Scar-modulating agents post urethroplasty: Could phosphodiesterase-5 inhibitors be the answer?

2020 ◽  
pp. 205141582092242
Author(s):  
Shady Emara ◽  
Ammar Alhasso
Keyword(s):  
Urinary Tract ◽  
Enzyme Inhibitors ◽  
Smooth Muscles ◽  
Original Research ◽  
Vascular Smooth Muscles ◽  
Level Of Evidence ◽  
Search Terms ◽  
Urinary Tract Symptoms ◽  
Fibrotic Scar ◽  
Phosphodiesterase 5

Background: Phosphodiesterase enzyme inhibitors (PDEIs) are most commonly prescribed by urologists for the treatment of erectile dysfunction. They are also gaining popularity as a treatment for lower urinary tract symptoms, based on their effect on smooth muscles – either vascular smooth muscles or smooth muscles in the urinary tract. For vascular smooth muscles, they cause vasodilation, enhanced microcirculatory haemodynamics through inhibition of platelet aggregation and adhesion, induction of apoptosis of adhesion fibroblasts and a reduction in the scarring process. Methodology: We reviewed articles published in English and indexed in the PubMed, Embase and Google Scholar databases, and consulted textbooks. Key search terms used were: urethral stricture, anti-fibrotic, scar-modulating agent, PDEIs, urethral scarring and urethroplasty. We created a synopsis of relevant articles, including original research studies and reviews. Level of evidence: Not applicable.

Critical observations of the International Prostate Symptoms Score questionnaire and proposal for amendments to simplify and improve its quality: A review

2020 ◽  
pp. 205141582097256
Author(s):  
Sani Aminu
Keyword(s):  
Urinary Tract ◽  
Benign Prostatic Hyperplasia ◽  
Scoring System ◽  
Lower Urinary Tract ◽  
Fluid Intake ◽  
Family Physicians ◽  
Prostatic Hyperplasia ◽  
Level Of Evidence ◽  
Urinary Tract Symptoms ◽  
Lower Urinary

The International Prostate Symptoms Score (IPSS) is an important tool for evaluation and research in benign prostatic hyperplasia related lower urinary tract symptoms in men. It has also been validated in many languages. This article discusses issues observed in the symptoms domains, as well as issues related to the intensity of the numeracy in the scoring parameters. The objectives of this article are to analyse what could be improved on the IPSS questionnaire and to discuss a proposal for amendments. Such amendments include putting nocturia as the first question, modifying other questions, allowing maximum subjectivity for the patient, modifying the scoring system to reduce intense numeracy for the patient and adding a new section on fluid intake and medication. This would hopefully simplify the questionnaire for patients, improve its quality as well as improve communication between patients, family physicians and urologists. Level of evidence: Not applicable for this multicentre audit.

Guideline-based flexible cystoscopy safely improves capacity, avoiding unnecessary intervention with cost savings

2020 ◽  
Vol 13 (4) ◽  
pp. 303-306
Author(s):  
A Habib ◽  
J Noel ◽  
D Batura ◽  
G Hellawell
Keyword(s):  
Patient Safety ◽  
Urinary Tract ◽  
Financial Burden ◽  
Cost Savings ◽  
Cancer Surveillance ◽  
Level Of Evidence ◽  
Record System ◽  
Flexible Cystoscopy ◽  
Urinary Tract Symptoms ◽  
Enhance Patient Safety

Introduction: Flexible cystoscopy (FC) is a common and useful diagnostic tool. Because of its broader applications, availability and simplicity, there has been criticism of its overuse with accompanying financial burden to the health system and unnecessary invasive intervention to the patient. Therefore, we reviewed our local practice against current guidelines to evaluate compliance, enhance patient safety and capacity utilisation. Patients and methodology: Data were collected retrospectively on all patients having FC over two months. The indications and findings of FC were gathered from the hospital electronic patient record system. Results: A total of 413 FCs were carried out over the study period. The most common indications were cancer surveillance 116 (28%) and visible haematuria 76 (18.4%). A total of 152 (37%) FCs were performed for non-recommended indications. The most common conditions that deviated from guidelines were lower urinary tract symptoms (LUTS) (72, 17.4%), urinary tract infection (UTI) (41, 9.9%) and asymptomatic non-visible haematuria (35, 8.5%). In all non-visible haematuria cases, 65 (90%) of LUTS and 39 (95%) of UTI patients, FC was non-contributory. Adherence to guidelines would have yielded 37% of FC slots. Based on current UK National Tariffs, cost savings would have been £352,032 annually in this trust. Conclusions: FC is a frequent investigation within urology departments for which referral guidelines exist. Protocol-driven practice enables appropriate use, ensures patient safety and leads to efficient utilisation of capacity with substantial cost savings. Level of evidence: Not applicable for this multicentre audit.

Sign in / Sign up

Export Citation Format

Share Document