Conducting interviews about penile cancer: A patient-conducted-interview study

Objectives: Penile cancer is a rare but destructive condition. It has been found to be detrimental to body image, general health and sexual functioning, while increasing anxiety and social problems. The UK now manages penile cancer through specialist multi-disciplinary teams that see at least 25 new patients a year. There is a need to understand patients’ experiences so that treatment can be improved. The aim of this research is to allow patients to participate in the development of a nationwide interview study. Methods: A one-day participative workshop where a range of men diagnosed with penile cancer design and conduct audio and video interviews exploring experiences of treatment within the group. Results: Key themes included the rehabilitation of urinary functioning and strategies for coping with the physical and social impact of treatment. Conclusions: The findings emphasise the importance of day-to-day practicalities for men treated for penile cancer, which can form the basis for larger studies about how to better understand and manage their treatment

Psychology, men and cancer

A disease of the anatomical or social body, cancer raises fears about the uncontrollable division and multiplication of some abnormality that will lead ultimately to the destruction of those very conditions that make possible our lives. Cancer incidence and mortality rates are higher in men than women, raising questions about the roles for psychologists in relation to gender and cancer. Psychologists are wont to question the division of population level statistics by sex rather than other, such as behavioural, categories. Conceptual distinctions between biological sex and psychosocial gender are taught early in the psychology curriculum, but cancer of the breast questions the easy separation of the biological bod

THE IMPACT OF PENILE CANCER TREATMENT ON SEXUAL RELATIONSHIPS: A QUALITATIVE ENQUIRY

Background: Penile cancer is a rare but highly treatable condition. Current guidance recommends the use of a surgical procedure to excise the primary tumour (and a margin of normal penile tissue). Whilst treatment can be effective, treatment often has a significant impact on a patient's sexual and urinary function, and physical and mental wellbeing. The objective of this study was to explore the impact of treatment for penile cancer on sexual function and relationships. Methods: Qualitative data was collected via narrative video interviews. Maximum variation sampling was used to acquire the widest possible range of experiences. All interviews were recorded using either a digital video recorder or digital audio recorder, transcribed. A method of constant comparison analysis was used to illicit themes and outliers. Results: Twenty seven men were interviewed; mean age at diagnosis = 63 (range = 41-82); Mean number of years post-surgery = 3 (range = 0-15 years) 15 men were married, a further two were in a committed relationship, the remaining 10 were single/widowed. All men had received surgical treatment ranging from circumcision to total penectomy. Just two men had attended any form of psychological therapy. The impact of treatment varied considerably. The majority of men talked about still being able to experience arousal and sexual pleasure in some way. However, for many, penetrative sex was awkward and less gratifying than before treatment. One man who had received a total penectomy was surprised to experience a form of orgasm after surgery. For a number of men, the impact of treatment on their ability to satisfy their sexual partners was a key concern. Men who were able to openly talk with their partners about sex and the impact of the treatment on sexual practice found this a great comfort. Conclusion: The significance of sex for a man can differ considerably between individuals; relationship status, age and life stage are all likely to have a bearing on the role that sex plays in a man life. A diagnosis of cancer can also affect how a man (and his partner) views sex and the level of importance which he attaches to it. For men who are sexually active prior to treatment, surgery will undoubtedly result in changes to sexual practice, however, treatment does not have to result in sexual abstinence

Observation of critical phenomena and self-similarity in the gravitational collapse of radiation fluid

We observe critical phenomena in spherical collapse of radiation fluid. A sequence of spacetimes $\cal{S}[\eta]$ is numerically computed, containing models ($\eta\ll 1$) that adiabatically disperse and models ($\eta\gg 1$) that form a black hole. Near the critical point ($\eta_c$), evolutions develop a self-similar region within which collapse is balanced by a strong, inward-moving rarefaction wave that holds $m(r)/r$ constant as a function of a self-similar coordinate $\xi$. The self-similar solution is known and we show near-critical evolutions asymptotically approaching it. A critical exponent $\beta \simeq 0.36$ is found for supercritical ($\eta>\eta_c$) models.Comment: 10 pages (LaTeX) (to appear in Phys. Rev. Lett.), TAR-039-UN

Mortality and sexuality after diagnosis of penile cancer: A participative study

Objectives: Survival for penile cancer is high but treatment can have a long-term detrimental effect on urological function and quality of life. Due to its rarity, it is difficult to include men with penile cancer in research about their condition. The aim of this study was to identify aspects of their diagnosis and treatment that they would want explored in penile cancer research.    Design: The study employed a participative, mixed-qualitative-methods design; it utilised focus groups and patient-conducted interviews, combined into a one-day ‘pilot workshop’. The data were analysed using framework analysis.   Results: ‘Early signs and seeking help’, ‘disclosure of a ‘personal’ cancer’ and ‘urological (dys)function’ emerged as three key themes.   Conclusions: Men with penile cancer want research about their condition to explore early signs and helping seeking, disclosure of a ‘personal’ cancer and urological (dys)function. Research could use methodologies that include consideration of the chronological narrative of the experiences of men with penile cancer, which could be applied in clinical practice by integrating opportunities to explore specific aspects of their experiences at appropriate times along the care pathway

Bacteraemia during transurethral resection of the prostate: what are the risk factors and is it more common than we think?

The aim of this work was to investigate the microbial causes, incidence, duration, risk factors and clinical implications of bacteraemia occurring during transurethral resection of the prostate (TURP) surgery to better inform prophylaxis strategies. An ethically approved, prospective, cohort study of patients undergoing TURP was conducted. Clinical information and follow-up details were collected using standardized data collection sheets. Blood was obtained for culture at 6 different time points peri-procedure. Standard of care antibiotic prophylaxis was given prior to surgery. Bacteriuria was assessed in a pre-procedure urine sample. Histopathology from all prostate chips was assessed for inflammation and malignancy. 73 patients were consented and 276 blood samples obtained. No patients developed symptomatic bacteraemia during the procedure, 17 patients developed asymptomatic bacteraemia (23.2%). Enterococcus faecalis and Pseudomonas aeruginosa were the most common organisms cultured. 10 minutes after the start of the TURP, the odds ratio (OR) of developing bacteraemia was 5.38 (CI 0.97-29.87 p=0.05), and 20 minutes after the start of the procedure, the OR was 6.46 (CI 1.12-37.24, p=0.03), compared to before the procedure. We also found an association between the development of intra-operative bacteraemia and recent antibiotic use (OR 4.34, CI 1.14-16.62, p=0.032), the presence of a urinary catheter (OR 4.92, CI 1.13-21.51, p=0.034) and a malignant histology (OR 4.90, CI 1.30-18.46, p=0.019). There was no statistical relationship between pre-operative urine culture results and blood culture results. This study shows that asymptomatic bacteraemia is commonly caused by TURP and occurs in spite of antibiotic prophylaxis. Our findings challenge the commonly held view that urine is the primary source of bacteraemia in TURP-associated sepsis and raise the possibility of occult prostatic infection as a cause of bacteraemia. More work will be needed to determine the significance of transient bacteraemia in relation to more serious complications like infective endocarditis and malignancy

Null Geodesic Expansion in Spherical Gravitational Collapse

We derive an expression for the expansion of outgoing null geodesics in spherical dust collapse and compute the limiting value of the expansion in the approach to singularity formation. An analogous expression is derived for the spherical collapse of a general form of matter. We argue on the basis of these results that the covered as well as the naked singularity solutions arising in spherical dust collapse are stable under small changes in the equation of state.Comment: 10 pages, Latex File, No figure

Naked Singularities in Spherically Symmetric Inhomogeneous Tolman-Bondi Dust Cloud Collapse

We investigate the occurrence and nature of naked singularity for the inhomogeneous gravitational collapse of Tolman-Bondi dust clouds.It is shown that the naked singularities form at the center of the collapsing cloud in a wide class of collapse models which includes the earlier cases considered by Eardley and Smarr and Christodoulou. This class also contains self-similar as well as non-self-similar models. The structure and strength of this singularity is examined and the question is investigated as to when a non-zero measure set of non-spacelike trajectories could be emitted from the singularity as opposed to isolated trajectories coming out. It is seen that the weak energy condition and positivity of energy density ensures that the families of non-spacelike trajectories come out of the singularity. The curvature strength of the naked singularity is examined which provides an important test for its physical significance and powerful curvature growth near the naked singularity is pointed out for several subclasses considered. The conditions are discussed for the naked singularity to be globally naked. Implications for the basic issue of the final fate of gravitational collapse are considered once the inhomogeneities in the matter distribution are taken into account. It is argued that a physical formulation for the cosmic censorship may be evolved which avoids the features above. Possibilities in this direction are discussed while indicating that the analysis presented here should be useful for any possible rigorous formulation of the cosmic censorship hypothesis.Comment: 41 pages, TIFR preprint TAP 9/9

On the Role of Initial Data in the Gravitational Collapse of Inhomogeneous Dust

We consider here the gravitational collapse of a spherically symmetric inhomogeneous dust cloud described by the Tolman-Bondi models. By studying a general class of these models, we find that the end state of the collapse is either a black hole or a naked singularity, depending on the parameters of the initial density distribution, which are $\rho_{c}$, the initial central density of the massive body, and $R_0$, the initial boundary. The collapse ends in a black hole if the dimensionless quantity $\beta$ constructed out of this initial data is greater than 0.0113, and it ends in a naked singularity if $\beta$ is less than this number. A simple interpretation of this result can be given in terms of the strength of the gravitational potential at the starting epoch of the collapse.Comment: Original title changed, numerical range of naked singularity corrected. Plain Tex File. 14 pages. To appear in Physical Review

Spatially self-similar locally rotationally symmetric perfect fluid models

Einstein's field equations for spatially self-similar locally rotationally symmetric perfect fluid models are investigated. The field equations are rewritten as a first order system of autonomous ordinary differential equations. Dimensionless variables are chosen in such a way that the number of equations in the coupled system of differential equations is reduced as far as possible. The system is subsequently analyzed qualitatively for some of the models. The nature of the singularities occurring in the models is discussed.Comment: 27 pages, pictures available at ftp://vanosf.physto.se/pub/figures/ssslrs.tar.g