Howard Lau | Western Sydney University (original) (raw)

Papers by Howard Lau

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European urology open science, May 1, 2024

Journal of Clinical Urology, Apr 25, 2017

Objectives: The purpose of this study was to determine whether commonly used methods of securing ... more Objectives: The purpose of this study was to determine whether commonly used methods of securing an indwelling catheter decrease the force transmission along the indwelling catheter to the bladder neck in response to an externally applied force. Materials and methods: A test apparatus was constructed to simulate key features of a catheter drainage system. A "bladder neck" was suspended from a force gauge, with an indwelling catheter inserted through it, tensioned with a urine drainage bag. The system was calibrated, and various methods of securement were tested, with the level of force transmitted to the bladder neck recorded. The methods of securement tested included: adhesive tape taped used a number of ways (including direct taping and a taped mesentery), and three commercially available devices. Results: Some securement devices were able to completely eliminate force transmission to the bladder neck (the Flexi-Trak and Grip-Lok devices). A taped mesentery performed well reducing the transmitted force by up to 85% compared with an unsecured control. Conclusion: Within the limitations of this study we were able to demonstrate that some of the commonly used methods of securing indwelling catheters do work. We were also able to show that adhesive tape was still effective, although not as effective as commercially available devices.

Hong Kong Journal of Nephrology, Apr 1, 2005

Transplantation, Jul 1, 2014

post-transplant we observed in Group A one (2.1 %) and in Group B seven (14.8%) UTIs; p= 0.01. Af... more post-transplant we observed in Group A one (2.1 %) and in Group B seven (14.8%) UTIs; p= 0.01. After 12 weeks there were in Group A fi ve (10.6%) and in Group B twelve (25.5%) UTIs; P=0.02. Conclusions: Early removal of the ureteric stent tied with the urinary catheter is safe and in our experience was not associated with urinary leak. The obvious major benefi t for the patients, of not needing a new admission for cystoscopic stent removal, is also associated with a reduced incidence of early and late UTIs.

Journal of surgical case reports, Aug 1, 2020

Small bowel obstruction (SBO) following intraperitoneal renal transplantation, either solitary or... more Small bowel obstruction (SBO) following intraperitoneal renal transplantation, either solitary or due to simultaneous pancreaskidney transplantation, is a known complication. While SBO is most commonly due to adhesions, there have been documented cases of internal herniation following simultaneous pancreas-kidney transplantation with enteric drainage due to the formation of a mesenteric defect. We present a unique complication in which the transplant ureter has caused strangulation and necrosis of a length of small intestine. The transplant ureter was mistaken for a band adhesion and divided. Post-operative anuria signalled this difficult diagnosis. Subsequent re-look laparotomy and ureteric reimplantation with Boari f lap were required. Therefore, it is important to consider the ureter as a cause of internal herniation in kidney transplant patients and recognize that a band adhesion within the pelvis may in fact be the transplant ureter, obstructing a loop of small intestine beneath its course.

Transplantation, Jul 27, 2008

Abdominal Imaging, Sep 2, 2006

A case of giant renal artery aneurysm in a 63-year-old man is presented. Renal artery aneurysms a... more A case of giant renal artery aneurysm in a 63-year-old man is presented. Renal artery aneurysms are rare (incidence of <1%) and this case is one of the largest giant renal artery aneurysms recorded in the literature. This case also demonstrates the value of multidetector spiral CT renal angiography (CTA) in the diagnosis, planning and treatment of renal aneurysms.

Transplantation, Mar 27, 2014

Background. A shift towards partial nephrectomy (PN) in the management of small renal cell carcin... more Background. A shift towards partial nephrectomy (PN) in the management of small renal cell carcinoma (RCC) in recent years has prompted a parallel change in the management of rare cases of transplant allograft RCC. There are currently no guidelines on the management of allograft RCC. We present our center experience and review the latest evidence for management of RCC in renal transplant allografts. Methods. We performed a retrospective review of the transplant patient registry of a kidney-pancreas transplant center between 1984 and 2012. All confirmed allograft kidney RCC cases were included in this series. MEDLINE search of current literature on renal allograft RCC and selection of appropriate studies were conducted. Results. A total of 1,241 patients had received either a living, cadaveric, or combined kidney-pancreas transplant at our center, and four cases of allograft RCC were identified. The first case underwent a radical nephrectomy given the central location of the tumor and his young age. The second case underwent an open PN in the setting of a central tumor with minimal morbidity. The third case involved multiple renal lesions that were subsequently treated with radiofrequency ablation (RFA). The fourth case underwent a non-ischemic open PN in the setting of a midpole tumor with minimal morbidity. There have been no cases of local recurrence or metastatic progression at median 21.5 months' follow-up. Conclusion. We have shown the safety and efficacy of minimally invasive techniques such as PN and RFA in a variety of tumors. We consider PN as an appropriate therapy for localized, clinical T1 allograft RCC tumors.

PLOS ONE, Nov 28, 2017

Background Prostate cancer is the most commonly diagnosed non-skin cancer in men. Screening for p... more Background Prostate cancer is the most commonly diagnosed non-skin cancer in men. Screening for prostate cancer is widely accepted; however concerns regarding the harms outweighing the benefits of screening exist. Although patient's play a pivotal role in the decision making process, men may not be aware of the controversies regarding prostate cancer screening. Therefore we aimed to describe men's attitudes, beliefs and experiences of prostate cancer screening. Methods Systematic review and thematic synthesis of qualitative studies on men's perspectives of prostate cancer screening. Electronic databases and reference lists were searched to October 2016. Findings Sixty studies involving 3,029 men aged from 18-89 years, who had been screened for prostate cancer by Prostate Specific Antigen (PSA) or Digital Rectal Examination (DRE) and not screened, across eight countries were included. Five themes were identified: Social prompting (trusting professional opinion, motivation from family and friends, proximity and prominence of cancer); gaining decisional confidence (overcoming fears, survival imperative, peace of mind, mental preparation, prioritising wellbeing); preserving masculinity (bodily invasion, losing sexuality, threatening manhood, medical avoidance); avoiding the unknown and uncertainties (taboo of cancer-related death, lacking tangible cause, physiological and symptomatic obscurity, ambiguity of the procedure, confusing controversies); and prohibitive costs.

The Journal of Urology, Apr 1, 2019

preoperative plan based on conventional imaging using the McNemar correlation coefficient. RESULT... more preoperative plan based on conventional imaging using the McNemar correlation coefficient. RESULTS: Overall, 16 (80%) and 4 (20%) of the tumours were clinical T1a and T1b stage, respectively. Mean (AESD) operative time was 166 (AE 45) minutes and mean (AESD) Warm Ischemia Time was 10 (AE3.4) minutes. No intraoperative and post-operative complications were observed. After revision of the 3D reconstruction, PADUA and R.E.N.A.L. scores were reassessed in 12 (60%) and 16 (80%) cases, respectively (all p 0.02). Basing on conventional imaging, the preoperative plan of arterial clamping was: no clamping in 4 (20%), clamping of the main artery in 12 (60%) and selective clamping in 4 (20%) cases. The 3D virtual model revision induced the surgeon to modify the clamping plan in 8 (40%) cases, towards a selective approach, resulting in no cases of unclamped approach, clamping of the main artery in 8 (40%) individuals and selective clamping in 12 cases (60%; p[0.01). Moreover, basing on conventional imaging the surgeon was suggested to consider UCS repair in 40% of cases before surgery, while the 3D-based intraoperative plan resulted in UCS suture in 20% of patients (p[0.07). CONCLUSIONS: The use of 3D virtual models facilitated the preoperative knowledge of the tumour and changed the preoperative plan of arterial clamping in 40% of patients during RAPN toward a more selective clamping approach.

Anz Journal of Surgery, 2009

Background: Kidney transplants using organs from paediatric cadaver donors are uncommon and techn... more Background: Kidney transplants using organs from paediatric cadaver donors are uncommon and technically difficult. It has become accepted practice to transplant both kidneys en bloc from donors of 5 years into a single recipient. We aim to compare outcomes of en bloc kidney (EBK) transplants versus single kidney (SK) transplants from cadaver donors of age 5 years and lesser. Methods: Data reported to Australia and New Zealand Dialysis and Transplant Registry from 1989 to 2004 were analysed. Results: From donors 5 years of age and younger, there were 33 EBK and 38 SK transplants carried out. Overall graft survival rates at 1 and 5 years were 78 and 61%, respectively, in the EBK group and 63 and 55%, respectively, in the SK group (P = 0.94). Vascular thrombosis was the most common cause of early graft loss with an incidence of 11 and 18%, respectively, in the EBK and SK groups (P = 0.5). Conclusion: There is a trend towards a lower vascular thrombosis rate and a better long-term graft survival in EBK transplants. These transplants will remain a technical challenge for the surgeon and EBK transplants should remain the technique of choice for donors of 5 years and lesser.

Transplant International, Nov 1, 2006

The Journal of Urology, Apr 1, 2011

Anz Journal of Surgery, May 1, 2020

How to do it: a robotic kidney autotransplant Robotic kidney autotransplantation is an emerging a... more How to do it: a robotic kidney autotransplant Robotic kidney autotransplantation is an emerging alternative that has demonstrated outcomes comparable to the standard open technique. 1,2 We describe the first case of robotic kidney autotransplant in Australia. A 22-year-old female was diagnosed with refractory hypertension. Computed tomography angiogram demonstrated a pinhole stenosis for a length of 6 mm, close to the origin of the left renal artery (Fig. 1a). Distal to this, there was a 10-mm aneurysmal dilation which involved the branch point of the main renal artery. Percutaneous transluminal angioplasty was unsuccessful and resulted in infarction of the upper pole. Serum creatinine was 67 μmol/L. Following multidisciplinary consensus, decision was made to proceed with robotic kidney autotransplantation. This study

Journal of Medical Imaging and Radiation Oncology, May 1, 2001

Conventional digital subtraction renal arteriography (IA-DSA) has been traditionally used as the ... more Conventional digital subtraction renal arteriography (IA-DSA) has been traditionally used as the preoperative imaging modality for assessment of renal vascular anatomy for renal transplant donors. This study evaluates the potential use of spiral CT angiography in replacing IA-DSA in the preoperative assessment of this group of patients. Seven patients underwent both spiral CT angiography and IA-DSA between October 1997 and April 1998. It is concluded that spiral CT angiography can demonstrate the number, length and location of renal arteries and it is suggested that spiral CT angiography can potentially replace IA-DSA in the preoperative assessment of renal donors.

Anz Journal of Surgery, Nov 1, 2022

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European urology open science, May 1, 2024

Journal of Clinical Urology, Apr 25, 2017

Objectives: The purpose of this study was to determine whether commonly used methods of securing ... more Objectives: The purpose of this study was to determine whether commonly used methods of securing an indwelling catheter decrease the force transmission along the indwelling catheter to the bladder neck in response to an externally applied force. Materials and methods: A test apparatus was constructed to simulate key features of a catheter drainage system. A "bladder neck" was suspended from a force gauge, with an indwelling catheter inserted through it, tensioned with a urine drainage bag. The system was calibrated, and various methods of securement were tested, with the level of force transmitted to the bladder neck recorded. The methods of securement tested included: adhesive tape taped used a number of ways (including direct taping and a taped mesentery), and three commercially available devices. Results: Some securement devices were able to completely eliminate force transmission to the bladder neck (the Flexi-Trak and Grip-Lok devices). A taped mesentery performed well reducing the transmitted force by up to 85% compared with an unsecured control. Conclusion: Within the limitations of this study we were able to demonstrate that some of the commonly used methods of securing indwelling catheters do work. We were also able to show that adhesive tape was still effective, although not as effective as commercially available devices.

Hong Kong Journal of Nephrology, Apr 1, 2005

Transplantation, Jul 1, 2014

post-transplant we observed in Group A one (2.1 %) and in Group B seven (14.8%) UTIs; p= 0.01. Af... more post-transplant we observed in Group A one (2.1 %) and in Group B seven (14.8%) UTIs; p= 0.01. After 12 weeks there were in Group A fi ve (10.6%) and in Group B twelve (25.5%) UTIs; P=0.02. Conclusions: Early removal of the ureteric stent tied with the urinary catheter is safe and in our experience was not associated with urinary leak. The obvious major benefi t for the patients, of not needing a new admission for cystoscopic stent removal, is also associated with a reduced incidence of early and late UTIs.

Journal of surgical case reports, Aug 1, 2020

Small bowel obstruction (SBO) following intraperitoneal renal transplantation, either solitary or... more Small bowel obstruction (SBO) following intraperitoneal renal transplantation, either solitary or due to simultaneous pancreaskidney transplantation, is a known complication. While SBO is most commonly due to adhesions, there have been documented cases of internal herniation following simultaneous pancreas-kidney transplantation with enteric drainage due to the formation of a mesenteric defect. We present a unique complication in which the transplant ureter has caused strangulation and necrosis of a length of small intestine. The transplant ureter was mistaken for a band adhesion and divided. Post-operative anuria signalled this difficult diagnosis. Subsequent re-look laparotomy and ureteric reimplantation with Boari f lap were required. Therefore, it is important to consider the ureter as a cause of internal herniation in kidney transplant patients and recognize that a band adhesion within the pelvis may in fact be the transplant ureter, obstructing a loop of small intestine beneath its course.

Transplantation, Jul 27, 2008

Abdominal Imaging, Sep 2, 2006

A case of giant renal artery aneurysm in a 63-year-old man is presented. Renal artery aneurysms a... more A case of giant renal artery aneurysm in a 63-year-old man is presented. Renal artery aneurysms are rare (incidence of <1%) and this case is one of the largest giant renal artery aneurysms recorded in the literature. This case also demonstrates the value of multidetector spiral CT renal angiography (CTA) in the diagnosis, planning and treatment of renal aneurysms.

Transplantation, Mar 27, 2014

Background. A shift towards partial nephrectomy (PN) in the management of small renal cell carcin... more Background. A shift towards partial nephrectomy (PN) in the management of small renal cell carcinoma (RCC) in recent years has prompted a parallel change in the management of rare cases of transplant allograft RCC. There are currently no guidelines on the management of allograft RCC. We present our center experience and review the latest evidence for management of RCC in renal transplant allografts. Methods. We performed a retrospective review of the transplant patient registry of a kidney-pancreas transplant center between 1984 and 2012. All confirmed allograft kidney RCC cases were included in this series. MEDLINE search of current literature on renal allograft RCC and selection of appropriate studies were conducted. Results. A total of 1,241 patients had received either a living, cadaveric, or combined kidney-pancreas transplant at our center, and four cases of allograft RCC were identified. The first case underwent a radical nephrectomy given the central location of the tumor and his young age. The second case underwent an open PN in the setting of a central tumor with minimal morbidity. The third case involved multiple renal lesions that were subsequently treated with radiofrequency ablation (RFA). The fourth case underwent a non-ischemic open PN in the setting of a midpole tumor with minimal morbidity. There have been no cases of local recurrence or metastatic progression at median 21.5 months' follow-up. Conclusion. We have shown the safety and efficacy of minimally invasive techniques such as PN and RFA in a variety of tumors. We consider PN as an appropriate therapy for localized, clinical T1 allograft RCC tumors.

PLOS ONE, Nov 28, 2017

Background Prostate cancer is the most commonly diagnosed non-skin cancer in men. Screening for p... more Background Prostate cancer is the most commonly diagnosed non-skin cancer in men. Screening for prostate cancer is widely accepted; however concerns regarding the harms outweighing the benefits of screening exist. Although patient's play a pivotal role in the decision making process, men may not be aware of the controversies regarding prostate cancer screening. Therefore we aimed to describe men's attitudes, beliefs and experiences of prostate cancer screening. Methods Systematic review and thematic synthesis of qualitative studies on men's perspectives of prostate cancer screening. Electronic databases and reference lists were searched to October 2016. Findings Sixty studies involving 3,029 men aged from 18-89 years, who had been screened for prostate cancer by Prostate Specific Antigen (PSA) or Digital Rectal Examination (DRE) and not screened, across eight countries were included. Five themes were identified: Social prompting (trusting professional opinion, motivation from family and friends, proximity and prominence of cancer); gaining decisional confidence (overcoming fears, survival imperative, peace of mind, mental preparation, prioritising wellbeing); preserving masculinity (bodily invasion, losing sexuality, threatening manhood, medical avoidance); avoiding the unknown and uncertainties (taboo of cancer-related death, lacking tangible cause, physiological and symptomatic obscurity, ambiguity of the procedure, confusing controversies); and prohibitive costs.

The Journal of Urology, Apr 1, 2019

preoperative plan based on conventional imaging using the McNemar correlation coefficient. RESULT... more preoperative plan based on conventional imaging using the McNemar correlation coefficient. RESULTS: Overall, 16 (80%) and 4 (20%) of the tumours were clinical T1a and T1b stage, respectively. Mean (AESD) operative time was 166 (AE 45) minutes and mean (AESD) Warm Ischemia Time was 10 (AE3.4) minutes. No intraoperative and post-operative complications were observed. After revision of the 3D reconstruction, PADUA and R.E.N.A.L. scores were reassessed in 12 (60%) and 16 (80%) cases, respectively (all p 0.02). Basing on conventional imaging, the preoperative plan of arterial clamping was: no clamping in 4 (20%), clamping of the main artery in 12 (60%) and selective clamping in 4 (20%) cases. The 3D virtual model revision induced the surgeon to modify the clamping plan in 8 (40%) cases, towards a selective approach, resulting in no cases of unclamped approach, clamping of the main artery in 8 (40%) individuals and selective clamping in 12 cases (60%; p[0.01). Moreover, basing on conventional imaging the surgeon was suggested to consider UCS repair in 40% of cases before surgery, while the 3D-based intraoperative plan resulted in UCS suture in 20% of patients (p[0.07). CONCLUSIONS: The use of 3D virtual models facilitated the preoperative knowledge of the tumour and changed the preoperative plan of arterial clamping in 40% of patients during RAPN toward a more selective clamping approach.

Anz Journal of Surgery, 2009

Background: Kidney transplants using organs from paediatric cadaver donors are uncommon and techn... more Background: Kidney transplants using organs from paediatric cadaver donors are uncommon and technically difficult. It has become accepted practice to transplant both kidneys en bloc from donors of 5 years into a single recipient. We aim to compare outcomes of en bloc kidney (EBK) transplants versus single kidney (SK) transplants from cadaver donors of age 5 years and lesser. Methods: Data reported to Australia and New Zealand Dialysis and Transplant Registry from 1989 to 2004 were analysed. Results: From donors 5 years of age and younger, there were 33 EBK and 38 SK transplants carried out. Overall graft survival rates at 1 and 5 years were 78 and 61%, respectively, in the EBK group and 63 and 55%, respectively, in the SK group (P = 0.94). Vascular thrombosis was the most common cause of early graft loss with an incidence of 11 and 18%, respectively, in the EBK and SK groups (P = 0.5). Conclusion: There is a trend towards a lower vascular thrombosis rate and a better long-term graft survival in EBK transplants. These transplants will remain a technical challenge for the surgeon and EBK transplants should remain the technique of choice for donors of 5 years and lesser.

Transplant International, Nov 1, 2006

The Journal of Urology, Apr 1, 2011

Anz Journal of Surgery, May 1, 2020

How to do it: a robotic kidney autotransplant Robotic kidney autotransplantation is an emerging a... more How to do it: a robotic kidney autotransplant Robotic kidney autotransplantation is an emerging alternative that has demonstrated outcomes comparable to the standard open technique. 1,2 We describe the first case of robotic kidney autotransplant in Australia. A 22-year-old female was diagnosed with refractory hypertension. Computed tomography angiogram demonstrated a pinhole stenosis for a length of 6 mm, close to the origin of the left renal artery (Fig. 1a). Distal to this, there was a 10-mm aneurysmal dilation which involved the branch point of the main renal artery. Percutaneous transluminal angioplasty was unsuccessful and resulted in infarction of the upper pole. Serum creatinine was 67 μmol/L. Following multidisciplinary consensus, decision was made to proceed with robotic kidney autotransplantation. This study

Journal of Medical Imaging and Radiation Oncology, May 1, 2001

Conventional digital subtraction renal arteriography (IA-DSA) has been traditionally used as the ... more Conventional digital subtraction renal arteriography (IA-DSA) has been traditionally used as the preoperative imaging modality for assessment of renal vascular anatomy for renal transplant donors. This study evaluates the potential use of spiral CT angiography in replacing IA-DSA in the preoperative assessment of this group of patients. Seven patients underwent both spiral CT angiography and IA-DSA between October 1997 and April 1998. It is concluded that spiral CT angiography can demonstrate the number, length and location of renal arteries and it is suggested that spiral CT angiography can potentially replace IA-DSA in the preoperative assessment of renal donors.

Anz Journal of Surgery, Nov 1, 2022