Immediate endoscopic management of complete iatrogenic anterior urethral injuries: A case series with long-term results

BACKGROUND: Urethral injury produces partial or complete disruption of the urethral integrity. Advances in endourology have made endoscopic management of most of these injuries feasible without greatly compromising the final result. We report our institutional experience of immediate endoscopic realignment of complete iatrogenic anterior urethral injury. METHODS: From May 1997 to May 2003, seven patients with complete anterior urethral disruption were managed by immediate endoscopy guided splinting of urethra. Retrograde urethroscopy, combined with fluoroscopic guidance and in some cases antegrade cystoscopy through a suprapubic stab cystostomy was performed. A guide wire was negotiated across the disruption. Later, a 16 F Foley catheter was placed for 1–3 weeks. Patients were followed up at 1, 3, 6 and 12 months and then yearly to assess the long-term outcome of endoscopic management. RESULTS: Immediate endoscopic realignment was achieved in all patients. Three patients developed recurrence at six months; that was treated by optical urethrotomy. Only one patient developed multiple recurrences over an average follow-up of 49.2 months (range 7 to 74 months). He was offered open end-to-end urethroplasty at twenty months after third recurrence. Thus immediate endoscopic realignment avoided any further intervention in four patients (57.14%); while after an additional optical urethrotomy, urethroplasty could be avoided in six patients (87.2%). CONCLUSION: Immediate endoscopic realignment of traumatic urethral disruption is a feasible, safe and effective treatment modality for management of patients with iatrogenic complete anterior urethral injuries

Ablative therapy for people with localised prostate cancer : a systematic review and economic evaluation

The research reported in this issue of the journal was funded by the HTA programme as project number 10/136/01. The contractual start date was in April 2012. The draft report began editorial review in October 2013 and was accepted for publication in April 2014. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors’ report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report. Acknowledgements We thank l the people recruited from the local UCAN for providing valuable consumer insight and advice through their participation as members of the project focus group: - Mark Emberton (Professor of Interventional Oncology), Damian Greene (consultant urologist), Axel Heidenreich (Professor and Director of Department of Urology), Christoph von Klot (specialist in brachytherapy), Roger Kockelbergh (BAUS chairman and Clinical Director of Urology) and Axel Merserburger (Deputy Clinical Director of Urology and Urologic Oncology) for providing their clinical expertise as members of the project advisory group - Edgar Paez (consultant urologist) and Gill Lawrence (Head of Radiotherapy Physics) for providing a list of staff time by grade and specialty involved in EBRT - Debbie Bennett (Radiotherapy Service Manager) for providing estimates for the expected number of uses for EBRT - Ian Pedley (clinical director/clinical oncologist) and Gill Lawrence for providing a list of all resource inputs relevant to brachytherapy - Steve Locks (Consultant Clinical Scientist in Radiotherapy) for providing a list of reusable equipment and consumables used during brachytherapy, along with their unit costs - Sue Asterling (urology research nurse) and Mark Kelly (Acting Divisional General Manager – Theatres) for providing a list of all resource inputs relevant to cryotherapy - Lara Kemp for providing secretarial support. The Health Services Research Unit is core funded by the Chief Scientist Office of the Scottish Government Health Directorates.Peer reviewedPublisher PD

Non-surgical treatment of primary female urethral cancer

Primary carcinomas of the female urethra are extremely rare, with an annual incidence of less than ten in one million. Currently, there is no consensus regarding management of this malignancy. However, there have been several case reports demonstrating the efficacy of chemoradiation in the treatment of female urethral cancer. In this report we present two cases of female primary urethral adenocarcinoma that were treated by concomitant chemotherapy and external beam radiotherapy, followed by interstitial brachytherapy

Cheap Talk Games with Sequential Posterior Formation

People often have to acquire information from sources who may not share their preferences. This work studies the behavior of economic agents who face this situation through cheap talk games, where a potentially un-aligned sender communicates information about the state of the world to a receiver. In our model, the receiver exhibits a specific type of irrationality called sequential updating. Rather than directly using Bayes' Rule to form beliefs about the state of the world, this receiver first forms a belief about the sender's motivation based on their message and then uses that belief to determine the state. This behavior over-emphasizes the sender's motivation and leads the receiver to con rm their own priors by using the same message to update them twice. We show in three cheap talk contexts that, compared to the original Bayesian formulations, introducing sequentially-updating receivers does not dramatically alter the form of equilibrium or the receiver's expected utility. However, we identify a clear effect that depends on the sender's bias: sequential updating curtails the effects of misleading messages by un-aligned senders, but at the cost of making the receiver less responsive to the truth. By extending sequential updating from a non-strategic context to a game theoretic one, we showcase its strengths in producing realistic responses and also its weaknesses, in particular the complex conditions it induces. We also propose extensions of this paradigm to network models of communication which more accurately capture large-scale behavior in the face of potential misinformation

Examining Political Trustworthiness through Text-Based Measures of Ideology

This work shows the value of word-level statistical data from the US Congressional Record for studying the ideological positions and dynamic behavior of senators. Using classification techniques from machine learning, we predict senators’ party with near-perfect accuracy. We also develop text-based ideology scores to embed a politician’s ideological position in a one-dimensional policy space. Using these scores, we find that speech that diverges from voting positions may result in higher vote totals. To explain this behavior, we show that politicians use speech to move closer to their party’s average position. These results not only provide empirical support for political economy models of commitment, but also add to the growing literature of machine-learning-based text analysis in social science contexts

Persuasion with ambiguous receiver preferences

Abstract I describe a Bayesian persuasion problem where Receiver has a private type representing a cutoff for choosing Sender’s preferred action, and Sender has maxmin preferences over all Receiver type distributions with known mean and bounds. This problem can be represented as a zero-sum game where Sender chooses a distribution of posterior mean beliefs that is a mean-preserving contraction of the prior over states, and an adversarial Nature chooses a Receiver type distribution with the known mean; the player with the higher realization from their chosen distribution wins. I formalize the connection between maxmin persuasion and similar games used to model political spending, all-pay auctions, and competitive persuasion. In both a standard binary-state setting and a new continuous-state setting, Sender optimally linearizes the prior distribution over states to create a distribution of posterior means that is uniform on a known interval with an atom at the lower bound of its support