Objective To evaluate the effect on quality of life of being discharged home with a catheter before de®nitive treatment in patients with acute urinary retention (AUR). Patients and methods Patients attending the emergency department with AUR were assessed and discharged home with a catheter if they ful®lled predetermined criteria. They were admitted to the day-care unit for urological assessment and completed a disease-speci®c quality-of-life questionnaire. Results Of 101 patients presenting to the emergency department in AUR, 84 were sent home after catheterization (83%); 78 (93%) patients completed the questionnaire. The major side-effects reported were urinary leak (46%), mild haematuria (44%), urgency (42%), pain around the penis (42%), painful erection (31%) and catheter blockage (26%). Only 12% of patients felt having a catheter was very inconvenient and 93% would ®nd it acceptable to have a catheter in future. Conclusion A signi®cant minority of patients discharged home with a catheter had side-effects related to their catheter but were not greatly inconvenienced, and their capacity to carry out normal daily activities was not impaired. The immediate discharge of patients in AUR and planned treatment will enable better use of inpatient urology resources. Keywords Acute urinary retention, catheterization, quality of life IntroductionAcute urinary retention (AUR) is a common urological emergency and frequently results in TURP. The National Prostatectomy Audit (NPA) reported that 23% of all patients underwent TURP for this condition [1]. A subgroup analysis examined this patient population, particularly in relation to the practice of immediate discharge from hospital with a catheter compared with admission for investigation and treatment [2]. Of such patients, 52% were discharged immediately and 48% were admitted, highlighting the lack of consensus on whether it is safe or appropriate to discharge patients directly from the emergency department. The NPA con®rmed that the overall morbidity of these two patient groups was similar after TURP, except for an increased rate of urinary infection in those with prolonged catheterization. A reduction in the length of hospital stay bene®ts both the patient and the hospital, with potential cost savings. However, this has to be weighed against the potential morbidity and adverse impact on daily activities of having to manage a catheter at home. It has been the practice in our department, within established guidelines, to discharge patients from casualty after catheterization. This prospective study addressed the disease-speci®c quality of life of these patients to assess whether this is acceptable practice. Patients and methodsData were obtained prospectively over a 13-month period on all patients presenting with their ®rst episode of AUR. Criteria for immediate discharge were established and approved. These included normal renal function, absence of macroscopic haematuria and/or clot retention, lack of concomitant medical condition warranting hospital admission, and ade...
Twenty-one ureteric strictures due to bilharzia have been treated surgically in 13 patients. Two required nephrectomy; 19 had direct ureteric reimplantation into the dome of the bladder after excision of the strictured segment of ureter. A simple technique of reimplantation into the dome of the bladder is described and early results have justified its further use.
SummaryFifty-four patients on haemodialysis for chronic renal failure underwent renal transplantation. Basal and maximum acid output and the incidence of peptic ulcer before transplantation were not significantly different from those of controls. But after renal transplantation the incidence of symptoms of peptic ulcer was high (22%) and four out of six patients who developed gastrointestinal bleeding died from this complication.In men peak acid output was significantly increased after renal transplantation and was associated with a 30% incidence of symptoms of peptic ulcer compared with 10% in women, who showed no significant change in mean basal or peak acid output. Peptic ulceration after transplantation was not associated with steroid dosage, hyperparathyroidism, or the height of blood urea concentrations.Given criteria of a history of dyspepsia, abnormal barium meal findings, or gastric hypersecretion, it was not possible to identify patients at risk from peptic ulceration or life-threatening complications after renal transplantation. Thus the routine screening of these patients for peptic ulcer has no practical value, and the incidence of fatal complications is not high enough to justify routine prophylactic anti-ulcer surgery aimed at reducing acid secretion before renal transplantation.
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