Turo
- Department of Urology, Countess of Chester Hospital, Chester, UK
| | - Seth Horsu
- Department of Urology, Countess of Chester Hospital, Chester, UK
| | - James Broome
- Department of Urology, Leighton Hospital, Crew, UK
| | - Sanjay Das
- Department of Urology, Countess of Chester Hospital, Chester, UK
| | - Dev Mohan Gulur
- Department of Urology, Countess of Chester Hospital, Chester, UK
| | - Bo Pettersson
- Department of Urology, Countess of Chester Hospital, Chester, UK
| | - Gerard Doyle
- Department of Radiology, Countess of Chester Hospital, Chester, UK
| | - Ninaad Awsare
- Department of Urology, Countess of Chester Hospital, Chester, UK
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Turo R, Horsu S, Calinciuc A, Smolski M, Thygesen H, Doyle G, Gulur DM, Das S, Pettersson B, Awsare N. Is magnetic resonance imaging helpful in detecting significant prostate cancer in patients with haematospermia, normal prostate specific antigen level and digital rectal examination. A single institution, observational, and retrospective study in a United Kingdom hospital. Cent European J Urol 2018; 71:26-30. [PMID: 29732203 PMCID: PMC5926635 DOI: 10.5173/ceju.2017.1517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/31/2017] [Accepted: 01/20/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction Haematospermia is an uncommon clinical condition that may be associated with prostate cancer. The optimal investigation of haematospermia is unknown. The aim of this study was to investigate haematospermia as a presenting symptom of significant pathology and to assess the diagnostic value of magnetic resonance imaging (MRI). Material and methods Patient and treatment parameters were collected from a practice cohort of men referred to a urology center presenting with haematospermia. We used a multivariate logistic regression model to test the independent significance of MRI in detecting prostate cancer (PCa) after adjusting for other known predictors of PCa detection. Results A total of 125 men (median age 58 years) were evaluated between 2012-2015. In the univariate and multivariate logistic regression model MRI was a significant predictor of PCa diagnosis after adjusting for age, prostate specific antigen (PSA) and digital rectal examination (DRE) results (Odds Ratio (OR) 14.15, p = 0.001). Of 107 patients who underwent MRI prostate imaging, 31 (28.9%) had reports suspicious of PCa. In 26 patients, other benign conditions were detected on MRI. PCa was detected in 12 (25.5%) of the 47 men (median age 61 years; range 43 to 85) who underwent prostate biopsies. Eight (17%) of these patients had Gleason ≥7 grade cancer. The persistence of haematospermia was not an independent predictor of cancer diagnosis (OR 0.20, p = 0.15). Conclusions PCa is not commonly associated with haematospermia. MRI seems to be improving detection rate of a significant PCa, particularly in patients presenting with haematospermia and normal PSA levels and DRE examination. Duration of haematospermia does not predict the presence of PCa.
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Affiliation(s)
- Rafał Turo
- Countess of Chester Hospital, Department of Urology, Chester, United Kingdom
| | - Seth Horsu
- Countess of Chester Hospital, Department of Urology, Chester, United Kingdom
| | - Andra Calinciuc
- Countess of Chester Hospital, Department of Urology, Chester, United Kingdom
| | - Michal Smolski
- Stepping Hill Hospital, Department of Urology, Stockport, United Kingdom
| | | | - Gerard Doyle
- Countess of Chester Hospital, Department of Radiology, Chester, United Kingdom
| | - Dev Mohan Gulur
- Countess of Chester Hospital, Department of Urology, Chester, United Kingdom
| | - Sanjay Das
- Countess of Chester Hospital, Department of Urology, Chester, United Kingdom
| | - Bo Pettersson
- Countess of Chester Hospital, Department of Urology, Chester, United Kingdom
| | - Ninaad Awsare
- Countess of Chester Hospital, Department of Urology, Chester, United Kingdom
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Davis J, Banks I, Wrigley D, Peedell C, Pollock A, McPherson K, McKee M, Irving WL, Crome P, Greenhalgh T, Holland W, Evans D, Maryon-Davis A, Smyth A, Fleming P, Coleman M, Sharp DJ, Whincup P, Logan S, Cook D, Moore R, Rawaf S, McEewen J, West R, Yudkin JS, Clarke A, Finer N, Domizio P, Bambra C, Jones A, Feder G, Scott-Samuel A, Irvine L, Sharma A, Fitchett M, Boomla K, Folb J, Paul A, McCoy D, Tallis R, Burgess-Allen J, Edwards M, Tomlinson J, Colvin D, Gore J, Brown K, Mitchel S, Lau A, Sayer M, Clark L, Silverman R, Marmot S, Rainbow D, Carter L, Mann N, Fielding R, Logan J, Tebboth L, Arnold N, Stobbart K, Cabot K, Finer S, Edwards M, Davies D, Buttivant H, Kraemer S, Newell J, Griffiths A, Fitzgerald R, Macgibbon R, Lee A, Macklon AF, Hobson E, Jenner D, Jacobson B, Timmis A, Salim A, Evans-Jones J, Caan W, Awsare N, Pride N, Suckling R, Bratty C, Rossiter B, Hawkins D, Currie J, Camilleri-Ferrante C, Fluxman J, Bhatti O, Anson J, Etherington R, Lawrence D, Fell H, Clarke E, Ormerod J, Ormerod O, Ireland M, Duncan JAT, Chandy R, Mindell J, Mullen P, Bennett-Richards P, Hirst J, Murphy E, Martin P, Lowes S, Fleming P, Grunewald R, Reeve J, Schweiger M, Coates J, Farrelly G, Chamberlain MA, Lewis G, Young J, Scott B, Gibbs J, Landers A, Deveson P, Ingrams G, Leigh M, Gawler J, Ford A, Nixon J, McCartney M, Bareford D, Singh S, Lockwood K, Cripwell M, Ehrhardt P, Bell D, Wortley P, Tomlinson L, Hotchkiss J, Ford S, Turner G, Reissman G, Lewis D, Johnstone C, Tomson M, Torabi P, Bell D, Tomson D, Tulloch A, Johnston S, Dickinson J, McElderry E, Ross W, Holt K, Logan M, Klonin H, Jenner D, Danby J, Goodger V, Puntis J, Dickson H, Gould DA, Livingstone A, Lefevre D, Kendall B, Singh G, Hall P, Darling J, Hamlyn AN, Patel A, Erskine J, Fisher B, Hughes R, Highton C, Venning H, Singer R, Brearey S, Sikorski J, Paintin D, Feehally J, Savage W, Freud KM, Holt VJ, Gill A, Waterston T, Souza RD, Hopkinson N, Beadsworth M, Franks A, Daley H, Cullinan P, Basarab A, Folb J, Gurling H, Zinkin P, Kirwin S, Buhrs E, Brown R, West A, Marlowe G, Fellows G, Main J, Applebee J, Koperski M, Jones P, Macfarlane A, Beer N, Mason R, West R, Eisner M, Smailes A, Timms P, Knight D, Jones C, Wesby B, Lyttelton L, Morrison R, Bossano D, Walker J, Davies G, Godfrey P, Wolfe I, Nsutebu E, Stevenson N, Cheeroth S, Miller J, Johnson G, Noor R, Hall A, Bostock D, Michael B, Sharvill J, Macpherson J, Lewis D, Ma R, Middleton J, Jeffreys A, Cole J, Boswell JP, Bury B, Mitchison S, Kinmonth AL, Young G, Maclennan I, Munday P. Act now against new NHS competition regulations: an open letter to the BMA and the Academy of Medical Royal Colleges calls on them to make a joint public statement of opposition to the amended section 75 regulations. BMJ 2013; 346:f1819. [PMID: 23516260 DOI: 10.1136/bmj.f1819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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