Julian Shah - Academia.edu (original) (raw)

Papers by Julian Shah

Long term complications of urolume wall stents in the treatment of urethral stricture disease

European Urology Supplements, 2003

The majority of patients with spinal cord injury (SCI) will develop Neurogenic Lower Urinary Trac... more The majority of patients with spinal cord injury (SCI) will develop Neurogenic Lower Urinary Tract Dysfunction (NLUTD).These patients require long term urological follow-up. However, the protocol varies across spinal injury units. We audited the urological practice in SCI units across the UK and Eire and evaluated the impact of proposed British guidelines on the long term management of NLUTD in SCI patients.

Laparoscopic Clam Ileocystoplasty: Technical Feasibility and Reduced Morbidity

The Journal of Urology, 2008

Spinal Cord, 2006

Study design: Retrospective analysis. Objectives: To evaluate long-term efficacy and complication... more Study design: Retrospective analysis. Objectives: To evaluate long-term efficacy and complications of AMS 800 (American Medical Systems s) artificial urinary sphincter (AUS) in treatment of urodynamic stress incontinence (USI) in male patients with spinal cord lesion (SCL).

BJU International, 2004

With urodynamic studies now being considered an essential investigation in assessing SCI and neur... more With urodynamic studies now being considered an essential investigation in assessing SCI and neuropathic bladder

EFFECTS OF MAGNETIC STIMULATION ON DETRUSOR INSTABILITY IN UNOBSTRUCTED AND OBSTRUCTED PATIENTS

J Urol, 1999

The need for rigid cystoscopy and resection of tumour (TURBT)

Annals of the Royal College of Surgeons of England, 2008

Clinical features and management of benign prostatic hyperplasia

Hospital Medicine, 1999

Benign prostatic hyperplasia represents the most common benign neoplastic condition afflicting me... more Benign prostatic hyperplasia represents the most common benign neoplastic condition afflicting men and has a major impact on the health of the population. It refers to a regional and nodular growth of stromal proliferation which, because of its proximity to the urethra, causes varying degrees of bladder outflow obstruction.

Carcinoma following Augmentation Ileocystoplasty

Urologia Internationalis, 2000

Carcinoma of the bladder following augmentation cystoplasty is rare. Only 15 cases have been repo... more Carcinoma of the bladder following augmentation cystoplasty is rare. Only 15 cases have been reported worldwide. We report a further 2 cases, 1 of which, a squamous cell carcinoma, has not previously been described in this context.

Effects of spinal cord injury on semen parameters

The journal of spinal cord medicine, 2008

Neurogenic reproductive dysfunction in men with spinal cord injury (SCI) is common and the result... more Neurogenic reproductive dysfunction in men with spinal cord injury (SCI) is common and the result of a combination of impotence, ejaculatory failure, and abnormal semen characteristics. It is well established that the semen quality of men with SCI is poor and that changes are seen as early as 2 weeks after injury. The distinguishing characters of poor quality are abnormal sperm motility and viability. In the majority of the men with SCI, the sperm count is not abnormal. We elaborate on the effects of the SCI on semen parameters that may contribute to poor motility and poor viability. Review. PubMed and MEDLINE databases were searched using the following key words: spinal cord injuries, fertility, sexual dysfunction, and spermatogenesis. All literature was reviewed by the team of authors according to the various stages of sperm development and transport in the male reproductive cycle. The cause of asthenozoospermia appears to be multifactorial. Current literature does not support the...

Long-term Results of Surgery for Stress Urinary Incontinence — A Urologist’s View

Urinary and Fecal Incontinence, 2005

International Journal of Surgery, 2014

Introduction: Flexible cystoscopy (FC) is a common urology procedure; over 220,000 are performed ... more Introduction: Flexible cystoscopy (FC) is a common urology procedure; over 220,000 are performed in UK annually. Urinary tract infection (UTI) is a potential complication with rates varying from 0.8-10%; most requiring antibiotic treatment in primary care. There is on-going debate regarding antibiotic prophylaxis for FC. Our aim was to evaluate the incidence of UTI following FC in our institution ascertaining whether prophylaxis is indicated. Identify the antibiotic profile of causative organisms to guide treatment of post-FC UTIs. Methods: We retrospectively analysed 288 patients who underwent FC over 3 months. Patients were cross-matched with our microbiology results reporting system (Sunquest-Ice€ a) to identify those who had a urine sample sent for analysis within 30 days of their procedure. Results: Of the 288 FCs performed 37 patients (12.8%) had a urine sample sent for microbiology analysis. Twenty-five were from primary care and 15 from hospital with the median time from FC of 15 days. Ten samples showed significant bacterial growth with E. coli predominating. Most were sensitive to cefalexin (75%), nitrofurantoin (100%) or trimethoprim (67%). No organisms had extended antibiotic resistance. Conclusions: Our incidence of post-FC UTI is 3.47% suggesting prophylaxis is unwarranted. No extended antibiotic resistance was exhibited therefore no changes to antibiotic recommendations are required.

Management of the neuropathic bladder

Hospital Medicine, 2003

Neurological injury and disease are common, and intimately related to abnormalities of the urinar... more Neurological injury and disease are common, and intimately related to abnormalities of the urinary system. The prevention and treatment of urological sequelae in patients with neurological injury or disease requires a clear multidisciplinary management strategy.

Outcome of renal denervation for the treatment of loin pain haematuria syndrome

European Urology Supplements, 2002

An effective day case treatment combination for refractory neuropathic mixed incontinence

International braz j urol, 2008

Women with drug refractory neurogenic mixed incontinence (NMI) have limited minimally invasive tr... more Women with drug refractory neurogenic mixed incontinence (NMI) have limited minimally invasive treatment options and require reconstructive surgery. We examined efficacy of a combination of day case intradetrusor (ID) botulinum toxin (BTX-A) bladder injections and transobturator (TOT) or tension free vaginal tape (TVT). Eleven women who are pharmacotherapy intolerant or who have drug refractory NMI were treated. Two opted for open surgery and the remaining 9 received 1000 units of Dysport diluted in 30 mL saline cystoscopically at 30 ID sites followed by TOT in 6 or TVT in 3 as a day case combination treatment. Patient demographics, pre and post treatment videocystometrogram (VCMG), pad test and International Committee on Incontinence Questionnaire (ICIQ) scores were recorded. At 6 weeks (repeat ICIQ, pad test and patient satisfaction), at 3 and 12 months (VCMG) and 'current' (ICIQ and patient satisfaction) was recorded. The mean age was 56.7 years (range 41 to 78) with a mean follow up of 19.1 months (range 7 to 33). All women were continent at 3 and 12 months. Quality of life (ICIQ scores) improved at 6 weeks (p > 0.001) and remained stable up to the last follow up (p > 0.001). Eight women have stopped using pads. At 3 months, there was significant improvement in MDP (p > 0.014) and MCC (p = 0.002). Anticholinergics were discontinued in 7 with global high satisfaction with the treatment BTX-A injections were repeated in 4 (mean 13.5 months). Anticholinergic refractory women with NMI can be effectively treated as a day case with combination of ID BTX-A injections and TVT or TOT.

Spinal Cord, 2007

Study design: Systematic review. Objectives: To review systematically fertility of persons with s... more Study design: Systematic review. Objectives: To review systematically fertility of persons with spinal cord injuries (SCI) and their partners. Methods: Reports from six databases , selected annual proceedings (1997)(1998)(1999)(2000)(2001)(2002) and manufacturer's information were screened against eligibility criteria. Searches covered female obstetrical issues, and the efficacy of vibration and electroejaculation for males, as well as advanced fertility (AF) treatments for partners of SCI males. Data were pooled from case-series reports on SCI males' ejaculation, and pregnancies and live births for partners of SCI males. Results: In all, 2127 unique reports were evaluated, of which 66 reports were included. No studies investigated fertility in SCI females. Ejaculation interventions in the last decade resulted in response rates of 95% (95% confidence intervals (CI) 91%, 99%), with 100% response rate reported in several recent publications. A total of 13 studies (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001) yielded pregnancy rates of 51% (95% CI 42%, 60%) in partners of SCI males. Of these, 11 studies (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003) yielded live birth rates of 41% (95% CI 33%, 49%). Conclusions: Fertility of SCI males is extensively studied. Semen for fertility purposes can generally be obtained using vibration and electroejaculation. AF techniques are increasing pregnancy rates. Research is needed to improve sperm quality. Freezing of sperm is unlikely to significantly improve fertility rates. Fertility of SCI females is addressed only in case reports and opinion articles. The opinion that female fertility is unaffected by SCI should be further investigated using appropriate research methodology.

Neurourology and Urodynamics, 2004

Aims: To investigate variations in common urological practice between the Spinal Injuries Units (... more Aims: To investigate variations in common urological practice between the Spinal Injuries Units (SIU) of UK and Eire. Methods: In December 2002, each of the 12 SIU in the UK and Eire were sent a questionnaire addressing basic practice relating to urological outpatient follow-up, management of urinary tract infection, upper tract surveillance, and urodynamic studies. Results: Regarding frequency of urological review, two units only saw patients when speci¢cally required. One unit reviewed patients every 6 months and six centres reviewed patients annually. The remaining three units had a patient-speci¢c follow-up protocol. Regarding urinary tract infection, only ¢ve units had a uni¢ed departmental management protocol. Four units advocated antibiotic prophylaxis for recurrent UTI. Only one unit would routinely treat asymptomatic UTI in individuals using catheters. The range of recommended duration of treatment for symptomatic UTI was 3^14 days (mean 6.3). All units performed routine upper tract screening, ranging from annually to every 3 years. Six units did not perform routine urodynamic studies; in other units the range of frequency of urodynamics was from annually to every 3 years. Conclusions: The variation in urological practice amongst SIU in the UK and Eire is considerable. This ¢nding supports the need for an increase in the level of collaboration and research.

1015 7 YEAR FOLLOW UP OF THE FIRST GROUP OF PATIENTS WITH NEUROGENIC DETRUSOR OVERACTIVITY RECEIVING BOTULINUM TOXIN-TYPE A (DYSPORT)

The Journal of Urology, 2010

942 THE MEDIUM TERM OUTCOME OF MITROFANOFF IN ADULTS

The Journal of Urology, 2010

1554 FEMALE URETHRAL DIVERTICULA EVALUATION OF VOIDING DYSFUNCTION BEFORE AND AFTER SURGERY

The Journal of Urology, 2012

Long term complications of urolume wall stents in the treatment of urethral stricture disease

European Urology Supplements, 2003

The majority of patients with spinal cord injury (SCI) will develop Neurogenic Lower Urinary Trac... more The majority of patients with spinal cord injury (SCI) will develop Neurogenic Lower Urinary Tract Dysfunction (NLUTD).These patients require long term urological follow-up. However, the protocol varies across spinal injury units. We audited the urological practice in SCI units across the UK and Eire and evaluated the impact of proposed British guidelines on the long term management of NLUTD in SCI patients.

Laparoscopic Clam Ileocystoplasty: Technical Feasibility and Reduced Morbidity

The Journal of Urology, 2008

Spinal Cord, 2006

Study design: Retrospective analysis. Objectives: To evaluate long-term efficacy and complication... more Study design: Retrospective analysis. Objectives: To evaluate long-term efficacy and complications of AMS 800 (American Medical Systems s) artificial urinary sphincter (AUS) in treatment of urodynamic stress incontinence (USI) in male patients with spinal cord lesion (SCL).

BJU International, 2004

With urodynamic studies now being considered an essential investigation in assessing SCI and neur... more With urodynamic studies now being considered an essential investigation in assessing SCI and neuropathic bladder

EFFECTS OF MAGNETIC STIMULATION ON DETRUSOR INSTABILITY IN UNOBSTRUCTED AND OBSTRUCTED PATIENTS

J Urol, 1999

The need for rigid cystoscopy and resection of tumour (TURBT)

Annals of the Royal College of Surgeons of England, 2008

Clinical features and management of benign prostatic hyperplasia

Hospital Medicine, 1999

Benign prostatic hyperplasia represents the most common benign neoplastic condition afflicting me... more Benign prostatic hyperplasia represents the most common benign neoplastic condition afflicting men and has a major impact on the health of the population. It refers to a regional and nodular growth of stromal proliferation which, because of its proximity to the urethra, causes varying degrees of bladder outflow obstruction.

Carcinoma following Augmentation Ileocystoplasty

Urologia Internationalis, 2000

Carcinoma of the bladder following augmentation cystoplasty is rare. Only 15 cases have been repo... more Carcinoma of the bladder following augmentation cystoplasty is rare. Only 15 cases have been reported worldwide. We report a further 2 cases, 1 of which, a squamous cell carcinoma, has not previously been described in this context.

Effects of spinal cord injury on semen parameters

The journal of spinal cord medicine, 2008

Neurogenic reproductive dysfunction in men with spinal cord injury (SCI) is common and the result... more Neurogenic reproductive dysfunction in men with spinal cord injury (SCI) is common and the result of a combination of impotence, ejaculatory failure, and abnormal semen characteristics. It is well established that the semen quality of men with SCI is poor and that changes are seen as early as 2 weeks after injury. The distinguishing characters of poor quality are abnormal sperm motility and viability. In the majority of the men with SCI, the sperm count is not abnormal. We elaborate on the effects of the SCI on semen parameters that may contribute to poor motility and poor viability. Review. PubMed and MEDLINE databases were searched using the following key words: spinal cord injuries, fertility, sexual dysfunction, and spermatogenesis. All literature was reviewed by the team of authors according to the various stages of sperm development and transport in the male reproductive cycle. The cause of asthenozoospermia appears to be multifactorial. Current literature does not support the...

Long-term Results of Surgery for Stress Urinary Incontinence — A Urologist’s View

Urinary and Fecal Incontinence, 2005

International Journal of Surgery, 2014

Introduction: Flexible cystoscopy (FC) is a common urology procedure; over 220,000 are performed ... more Introduction: Flexible cystoscopy (FC) is a common urology procedure; over 220,000 are performed in UK annually. Urinary tract infection (UTI) is a potential complication with rates varying from 0.8-10%; most requiring antibiotic treatment in primary care. There is on-going debate regarding antibiotic prophylaxis for FC. Our aim was to evaluate the incidence of UTI following FC in our institution ascertaining whether prophylaxis is indicated. Identify the antibiotic profile of causative organisms to guide treatment of post-FC UTIs. Methods: We retrospectively analysed 288 patients who underwent FC over 3 months. Patients were cross-matched with our microbiology results reporting system (Sunquest-Ice€ a) to identify those who had a urine sample sent for analysis within 30 days of their procedure. Results: Of the 288 FCs performed 37 patients (12.8%) had a urine sample sent for microbiology analysis. Twenty-five were from primary care and 15 from hospital with the median time from FC of 15 days. Ten samples showed significant bacterial growth with E. coli predominating. Most were sensitive to cefalexin (75%), nitrofurantoin (100%) or trimethoprim (67%). No organisms had extended antibiotic resistance. Conclusions: Our incidence of post-FC UTI is 3.47% suggesting prophylaxis is unwarranted. No extended antibiotic resistance was exhibited therefore no changes to antibiotic recommendations are required.

Management of the neuropathic bladder

Hospital Medicine, 2003

Neurological injury and disease are common, and intimately related to abnormalities of the urinar... more Neurological injury and disease are common, and intimately related to abnormalities of the urinary system. The prevention and treatment of urological sequelae in patients with neurological injury or disease requires a clear multidisciplinary management strategy.

Outcome of renal denervation for the treatment of loin pain haematuria syndrome

European Urology Supplements, 2002

An effective day case treatment combination for refractory neuropathic mixed incontinence

International braz j urol, 2008

Women with drug refractory neurogenic mixed incontinence (NMI) have limited minimally invasive tr... more Women with drug refractory neurogenic mixed incontinence (NMI) have limited minimally invasive treatment options and require reconstructive surgery. We examined efficacy of a combination of day case intradetrusor (ID) botulinum toxin (BTX-A) bladder injections and transobturator (TOT) or tension free vaginal tape (TVT). Eleven women who are pharmacotherapy intolerant or who have drug refractory NMI were treated. Two opted for open surgery and the remaining 9 received 1000 units of Dysport diluted in 30 mL saline cystoscopically at 30 ID sites followed by TOT in 6 or TVT in 3 as a day case combination treatment. Patient demographics, pre and post treatment videocystometrogram (VCMG), pad test and International Committee on Incontinence Questionnaire (ICIQ) scores were recorded. At 6 weeks (repeat ICIQ, pad test and patient satisfaction), at 3 and 12 months (VCMG) and 'current' (ICIQ and patient satisfaction) was recorded. The mean age was 56.7 years (range 41 to 78) with a mean follow up of 19.1 months (range 7 to 33). All women were continent at 3 and 12 months. Quality of life (ICIQ scores) improved at 6 weeks (p > 0.001) and remained stable up to the last follow up (p > 0.001). Eight women have stopped using pads. At 3 months, there was significant improvement in MDP (p > 0.014) and MCC (p = 0.002). Anticholinergics were discontinued in 7 with global high satisfaction with the treatment BTX-A injections were repeated in 4 (mean 13.5 months). Anticholinergic refractory women with NMI can be effectively treated as a day case with combination of ID BTX-A injections and TVT or TOT.

Spinal Cord, 2007

Study design: Systematic review. Objectives: To review systematically fertility of persons with s... more Study design: Systematic review. Objectives: To review systematically fertility of persons with spinal cord injuries (SCI) and their partners. Methods: Reports from six databases , selected annual proceedings (1997)(1998)(1999)(2000)(2001)(2002) and manufacturer's information were screened against eligibility criteria. Searches covered female obstetrical issues, and the efficacy of vibration and electroejaculation for males, as well as advanced fertility (AF) treatments for partners of SCI males. Data were pooled from case-series reports on SCI males' ejaculation, and pregnancies and live births for partners of SCI males. Results: In all, 2127 unique reports were evaluated, of which 66 reports were included. No studies investigated fertility in SCI females. Ejaculation interventions in the last decade resulted in response rates of 95% (95% confidence intervals (CI) 91%, 99%), with 100% response rate reported in several recent publications. A total of 13 studies (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001) yielded pregnancy rates of 51% (95% CI 42%, 60%) in partners of SCI males. Of these, 11 studies (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003) yielded live birth rates of 41% (95% CI 33%, 49%). Conclusions: Fertility of SCI males is extensively studied. Semen for fertility purposes can generally be obtained using vibration and electroejaculation. AF techniques are increasing pregnancy rates. Research is needed to improve sperm quality. Freezing of sperm is unlikely to significantly improve fertility rates. Fertility of SCI females is addressed only in case reports and opinion articles. The opinion that female fertility is unaffected by SCI should be further investigated using appropriate research methodology.

Neurourology and Urodynamics, 2004

Aims: To investigate variations in common urological practice between the Spinal Injuries Units (... more Aims: To investigate variations in common urological practice between the Spinal Injuries Units (SIU) of UK and Eire. Methods: In December 2002, each of the 12 SIU in the UK and Eire were sent a questionnaire addressing basic practice relating to urological outpatient follow-up, management of urinary tract infection, upper tract surveillance, and urodynamic studies. Results: Regarding frequency of urological review, two units only saw patients when speci¢cally required. One unit reviewed patients every 6 months and six centres reviewed patients annually. The remaining three units had a patient-speci¢c follow-up protocol. Regarding urinary tract infection, only ¢ve units had a uni¢ed departmental management protocol. Four units advocated antibiotic prophylaxis for recurrent UTI. Only one unit would routinely treat asymptomatic UTI in individuals using catheters. The range of recommended duration of treatment for symptomatic UTI was 3^14 days (mean 6.3). All units performed routine upper tract screening, ranging from annually to every 3 years. Six units did not perform routine urodynamic studies; in other units the range of frequency of urodynamics was from annually to every 3 years. Conclusions: The variation in urological practice amongst SIU in the UK and Eire is considerable. This ¢nding supports the need for an increase in the level of collaboration and research.

1015 7 YEAR FOLLOW UP OF THE FIRST GROUP OF PATIENTS WITH NEUROGENIC DETRUSOR OVERACTIVITY RECEIVING BOTULINUM TOXIN-TYPE A (DYSPORT)

The Journal of Urology, 2010

942 THE MEDIUM TERM OUTCOME OF MITROFANOFF IN ADULTS

The Journal of Urology, 2010

1554 FEMALE URETHRAL DIVERTICULA EVALUATION OF VOIDING DYSFUNCTION BEFORE AND AFTER SURGERY

The Journal of Urology, 2012