Nature reviews. Urology
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Nature reviews. Urology · Mar 2013
ReviewSafety in the operating theatre--a transition to systems-based care.
All surgeons want the best, safest care for their patients, but providing this requires the complex coordination of multiple disciplines to ensure that all elements of care are timely, appropriate, and well organized. Quality-improvement initiatives are beginning to lead to improvements in the quality of care and coordination amongst teams in the operating room. ⋯ Although evidence suggests that postoperative mortality rates are declining, there is substantial room for improvement. Multiple quality metrics are used as surrogates for safe care, but surgical teams--including surgeons, anaesthetists, and nurses--must think beyond these simple interventions if they are to effectively communicate and coordinate in the face of increasing demands.
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Nature reviews. Urology · Feb 2013
ReviewSurgical management of female SUI: is there a gold standard?
Many surgical options exist for women with stress urinary incontinence (SUI). The traditional gold standards of Burch retropubic colposuspension and pubovaginal slings are still appropriate treatment options for some patients, but randomized controlled trials have demonstrated that synthetic midurethral slings are just as effective as these traditional procedures but with less associated morbidity. Thus, midurethral slings--inserted via a retropubic or transobturator approach--have become the new gold standard first-line surgical treatment for women with uncomplicated SUI. ⋯ Single-incision slings have a number of benefits, including decreased operative times and early return to regular activities, but they are yet to be shown to be as effective as midurethral slings. Both retropubic and transobturator midurethral slings are effective for patients with mixed urinary incontinence, but the overall cure rate is lower than for patients with pure SUI. Based on the literature a new gold standard first-line surgical treatment for women with SUI is the synthetic midurethral sling inserted through a retropubic or transobturator approach [corrected].
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Nature reviews. Urology · Apr 2011
ReviewPriapism in hematological and coagulative disorders: an update.
Priapism is a true urological emergency that is typified by a persistent and painful erection. High-risk groups include patients with hematological or coagulative disorders; for example, those with sickle cell disease, leukemia or glucose-6-phosphate dehydrogenase deficiency. The diagnosis for priapism must be made urgently using patient history, physical examination and blood gas findings on corporal aspiration. ⋯ However, in high-risk groups, prophylaxis must be encouraged. A number of prophylactic measures are emerging based on progress in the understanding of the pathophysiology of priapism in these particular patients. In this Review, priapism as it relates to hematological disorders is discussed, focusing on treatment and prophylaxis.
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The priority for care at the end of life is to ensure that all patients experience high-quality care, irrespective of their diagnosis or preferred place of care. This phase of an individual's disease journey is fraught with complex decision-making that can obscure and impair the provision of high-quality care in the absence of advance care planning. In the past few years, the Department of Health in the UK has emphasized this through a number of initiatives and strategies aimed at preparing patients, carers, and indeed professionals, for the terminal phase of disease. This Review explores these initiatives and demonstrates, through the discussion of a recent case history of an individual with a diagnosis of a urological malignancy, how they have been implemented at a local level by The Royal Marsden NHS Foundation Trust.