Objective To compare the long-term outcome of arti®cial urinary sphincter (AUS) implantation in patients after prostatectomy, with and with no history of previous irradiation. Patients and methods The study included 98 men (mean age 68 years) with urinary incontinence after prostatectomy for prostate cancer (85 radical, 13 transurethral resection) who had an AUS implanted. Twenty-two of the patients had received adjuvant external beam irradiation before AUS implantation. Over a mean (range) follow-up of 46 (5±118) months, the complication and surgical revision rates were recorded and compared between irradiated and unirradiated patients. The two groups were also compared for the resolution of incontinence and satisfaction, assessed using a questionnaire. Results Overall, surgical revision was equally common in irradiated (36%) and unirradiated (24%) patients.After activating the AUS, urethral atrophy, infection and erosion requiring surgical revision were more common in irradiated patients (41% vs 11%; P<0.05); 70% of patients reported a signi®cant improvement in continence, regardless of previous irradiation. Patient satisfaction remained high, with >80% of patients stating that they would undergo surgery again and/or recommend it to others, despite previous irradiation and/or the need for surgical revision. Conclusions Despite higher complication and surgical revision rates in patients who have an AUS implanted and have a history of previous irradiation, the longterm continence and patient satisfaction appear not to be adversely affected.

BackgroundEnd-stage kidney disease is a life-changing illness. Many patients require haemodialysis, a treatment that impacts profoundly on quality of life and mental health. Arts-based interventions have been used in other healthcare settings to improve mental health and quality of life; therefore, they may help address the impact of haemodialysis by improving these outcomes. However, there is a lack of evidence assessing their effectiveness in this population and few randomised controlled trials (RCTs) evaluating the effectiveness of complex arts-based interventions.MethodsThe aims of this study are to establish the feasibility of a cluster RCT of an arts-based intervention for patients with end-stage kidney disease whilst receiving haemodialysis through a cluster randomised pilot study, explore the acceptability of the intervention with a process evaluation and explore the feasibility of an economic evaluation. The study will have three phases. The first phase consists of a cluster randomised pilot study to establish recruitment, participation and retention rates. This will involve the recruitment of 30 participants who will be randomly allocated through cluster randomisation according to shift pattern to experimental and control group. The second phase will be a qualitative process evaluation to establish the acceptability of the intervention within a clinical setting. This will involve semi-structured interviews with 13 patients and three focus groups with healthcare professionals. The third phase will be a feasibility economic evaluation to establish the best methods for data collection within a future cluster RCT.DiscussionArts-based interventions have been shown to improve quality of life in healthcare settings, but there is a lack of evidence evaluating arts-based interventions for patients receiving haemodialysis. This study aims to assess the feasibility of a future cluster RCT assessing the impact of an arts-based intervention on the wellbeing and mental health of patients receiving haemodialysis and identify the key factors leading to successful implementation. The hope is this study will inform a trial that can influence future healthcare policy by providing robust evidence for arts-based interventions within the haemodialysis setting.Trial registrationThe trial was prospectively registered on clinicaltrials.gov on 14/8/2018, registration number NCT03629496.Electronic supplementary materialThe online version of this article (10.1186/s40814-018-0389-y) contains supplementary material, which is available to authorized users.

The urethra generates sufficient tone to prevent leakage from the bladder and thus plays an important role in maintaining urinary continence. Despite this central role, relatively little is known about the mechanisms that underlie the generation and modulation of urethral tone, although it can be influenced by a number of factors including blood flow through the lamina propria . There is little doubt that a myogenic mechanism also contributes significantly to urethral tone, since it is unaffected in vitro by nerve blockade in a variety of species including pigs (Bridgewater et al. 1993), sheep (Thornbury et al. 1992, rats (McKeag et al. 2001) and humans .A number of studies have demonstrated that urethral myogenic tone is critically dependent on the influx of Ca 2+ across the cell membrane, since removal of external Ca 2+ or inhibition of L-type Ca 2+ channels reduces tone significantly in rats, humans and pigs in vitro (Bridgewater et al. 1993;Brading, 1999;Shafei et al. 2003). Shafei et al. (2003) have demonstrated that application of nifedipine or Ni 2+ significantly reduces tone in an isolated rat whole urethra preparation, suggesting that Ca 2+ influx through both T and L channels contributes to urethral tone. Recent studies by Bradley et al. (2003) have characterised the Ca 2 currents in isolated rabbit urethral myocytes and demonstrated the existence of currents with biophysical and pharmacological properties typical of L-and T-type Ca 2+ currents in arterial (Benham et al. 1987), venous (Yatani et al. 1987) and bladder myocytes (Sui et al. 2001).To date, no study has examined successfully the electrophysiology of human urethral myocytes, presumably because of the poor availability of suitable tissue and the difficulty of obtaining viable cells from small biopsy samples. In this study we provide the first electrophysiological data from freshly dispersed human myocytes obtained from adults undergoing treatment for bladder or prostate cancer. Our results suggest that human urethral myocytes possess Ca 2+ currents with electrophysiological and pharmacological properties typical of T and L channels (for reviews see Kotlikoff et al. 1999;Perez-Reyes, 2003 The purpose of the present study was to characterise Ca 2+ currents in smooth muscle cells isolated from biopsy samples taken from the proximal urethra of patients undergoing surgery for bladder or prostate cancer. Cells were studied at 37°C using the amphotericin B perforated-patch configuration of the patch-clamp technique. Currents were recorded using Cs

No abstract

Background: Many patients who develop end stage kidney disease require haemodialysis, a treatment that requires attending hospital three times a week for four hours each visit. This treatment impacts profoundly on quality of life (QoL) and mental health. Arts-based interventions for patients receiving haemodialysis could help address the impact of this treatment; however there is a lack of consensus on the methods of implementation and the mechanisms of these interventions in specific clinical contexts.Methods: Using a realist approach, relevant articles were synthesised to inform theory relating to the mechanism and implementation of complex arts-based interventions for patients receiving haemodialysis. Results: The theoretical framework includes two implementation phases, firstly one to one delivery of person-centred arts activities during haemodialysis and secondly, display of completed artwork within the unit. This intervention triggers mechanisms such as flow, social capital and an aesthetic experience. Implementation is hindered by the constraints of the haemodialysis unit and patients lack of confidence in their artistic skills. The impacts of these issues are reduced by a flexible approach to implementation, patient's desire to pass time and support from healthcare professionals. KeywordsArts-based intervention, arts in medicine, haemodialysis, arts in health, end-stage kidney disease, Realist synthesis included in their remit; they are not presented as classifications in themselves. Previously Arts Council England outlined seven areas of arts in their policy, these include combined arts, dance, interdisciplinary arts, literature, music, theatre and visual arts (Arts Council England, 2006). These classifications are determined by the focus of the policy, not a developed classification system.Evidence-based classifications have been developed for the purpose of health research. Davies et al., (2012) acknowledged the inconsistencies in defining arts within the literature. They conducted an online survey, sampling 57 international experts in the field of art or arts in health, to develop a definition of arts engagement. Five classifications of art forms were defined: performing arts, visual arts, design and craft, literature, online, digital and electronic arts, and community and cultural festivals, fairs and events. A factor analysis of the identified arts engagement activities identified two dominant factors; active or receptive engagement. Active engagement was defined as creating art, while receptive engagement is observing or listening to the arts. This taxonomy is acknowledges both artistic medium and level of engagement as important factors in arts research (Davies et al., 2012). This enables health research not only to examine the effectiveness of particular arts forms, but examine how different levels of engagement can impact patients.There also remains a lack of clarity in health research literature when defining arts-based interventions.This results from a lack of consensus on whether arts therapi...