audit conference

audit conference
audit conference

Monday, October 3, 2011

Drug treatment in Urology

The final conference came about so quickly, it was on the 19th September 2011, . The theme of the conference was on drug treatments in Urology. We had an excellent program lined up for the day. As usual I conducted the pre- lecture survey, asking attendees about their knowledge on urology and some of the treatments provided in the area.
The first lecture was given by Brid Byrne from A&E in St. Michael's Hospital. Brid gave us a very comprehensive and detailed talk on the anatomy and the physiology of the urinary tract as you will read below

The second lecture was given by Mary Jacob, AMP Women's Health. National Maternity Hospital. The title of her presentation was "Nurse prescribing, continence /overactive bladder".  In her lecture she described the different types of bladder storage problems: overactive bladder, stress urinary incontinence and mixed incontinence. Mary described the symptoms and the treatments for over active bladder. How the medical management can be divided into either drug agents or behavioural modification. She completed her excellent presentation by describing the side effects of medications for urgency urinary incontinence. I have downloaded it below.

The next presentation was from Teresa Ronan Product specialist from Braun Company. Teresa discussed the two types of catheterisation: intermittent Catheterisation (being a clean procedure) and Indwelling catheterisation (being a sterile procedure). In her lecture she then described how the indwelling catheter was subdivided into urethral and supra-pubic catheterisation. She talked about the associated risks with the urethral and the supra-pubic infection - 44% of hospitalised patients develop urinary tract infections. She gave useful guidance on how to manage urinary tract infection and gave advice on catheter blockage and use of maintenance solutions.

The follow-on lecture after the coffee break was from Helen Forristal, Urology Cancer Nurse Specialist from St. Vincent’s University Hospital. She presented with Intravesical Treatments for Bladder Cancer. She described the stages of bladder cancer: Primary tumour to extended lymph node involvement to presence and the extent of distant metastases. She talked about the alarming report re- the CIS (Carcinoma in situ) where there is a high risk of disease progression, with an average 54% developing invasive disease in a  five year period. She then presented on the uses of Mitomycin C answeing questions e.g. When is Mitomycin C used? Why use Mitomycin? The side effect profile, the single dose Mitomycin C, the 4-8 week course Mitomycin C, the maintenance of Mitomycin C and lastly she talked about Patient Information.

Next Helen explained about the comparison of BCG – Bacillus Calmette Guerin with Mitomycin C. How BCG  is a live attenuated tuberculosis vaccine and that it has a neoplastic effect on the tumour.  How it should be considered for patient’s following a Trans Urethral Resection for the prophylaxis of tumour recurrence in patients with medium to high risk Ta and T1 bladder cancer. How it has been quoted that "BCG is said to be superior to Mitomycin C in reducing recurrence of bladder cancer".  Helan then talked about the use of BCG for the patient and the HCP. As well as the health and safety issues associated with BCG.
Helen's second lecture was on hormonal treatment for Prostate Cancer. She talked of how prostate cancer is the most commonly diagnosed cancer amongst men in many industrialised nations. Rates of prostate cancer vary widely across the world. Although the rates vary widely between countries, it is least common in South and East Asia, more common in Europe, and most common in the United States. (American Cancer Society). She talked about the routine investigations from DRE (digital rectal examination), to TRUS guided biopsy to bone (if applicable). How Prostate cancer is hormone-dependent LHRH, luteinising hormone-releasing hormone LH, luteinising hormone ACTH and adrenocorticotrophin. Helen then discussed the Medical Endocrine Therapy Options: LHRH analogue, Anti-androgen and Oestrogen.  She gave a breakdown of the main side effects of these treatments. Helen completed her presentation on the importance of the holistic care of the patient.

Mary spoke about benign prostate hyperplasia (BPH) and that this is a common condition affecting older men. BPH is commonly defined as a benign enlargement of the prostate gland due to an increase in cellular proliferation which can lead to a range of lower urinary tract symptoms (LUTS).
This condition has a very significant impact on the activities of daily living. She spoke about the assessment of these patient’s in the Uroflow Clinic, and follow up in the Urology Outpatient’s Department. The patient will have blood tests for PSA, U&E. Digital rectal examination and residual urine
volume is measured. The medical treatments currently available are,  Alpha Blockers, 5 Alpha Reductase Inhibitors, Combination therapy, and drugs for overactive bladder.
If medical therapy fails, surgery may be indicated.