Browsing by Author "Howlett, Justin"

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    Open Access
    A 15-year retrospective review of urodynamic studies in Children at Red Cross War Memorial Childrens Hospital (RCWMCH), Cape Town, South Africa
    (2022) Mosalakatane, Thembisile Dintle; Coetzee, Ashton; Wright, Anne; Raad, Jeanette; Lazarus, John; Nourse, Peter; Howlett, Justin; McCulloch, Mignon
    Background: Despite the undeniable diagnostic benefits of urodynamic studies (UDS), their adoption into clinical practice in Africa has been slow. This study aimed to review the use of invasive UDS in children at a tertiary paediatric hospital in South Africa. Methods: A retrospective analysis of 1108 UDS was conducted. Patient demographic characteristics, primary diagnosis, indication and urodynamic outcomes were reviewed. Presence of urodynamic high-risk features were documented, and a comparison was made between the first study and follow-up study. Results: This study revealed increasing trends in the use of UDS from 2015. Referrals were from Urology (37.7%), Spinal defects clinic (34.4%), Nephrology (20.8%) and other departments (7.0%). The most common reason for referral was review of medical treatment (36.5%). Spinal dysraphism (58.3%) accounted for the majority of conditions seen. Majority (59.1%) of the patients were receiving more than one type of bladder treatment at the time of their first study, with clean intermittent catheterisation (46.5%) being the most common form of bladder management. 97.5% of studies were performed using transurethral bladder catheterization. Urodynamic diagnosis was neurogenic in 74.0%, anatomical (12.2%), functional (8.8%) and normal (5.0%). There was statistically significant improvement in bladder compliance, detrusor leak point pressure and detrusor sphincter dyssynergia between the first study and a subsequent study following therapeutic intervention. Conclusion: The unique ability of UDS to demonstrate changes in detrusor pressures, which is a common reason for therapy failure, makes UDS an invaluable tool in the diagnosis and management of children with lower urinary tract dysfunction.
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    Open Access
    Does the use of video improve patient satisfaction in the consent process for local-anaesthetic urological procedures?
    (2021) Moore, Allison Louise; Howlett, Justin
    Purpose To assess patient satisfaction with the use of Portable Video Media (PVM) for the purpose of taking informed consent for common urological outpatient procedures performed under local anaesthesia. Methods Patients undergoing the following procedures were approached for recruitment: flexible cystoscopy with or without biopsy, transrectal ultrasound-guided prostate biopsy or flexible cystoscopy with insertion or removal of a ureteric stent. Audio-visual media were developed for each procedure, with each script translated from English into isiXhosa and Afrikaans. The study involved a cross-over for each patient between Standard Verbal Consent (SVC) and PVM consent, with each patient randomised to start with SVC or PVM consent. Each of these consent-arms were assessed via a questionnaire. Results 60 patients completed participation, with PVM as the first exposure for 28 patients and 32 patients receiving SVC as their first arm of the study. When comparing the overall satisfaction between SVC and PVM consent (the total scores out of 18 for the questionnaire), patients scored significantly higher for PVM consent (M = 16.3 ± 2.4) compared to SVC (M = 15.4 ± 2.9) (p = 0.002). 92% of the total patient sample preferred PVM consent. Conclusion PVM proved superior to SVC in improving satisfaction in the consent process for common outpatient urological procedures performed under local anaesthesia.
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    Open Access
    Is The Learning Curve In Robotic Assisted Laparoscopic Radical Prostatectomies (RALP) in South Africa Comparable to International Standards?
    (2020) de Jager, Simon; Howlett, Justin
    Background and purpose Prostate cancer (PCa) is the second most common cancer in men, and the sixth leading cause of cancer death among men worldwide (1). Radical Prostatectomy (RP) is widely considered a gold standard treatment for clinically significant localized PCa. Robotic assisted laparoscopic radical prostatectomy (RALP) represents a modern minimally invasive technique for performing a RP. The aim of the study is to demonstrate a progression in the learning curve of two South Africa based urologists, as each embarks on their first series of RALP cases between September 2014 to July 2019. An audit of peri-operative outcomes for each surgeon's first uninterrupted series of RALP's has been undertaken. We also compare our results to international series to assess if local South African outcomes are similar to these. Materials and Methods We performed a retrospective audit of all patients who had a RALP with our two urologists between the dates of September 2014 to May 2019. Patients were only excluded if critical data could not be collected. For each included patient we collected peri-operative data. Pre-operative data collected was required for risk stratification grouping of patients according the D'Amico Risk group classification. Post-operative data included operative details (such as console time and blood loos), functional outcomes (such as potency and continence rates), and pathological outcomes (such a T-staging and positive surgical margin rates). The total number of patients for each of the two surgeons have been divided into a series of consecutive groups. The first 100 have been divided into groups of 25, and the subsequent patients into groups of 50. Results/main findings Our two surgeons have been designated Surgeon-X and Surgeon-Y. A total of 700 patients met our inclusion criteria, 400 and 300 cases for Surgeons-X and -Y respectively. Our study demonstrates that in a South Africa setting, for the parameters of median console time (CT), estimated blood loss (EBL), length of hospital stay (LOS), and positive surgical margins (PSM), there were notable improvements between the first and last groups of each surgeon's series. Although each parameter tends to fluctuate around a median value, there is a general trend towards improved outcomes. For the parameters of post-operative continence and potency our study failed to show a statistically significant improvement in outcomes between the first and last groups in each surgeon's series. Conclusions This study demonstrates that, similar to internationally published data, notable improvements in perioperative outcomes can be observed as each of our two surgeons gain experience in this relatively new operative approach to managing men with localized prostate cancer. The overall picture is one of improved outcomes with each consecutive group analysed and that when individually assessed, these outcomes display differing rates of improvement depending on which is being assessed. When analysing our outcomes of CT, EBL, PSM rate and LOS, we see that our results compare favourably to other internationally published data. For all intents and purposes our learning curve and peri-operative results are on par with our overseas counterparts and in some cases bette
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    The functional and cosmetic outcome of the ventral slit procedure for congenital megaprepuce
    (2022) Tasker, David Beaumont; Howlett, Justin; Rode, Heinz
    Background: Congenital Megaprepuce is a urological condition characterized by a megapreputial reservoir with a long redundant inner prepuce. The condition has been linked to urinary tract infections, lower urinary tract symptoms, and ballooning of the penis during voiding. An impeded urinary stream and resultant ballooning is associated with discomfort and causes parental anxiety due to the unusual appearance of phallus. Surgical correction should improve functionality, but cosmesis is also important. This study took place in a community in which traditional circumcision remains an essential rite of passage. Therefore, early surgical correction of congenital megaprepuce was complicated by the unique requirement that patients remain uncircumcised. Methodology: Here we investigated the functional and cosmetic outcomes of the ventral slit procedure, an uncomplicated technique used to restore urinary flow which, importantly, preserves the foreskin. Parents of 18 paediatric patients were interviewed post-operatively regarding phallic appearance and functionality following surgery. Results: Overall, the ventral slit procedure successfully restored flow, prevented ballooning and alleviated discomfort during voiding in all patients. Parents interviewed were highly satisfied with surgical outcomes, as assessed by the Pediatric Penile Perception score. Conclusion: The ventral slit procedure was found to be a culturally acceptable and simple surgical solution to congenital megaprepuce.