Significance of recent onset nocturnal enuresis in adult men: a prospective study.

INTRODUCTION: Although literature on childhood nocturnal enuresis and its persistence into adulthood is abundant, recent onset nocturnal enuresis in adults is a poorly studied symptom. OBJECTIVE: To determine the significance of recent onset nocturnal enuresis in adult males in relation to lower urinary tract pathology, and its treatment. METHODS: All men with recent onset nocturnal enuresis attending a urology unit over a period of 12 months were evaluated prospectively. Their treatment and outcome were recorded. RESULTS: There were 30 patients (mean age 64 years). Ultrasonography revealed upper urinary tract dilatation in 22 patients. Another six patients had post-void residual urine volume over 500 mL without upper tract dilatation. Only two patients did not have ultrasonographic evidence of bladder outflow obstruction. Elevated blood urea was noted in 14 patients. Twenty patients underwent transurethral resection of the prostate (TURP) and one patient with balanitis xerotica obliterans had circumcision and meatotomy. Three patients were taught clean intermittent self catheterisation, and three patients preferred indwelling urethral catheters. One patient while awaiting TURP died of a myocardial infarction. Eight patients, who were treated with alpha-adrenergic antagonists initially, required further intervention later as the response to medical therapy was poor. CONCLUSIONS: Recent onset nocturnal enuresis in adult males is a symptom closely associated with significant lower urinary tract pathology requiring early urological intervention. Considering its impact on management it is reasonable to classify recent onset nocturnal enuresis as a lower urinary tract symptom in adult men and including it in symptom scores used to assess bladder outflow obstruction.

Management of men with a first episode of acute urinary retention due to benign prostatic enlargement.

OBJECTIVE: To determine the effect of the existing management protocol of patients presenting with acute urinary retention due to benign prostatic enlargement on clinical efficacy and surgical practice. DESIGN: Prospective study. SETTING: The Urology Unit at the Teaching Hospital, Karapitiya, Galle. PATIENTS: 100 consecutive patients with a first episode of acute urinary retention due to a clinically benign enlarged prostate. MEASUREMENTS: Success of voiding urine after one week of treatment with an alpha adrenoceptor blocker (prazosin). Incidence of subsequent urinary retention during the follow up period of 6 months despite continuing treatment with the drug. RESULTS: Of the 94 patients who completed the follow up period of 6 months, 56 voided successfully after the initial trial without catheter at one week. However, 12 of them developed urinary retention during the follow up and required surgery. CONCLUSION: Treatment with an alpha adrenoceptor blocker followed by a single trial without catheter can avoid prostatic surgery in 40% of patients with acute urinary retention due to benign prostatic enlargement.

Prevalence of prostatic intraepithelial (PIN) in surgical resections.

OBJECTIVES: To determine the prevalence of prostatic intraepithelial neoplasia (PIN) in surgical specimens and assess its relationship to adenocarcinoma. METHOD: 205 surgical specimens (191) transurethral resections, 6 open prostatectomies, 8 needle biopsies) reported at the University Department of Pathology, Colombo over 64 months were reviewed. RESULTS: There were 170 benign hyperplasias and 35 adenocarcinomas. PIN I was present in 22.92% PIN II in 5.36% and PIN III in 7.32% of the specimens. 8.51%, 27.27% and 93.3% PIN I, PIN II and III were associated with invasive adenocarcinoma. Nine cases (4.39%) had high grade PIN (PIN II & III) in the absence of adenocarcinoma. CONCLUSION: PIN II & III were strongly associated with coexistent carcinoma but PIN I was not. The finding of high grade PIN in surgical biopsies with no obvious adenocarcinoma warrants examination of all available tissue and deep sections.

Haematuria as the presenting symptom: experience from a tertiary referral centre in Sri Lanka.

OBJECTIVES: To examine the causes of macroscopic (gross) haematuria in patients where it is the main presenting symptom and to evaluate the role of cystoscopy in their investigation. DESIGN: Prospective audit. SETTING: One urology unit at the National Hospital of Sri Lanka, Colombo. PATIENTS: 174 consecutive new patients with macroscopic haematuria, where haematuria was the presenting symptom. OUTCOME MEASURES: Causes of macroscopic haematuria in the under 40 years and over 40 age groups; role of cystoscopy. RESULTS: Of the 156 (130 male and 26 female) patients evaluated for macroscopic haematuria 67 were under the age of 40 years and 89 over 40. The causes of macroscopic haematuria in the under 40s in descending order of frequency are urinary stone disease, idiopathic and inflamed urothelium. In the over 40 group bladder cancer was the commonest cause, affecting 31.5% of patients, followed by stone disease. CONCLUSIONS: Macroscopic haematuria in a patient over the age of 40 years could be due to bladder cancer and merits cystourethroscopy. In younger patients, urolithiasis is the predominant cause.

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.