Introduction:Many emergency department (ED) visits are non-urgent. Postulated reasons for these visits include lack of access to family physicians, convenience and 24/7 access, perceived need for investigations or treatment not available elsewhere, and as a mechanism for expedited referral to other specialists. We conducted a patient survey to determine why non-urgent patients use our tertiary care ED. Our primary objective was to determine how often the lack of a family physician was associated with non-urgent ED use. Methods: The survey was administered to Canadian Emergency Department Triage and Acuity Scale (CTAS) Level IV and V patients who attended the ED of the Queen Elizabeth II Health Sciences Centre in Halifax, NS, from March 7 to March 13, 2005. Results: Of the 352 eligible patients, 235 completed the survey (response rate, 67%). Fifty-six percent (132/235) had an acute medical problem of less than 48 hours, including 48% (114/235) with a recent injury. Thirty-four percent (82/235) had been referred to the ED, 49% (114/235) believed they required a specific service that was unavailable elsewhere (e.g., radiology, suturing, casting) and 43% (100/235) presented because of self-perceived urgency of their condition. Eighty-four percent (198/235) had a family physician; 23% (55/235) used the ED because of limited access to theirfamily physician and 3% (6/235) used the ED because they did not have a family physician. Conclusions: In this setting, most non-urgent ED visits involved patients who required a specific service offered by the ED, patients who believed their condition was urgent, or patients who were referred from the community to the ED. From a patient perspective, relatively few visits would be considered inappropriate. Lack of a family physician was not associated with non-urgent ED use; however, inability to obtain timely access to the FP was a factor in one-quarter of cases. RÉSUMÉ Introduction :De nombreuses visites au service des urgences ne sont pas urgentes. Les raisons hypothétiques pour ces visites comprennent un accès limité aux médecins de famille, un accès commode 24 heures par jour, sept jours par semaines, la perception d'un besoin d'investigations ou de traitements non disponibles ailleurs et un mécanisme de consultation rapide auprès d'autres spé-cialistes. Nous avons mené un sondage auprès de patients afin de déterminer pourquoi les patients ayant des problèmes non urgents utilisent le service d'urgence à notre hôpital de soins tertiaires. Notre objectif principal était de déterminer à quelle fréquence le fait de ne pas avoir de ORIGINAL RESEARCH • RECHERCHE ORIGINALE ADVANCES

Introduction: Testicular lymphoma is a rare and deadly disease representing 1% to 2% of all non-Hodgkin lymphomas (NHLs) and approximately 5% of all testicular neoplasms. Our objective is this study was to identify the presenting signs and symptoms, treatment and outcome of patients with testicular lymphoma diagnosed at our institution from 1992 to 2005, and to identify any differences in survival based on Ann Arbor Stage and International Prognostic Index (IPI). Methods:A retrospective chart review was performed to identify demographic characteristics, presenting signs and symptoms, treatment and outcomes. Survival was assessed using Kaplan-Meier survival curves and log-rank testing.

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This study demonstrates that a SBT curriculum for fURS can lead to improved short-term technical skills among junior level urology residents. The Cook URS model demonstrated good face, content and construct validity.

Urologists face various distractions in the OR that can negatively impact surgical performance, potentially compromising patient outcomes and safety. Further studies are needed to elucidate the true impact of such distractions and to develop strategies to mitigate their effects.

CT measurements, rather than height, correlate well with measured length and could be used to choose the appropriate stent length. Stents matching directly measured ureteral lengths are associated with high rates of ideal stent position.

Background: Orthotopic reconstruction following cystectomy has evolved in an attempt to restore anatomy and function to as close as possible to the preoperative state. We review the renal and functional outcomes of patients who underwent cystectomy and neobladder reconstruction at our institution. Methods: Between December 2003 and October 2007, 31 patients underwent cystectomy with Studer neobladder reconstruction at the Ottawa Hospital, Ottawa, Ontario, Canada. Follow-up data were obtained regarding renal function (serum creatinine, mmol/L), continence, urinary flow rates and post-void residual (PVR) at 3, 6 and 12 months after surgery. Change in creatinine from preoperative baseline was calculated and analyzed by student t-test to determine if there was a significant rise in creatinine. Results: There was a statistically significant increase in creatinine from preoperative baseline, with an average increase of 17.3 mmol/L, 21.8 mmol/L and 26.3 mmol/L at 3, 6 and 12 months, respectively. Six patients developed hydronephrosis. Excluding patients with hydronephrosis, there continued to be a statistically significant rise in creatinine with an average increase of 11.9 mmol/L, 14.7 mmol/L and 19.4 mmol/L at 3, 6 and 12 months, respectively. At 1 year, daytime continence was achieved by 89% of patients; 70% were continent at night. Interpretation: Orthotopic neobladders have excellent functional outcomes with low rates of incontinence, which improved throughout follow-up. A significant proportion of patients developed hydronephrosis, highlighting the need for close follow-up to prevent reversible renal deterioration. Creatinine increased during follow-up irrespective of the development of hydronephrosis, but the clinical significance is unknown.

Background: Orthotopic reconstruction following cystectomy has evolved in an attempt to restore anatomy and function to as close as possible to the preoperative state. We review the renal and functional outcomes of patients who underwent cystectomy and neobladder reconstruction at our institution. Methods: Between December 2003 and October 2007, 31 patients underwent cystectomy with Studer neobladder reconstruction at the Ottawa Hospital, Ottawa, Ontario, Canada. Follow-up data were obtained regarding renal function (serum creatinine, mmol/L), continence, urinary flow rates and post-void residual (PVR) at 3, 6 and 12 months after surgery. Change in creatinine from preoperative baseline was calculated and analyzed by student t-test to determine if there was a significant rise in creatinine. Results: There was a statistically significant increase in creatinine from preoperative baseline, with an average increase of 17.3 mmol/L, 21.8 mmol/L and 26.3 mmol/L at 3, 6 and 12 months, respectively. Six patients developed hydronephrosis. Excluding patients with hydronephrosis, there continued to be a statistically significant rise in creatinine with an average increase of 11.9 mmol/L, 14.7 mmol/L and 19.4 mmol/L at 3, 6 and 12 months, respectively. At 1 year, daytime continence was achieved by 89% of patients; 70% were continent at night. Interpretation: Orthotopic neobladders have excellent functional outcomes with low rates of incontinence, which improved throughout follow-up. A significant proportion of patients developed hydronephrosis, highlighting the need for close follow-up to prevent reversible renal deterioration. Creatinine increased during follow-up irrespective of the development of hydronephrosis, but the clinical significance is unknown. Les données concernant la fonction rénale (créatinine sérique, µmol/L), la continence, le débit urinaire et le volume résiduel postmictionnel ont été obtenues pendant le suivi 3, 6 et 12 mois après l'intervention. Les variations de la créatinine sérique par rapport aux valeurs préopératoires ont été calculées et analysées par test t afin de déterminer la présence d'une hausse significative de la créatinine sérique. Résultats : On a noté une hausse significative du taux de créatinine sérique par rapport aux valeurs de départ (avant l'intervention); la valeur moyenne de la hausse était de 17,3 µmol/L, 21,8 µmol/L et 26,3 µmol/L après 3, 6 et 12 mois, respectivement. Six patients ont présenté une hydronéphrose. Si on exclut les patients ayant signalé une hydronéphrose, on note toujours une hausse significative sur le plan statistique du taux de créatinine, la valeur moyenne de la hausse étant de 11,9 µmol/L, 14,7 µmol/L et 19,4 µmol/L après 3, 6 et 12 mois, respectivement. Après 1 an, 89 % des patients étaient continents le jour, et 70 % étaient continents la nuit. Interprétation : La reconstruction néovésicale orthotopique produit d'excellents résultats fonctionnels démontrés par les faibles taux d'incontinence, qui se sont améliorés pendant le suivi. Une proportion s...