A patient reported outcome measure (PROM) assessing quality of care in the urology hospital outpatient setting.

A prospective blind PROM (patient reported outcome measure) study performed in our urology department examined the outpatient-clinic experience. 104 questionnaires were completed. 23 patients (22%) felt the waiting times for appointments was excessive. 13 patients (13%) experienced difficulty in contacting administrative staff. 98 patients (94%) considered the waiting areas good but 31 patients (31%) considered lack of privacy an issue. Consultants saw 65 patients (63%). 62 patients (60%) expected to be seen by a consultant. 32 patients (31%) felt consultation with a different doctor on return visits was unsatisfactory. 76 patients (73%) "fully trusted" their doctors. 78 patients (75%) rated their visit excellent, 10 patients (10%) added comments. Despite frustration with waiting times, the experience of patients reflects a positive rapport and trust between patient and doctor.

Audit of rapid access introduction reveals high prevalence of prostate cancer in Western Region.

INTRODUCTION: Men with symptoms suggestive of prostate cancer are now directly referred by their general practitioners to rapid access prostate assessment clinics (RAPACs). This service implements recommendations outlined by the National Cancer Control Programme. The RAPAC was introduced at Galway University Hospital, Galway, Ireland in June 2009, aiming to structure GP referral of patients with suspected prostate cancer to a urology service. AIMS: The aims of this study are to assess our initial experience with particular emphasis on access times, patient demographics, detection rates and treatment outcomes. METHODS: Data on all patients presenting to the RAPAC during the preliminary 2-year period have been gathered prospectively and analysed using standard parametric analysis methods. RESULTS: A total of 1,106 patients were reviewed at 278 clinic sessions during the initial 2-year period. The average waiting time to first clinic visit was 18 days (12-39 days). The mean age of referral to the clinic is 65 years (44-88 years). The mean PSA is 16.31 g/dL (0.4-845 g/dL). Of the 1106 patients undergoing TRUS biopsies, 503 (45.5 %) patients were diagnosed with prostate cancer. Further analysis patient demographics and cancer grading is presented in the article. Seventy-one patients (14.1 %) underwent radical retropubic prostatectomy. Sixty-seven patients (13.3 %) are being followed on an active monitoring programme, whilst 235 (56.7 %) received primary treatment with external beam radiotherapy and 68 (13.5 %) received brachytherapy. CONCLUSION: This data highlight the necessity of a RAPAC to streamline the provision of prostate cancer services in the west of Ireland.

Incidental renocolic fistula with xanthogranulomatous pyelonephritis.

INTRODUCTION: We report the case of a 66-year-old female undergoing elective nephrectomy for a non-functioning kidney in whom an incidental renocolic fistula was detected. PRESENTATION OF CASE: She presented with recurrent urinary tract infections and left flank pain. Investigations revealed a nonfunctioning left kidney with a large staghorn calculus and features suggestive of xanthogranulomatous pyelonephritis (XPG). At nephrectomy, an incidental renocolic fistula was found and excised. DISCUSSION: XGP is a rare, chronic inflammatory disorder of the kidney characterized by a destructive mass invading the renal parenchyma. Renocolic fistulae complicating XGP are uncommon and not widely reported in the literature. CONCLUSION: Herein, we describe a case of XGP with renocolic fistula formation, its management and a review of the literature.

Emergency management of acute urinary retention: results from an all-Ireland urologist practice survey.

INTRODUCTION: Anecdotal evidence suggests that current service restrictions and operative cancellations are resulting in increased numbers of catheterized men in the community awaiting definitive management of their bladder outlet obstruction. We wished to analyse current admission policies and management strategies of acute urinary retention (AUR) secondary to benign prostatic enlargement (BPE) in Ireland. METHODS: A total of 58 consultant urologists practicing in Ireland were sent a questionnaire about their management of AUR secondary to BPE. Data was collected relating to initial emergency management, timing of trial without catheter (TWOC), their use of alpha-blockers and follow-up policy. RESULTS: Urethral catheterization is the initial management of choice by all 42 respondents. The patient is routinely admitted after catheterization by 20/42 consultants (48 %) and 22/42 (52 %) discharge the patient home with a urinary catheter (UC). TWOC is performed on day 2 in 11/20 (55 %) and on day 3 in 9/20 (45 %). In terms of individuals who admit patients presenting with AUR one failed TWOC is an indication for transurethral resection of the prostate in 10/20 (50 %), with 6/20 (30 %) performing a second TWOC on the same admission and 4/20 (20 %) discharging the patient for interval TURP. A total of 83 % of respondents, all of whom work in public institutions, expressed concerns relating to elective admission difficulties for definitive management of catheterized patients following AUR. CONCLUSION: There is variation in the admission policy for AUR in Ireland. Elective admission and operative restrictions for catheterized patients following episodes of AUR are causing concern to the urologists in Ireland.

Primary paratesticular seminoma - A case report.

INTRODUCTION: Paratesticular tumours are rare. Rhabdomyosarcomas are the commonest malignant paratesticular tumours although tumours can arise from any paratesticular structure. Here we report a case of a primary paratesticular seminoma and a review of the literature. PRESENTATION OF CASE: A 42 year old man presented with a right scrotal mass. Histology revealed a paratesticular seminoma. Following a radical orchidectomy, there was no evidence of testicular seminoma. DISCUSSION: Primary paratesticular seminoma in the absence of testicular seminoma is extremely rare. CONCLUSION: After a thorough review of the literature, this is, to our knowledge only the second reported case of a primary paratesticular seminoma.

The impact of the National Treatment Purchase Fund on numbers of core urology training cases at University Hospital Galway.

Since the National Treatment Purchase Fund (NTPF) scheme was introduced in 2002, public patients waiting longer than three months for investigations and treatment are offered care in the private medical sector. Our aim was to assess the impact of the NTPF scheme on the number of training cases performed at University Hospital Galway (UHG). The number and type of urological procedures performed in the private medical sector under the NTFP scheme in 2008 were obtained from the UHG waiting list office. The number of these procedures performed on public patients by trainees at UHG in 2008 was determined retrospectively by reviewing theatre records. A significant number of core urology procedures were performed in the private sector via the NTPF scheme. Cancer centre designation and implementation of the EWTD will also place further pressures on urological training opportunities in Ireland.

Can pre-assessment of patients with LUTS result in early discharge from urology clinic?

Waiting times for appointments for urological out-patients in Ireland and the U.K. can be excessively long. Nurse-led Lower Urinary Tract symptom (LUTs) pre-assessment clinics have been introduced to streamline patient care pathways. We examined whether a nurse-led pre-assessment LUTS clinic could result in the rapid assessment and discharge of patients following their first out-patient visit. A pilot study was undertaken whereby patients referred with LUTS were sent for pre-assessment prior to their out-patients appointment. 214 consecutive patients underwent pre-assessment. Of these, 39 (18%) patients were discharged following their first out-patient visit and 27 (13%) patients were discharged after a second attendance. A further 35 (16%) patients continued to attend but underwent no further investigations or treatment, and possibly should have been discharged earlier. Overall 46% of pre-assessed patients could have been discharged early from the urology clinic. In conclusion a nurse-led pre-assessment LUTS clinic could result in the rapid assessment and discharge of patients following their first out-patient visit.

Sentinel lymph node biopsy in breast cancer.

The sentinel lymph node (SLN) procedure consists of identifying the first lymph node to receive lymphatic vessels draining a tumour. Sentinel node biopsy is a minimally invasive technique, resulting in lower morbidity than traditional axillary lymph node dissection. Screen detected breast cancers are associated with approximately a 20% incidence of axillary node involvement. Sentinel node biopsy represents a minimally invasive method of accurately staging these patients.