An audit of the surgical work-load in a urology unit.

OBJECTIVES: To assess the surgical work-load on a urology unit; to define the difference between case-load and work-load; and to assess the work-load in relation to surgical staffing levels. DESIGN: Prospective audit of all surgical procedures carried out on patients, excluding extracorporeal shockwave lithotripsy (ESWL), during a one year period, classified according to the British United Provident Association (BUPA) schedule of procedures. SETTING: One of the two urology units at the National Hospital of Sri Lanka, Colombo (NHSL). PATIENTS: Inpatients having surgical procedures in one year. MAIN OUTCOME MEASURES: The number of surgical procedures, according to their complexity, with particular reference to the level of surgical staffing; difference between case-load and the actual work-load computed using the Intermediate Equivalent (IE) system of Jones and Collins (1). RESULTS: The annual surgical work-load on the urology firm was 1900 IEs. In our unit BUPA complex major, major plus and major operations comprised 27.2% of the case-load but accounted for about 47% of the work-load. The BUPA intermediate and minor procedures comprising the remaining 72.8% of the case-load accounted for only 53% of the work-load. Endoscopic urological procedures made up 71% of the work-load. The specialist surgeon and the senior registrar have contributed to 51.4% (977 IEs) and 40.2% (765 IEs) of the total work-load respectively. CONCLUSION: Case-load is a poor performance indicator of surgical activity. IE weighted work-load has been shown to reflect surgical activity more appropriately than case-load. A well trained senior registrar's contribution to the total surgical work-load is appreciable.

Pharmacologically induced penile erections in the assessment and treatment of erectile impotence: a preliminary study of 100 patients.

OBJECTIVE: To assess and compare the immediate and subsequent response to pharmacologically induced penile erections, using intracavernosal injections of papaverine. DESIGN: Preliminary, prospective study. SETTING: Male sexual dysfunction clinic at the National Hospital of Sri Lanka. PATIENTS: 100 consecutive patients receiving 20 mg papaverine hydrochloride intracavernosally as the first dose. MAIN OUTCOME MEASURES: Assessment of the quality of the erection following the initial injection and determination of the optimum dose to achieve a normal erection; number who elected self-injection at home. RESULTS: Mean age of the 100 impotent men was 36.6 years and the mean duration of erectile dysfunction 43.9 months. Of men in the third decade 87.5% had a normal erection but only one-third of patients over 50 years showed a normal response. 16 patients had a reasonably well established organic problem. 42% of patients had normal nocturnal or early morning erections. The drop-out rate after the initial injection was 17%, 19% of men had a normal erection with 20 mg papaverine and 67% had a normal response to 20 to 80 mg papaverine. Seven patients continued on the self-injection program. Prolonged erections were experienced by 6% of men (1.9% of injections). CONCLUSIONS: Intracavernosal injection of papaverine hydrochloride is effective in a dose of 20 to 80 mg.