National audit of incontinence surgery in the United Kingdom.

The aim of the study was to describe the experience, current trends and management of incontinence surgery for urodynamic stress incontinence (USI) in the United Kingdom. The study was a postal questionnaire survey that was sent to a cohort of surgeons known to be performing continence surgery. The subjects addressed included the considered role of the surgeon, the total number and type of operations performed in the last year, urodynamics and physiotherapy prior to incontinence surgery, operative complications, postoperative advice and follow-up (lengths and methods). The response rate was 54%. Large variations were found in all areas. The survey provides evidence of the number of incontinence operations performed, potentially important trends and differences in the practice and management of incontinence in the United Kingdom. This survey may be helpful in making guidelines and standards for audit at regional, local and individual levels as well as recommendations for strategies to enhance professional expertise in urogynaecology in the United Kingdom.     

Traumatic rupture of the corpus cavernosum: evaluation and management

Rupture of the corpus cavernosum is a rare but probably under-reported entity. It truly represents a urological emergency and current recommendations are for early surgical intervention. We review 5 cases with evaluation, treatment and followup. Delays in treatment lead to long-term complications, such as erectile dysfunction and penile curvature.     

An unusual case of sundown syndrome subsequent to a traumatic head injury

An unusual case of sundown syndrome is here reported, in which a bilingual patient would involuntarily change languages at sunset. Numerous theories have been advanced in attempting to account for sundowning. Cameron [1] has suggested that nocturnal delirium was based on an inability to maintain a spatial image without the assistance of repeated visualization. Krai [2] and Wolanin and Phillips [3] have argued for a more psychogenic account, by stating that psychosocial stressors may, in concert with impaired cognitive functioning, account for sundowning. The present case concerns a 42-year-old white male who in January 1989 suffered a closed head injury. A thorough personal history as well as a detailed examination of the patient's daily activities allowed us to account for the unusual manner in which the sundowning manifested itself. The uniqueness of this case allows us to underscore both the psychological as well as environmental and neurological factors involved in sundowning. Thus, we have as a consequence been able to synthesize the seemingly disparate accounts of both Cameron and more recent published literature [2, 3].