Transperineal prostate biopsy is re-emerging after decades of being an underused alternative to transrectal biopsy guided by transrectal ultrasonography (TRUS). Factors driving this change include possible improved cancer detection rates, improved sampling of the anteroapical regions of the prostate, a reduced risk of false negative results and a reduced risk of underestimating disease volume and grade. The increasing incidence of antimicrobial resistance and patients with diabetes mellitus who are at high risk of sepsis also favours transperineal biopsy as a sterile alternative to standard TRUS-guided biopsy. Factors limiting its use include increased time, training and financial constraints as well as the need for high-grade anaesthesia. Furthermore, the necessary equipment for transperineal biopsy is not widely available. However, the expansion of transperineal biopsy has been propagated by the increase in multiparametric MRI-guided biopsies, which often use the transperineal approach. Used with MRI imaging, transperineal biopsy has led to improvements in cancer detection rates, more-accurate grading of cancer severity and reduced risk of diagnosing clinically insignificant disease. Targeted biopsy under MRI guidance can reduce the number of cores required, reducing the risk of complications from needle biopsy.
Australia has a large migrant population with variable fluency in English. Interpreting services help ensure that healthcare services are delivered appropriately to these populations. However, the use of professional interpreters in hospitals is expensive. There are also issues with service availability and convenience. Mobile devices containing software with translating abilities have promising potential to improve communication between patients and hospital staff as an adjunct to professional interpreters. It is highly convenient and inexpensive. There are concerns about the accuracy of the interpretation done with such software and more research needs to be carried out to support or allay these concerns. For now, clinically important and medicolegal related interpretation should be undertaken by professional interpreters whereas less crucial tasks may be performed with the help of interpreting software on mobile devices. Australia has a large community of migrants with first generation Australians making up 27% of the population in 2011.1 Although 51% of migrants who arrived before 2007reported to be fluent in English, 53% spoke a language other than English at home and 2.6% did not speak English at all. 1 Of the migrants who arrived more recently, only 43% were reportedly fluent in English while 3.1% did not speak English at all.1 Interpreting services are therefore important in ensuring healthcare services are delivered optimally to patients who are unable to speak English. However, there are various issues affecting the proper use of interpreting services such as availability and cost. Mobile technology enabled with interpreting software could potentially solve these issues. The objective of this article is to highlight these issues during the care of a non-English speaking patient with a complex past medical history and how mobile technology played a role as an adjuvant option of improving communication with the patient. Case HistoryA 37-year-old Persian speaking patient from Iran arrived in Australia as an asylum seeker. He had a past history of perineal radiotherapy for a perineal malignancy as a boy in Iran. He also had major abdominal surgery secondary to a motor vehicle accident approximately 12 years earlier.He presented to the hospital with a blocked Mitrofanoff appendicovesicostomy conduit and perineal vesicocutaneous fistulas. The urology team admitted him for computed tomography and magnetic resonance imaging, a diagnostic cystoscopy and conduitography for surgical planning. He had a cystectomy and ileal conduit urinary diversion performed at a later date.The team used a professional Persian interpreter during the initial encounter to help with history taking, obtaining consent for insertion of a 12Fr indwelling catheter into the Mitrofanoff appendicovesicostomy and consent for the above investigations. Once the team decided to perform a cystectomy and ileal conduit formation, the plan was discussed with the patient with the help of a professional interpreter and informed consent for the...
Orthotopic neobladder reconstruction is becoming an increasingly common urinary diversion following cystectomy for bladder cancer. This is in recognition of the potential benefits of neobladder surgery over creation of an ileal conduit related to quality of life (QoL), such as avoiding the need to form a stoma with its cosmetic, psychological and other potential complications. The PubMed database was searched using relevant search terms for articles published electronically between January 1994 and April 2014. Full-text articles in English or with English translation were assessed for relevance to the topic before being included in the review. Patients with neobladders have comparable or better post-operative sexual function than those with ileal conduits. They also have comparable QoL to those with ileal conduits. Orthotopic neobladder is a good alternative to ileal conduit in suitable patients who do not want a stoma and are motivated to comply with neobladder training. However, the selection of a neobladder as the urinary diversion of choice requires that patients have good renal and liver functions and are likely to be compliant with neobladder training. With benefits also come potential risks of neobladder formation. These include electrolyte abnormalities and nocturnal incontinence. This short review highlights current aspects of neobladder formation and its potential advantages.
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