David M Quinlan

St Vincent's University Hospital, Dublin, Leinster, Ireland

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Publications (42)73.87 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Renal cell carcinoma (RCC) represents about 3% of adult malignancies in Ireland. Worldwide there is a reported increasing incidence and recent studies report a stage migration towards smaller tumours. We assess the clinico-pathological features and survival of patients with RCC in a surgically treated cohort.
    03/2014; 8(3-4):125-32.
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    ABSTRACT: Renal artery aneurysms (RAA) are the second most common visceral artery aneurysm. In cases of rupture they pose a significant and emergent surgical challenge. Extracorporeal arterial reconstruction and autotransplantation is often necessary in certain complex cases that are not amenable to aneurysm repair in vivo. We report a case of a 35 year old female with a RAA in a solitary functioning kidney, requiring ex vivo reconstruction and autotransplantation to the iliac vessels.
    Irish medical journal 02/2014; 107(2):50-1. · 0.51 Impact Factor
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    ABSTRACT: PURPOSE To assess the value of PIRADs scoring in predicting positive biopsy in patients with previous negative biopsy and elevated PSA, where the repeat biopsy is MR directed, trans-rectal ultrasound guided. METHOD AND MATERIALS HIPAA compliant, IRB approved study. 52 patients (mean age 64 years, range 52-76), with previous negative prostate biopsy and elevated PSA (mean =14.4 , range =7-34.4 ) underwent combined targeted and 12 sample sectoral biopsy over a 14 month period. Each patient’s MRI was retrospectively reviewed, blinded to biopsy result and each area of abnormality on MRI was scored according to PIRADs scheme, with separate T2, DWI, and overall scores per lesion. RESULTS Positive biopsy was obtained in 24/52 patients (overall yield of 46%). Predictive values based on most suspicious lesion overall per patient. PIRADs scores 1-5 (clinically significant cancer highly unlikely, unlikely, equivocal, likely, highly likely respectively). The positive predictive values of T2 PIRADS scores of 1,2,3,4 and 5 were,0, 33,33, 58 and 100% respectively. The positive predictive value of DWI PIRADS score of 1,2,3,4 and 5, was 0,N/A(no scores of 2), 0, 42 and 57% respectively. Only patients with overall score of 3-5 were biopsied, the positive predictive value of overall PIRADs score of 3, 4, 5 was 14, 57 and 100% respectively. CONCLUSION PIRADs provides a useful framework for reporting likelihood of prostate cancer, facilitating communication and guiding expectation of clinicians and patients in the setting of MRI assessment for occult prostate cancer and targeted biopsy. CLINICAL RELEVANCE/APPLICATION In patients with raised PSA and previous negative prostate biopy, the use of MRI can help target repeat biopsy and predict the likelihood of a positive result.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: To identify the incidence and features of significant incidental findings discussed at our departmental multidisciplinary team meeting (MDM). The improved quality of radiological imaging has resulted in increased rates of incidental findings. Although some may be trivial, many have clinical significance and early diagnosis and treatment may be beneficial. A retrospective analysis was performed of all cases discussed at the MDM between January 2012 and February 2013. Cases were divided into two groups - Group 1 consisted of patients whose initial imaging was performed for a urological presentation which resulted in a synchronous finding; Group 2 consisted of patients who were referred with a synchronous urological finding for discussion following investigation of an initial benign urological condition or a non-urological condition. 696 patients were discussed at 53 MDMs. 109 (15.7%) patients had incidental findings. 61 (56%) of these were in Group 1. 16 (26.2%) were synchronous malignant diagnoses, 25 (41%) were benign and 20 (32.8%) were indeterminate. 48 (44%) patients in Group 2 - 40 (83.3%) were renal in origin and 30 (75%) of these proceeded to surgery. The median tumour size was 3.2 cm (Range: 1.2 cm-10 cm). One patient had radio-frequency ablation. Two were referred for palliative care. Seven patients are under ongoing surveillance - the median size of these lesions is 3.6 cm (Range: 2.1 cm-8.3 cm). A substantial workload is generated from the investigation of incidental findings discussed at MDM - these now represent the majority of the caseload for renal cancer surgery.
    The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 11/2013; · 1.97 Impact Factor
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    ABSTRACT: Bowel preparation was established as part of the pre-operative course for patients undergoing ileal conduit formation since the late 1970's. Rationales for its use include reduction in infection and wound complications, technically easier anastomosis and earlier return to bowel function. However, recent reports have challenged this practice. Traditionally antibiotics were also administered for several days prior to surgery with the assumption that bacterial load was reduced. Modification of antibiotic protocols resulted from evidence-based findings. Furthermore, publications emphasizing the benefit of Enhanced Recovery Protocols/Programmes (ERP) have become contemporary. An online multiple-choice questionnaire (via Monkey Survey(®)) was administered to all consultant urologists in Ireland. This national cross-sectional study evaluated the use of bowel preparation and antibiotic prophylaxis prior to urinary diversion. In addition, we also assessed consultant urologists' awareness of ERP and their views on the introduction and implementation of such a national program. Of the 41 consultant urologists surveyed, 80.4% (n = 33) responded. 63.6% routinely used bowel preparation. Klean Prep(®) was the most commonly used bowel preparation. 80.9% of urologists admit their patient's one-day pre-operatively for bowel preparation, with 87.8% using antibiotic prophylaxis at anesthesia induction, and 18.1% continuing the antibiotics for 24-48 h post-operatively. Although 74% of consultants are aware of ERP, only 66.6% are in favor of their national implementation. The majority of Irish urologists use bowel preparation prior to ileal conduit formation. Substantial recent evidence has emerged showing no difference in infective complications or anastomotic leakage when bowel preparation was not used. National guidelines would be beneficial regarding the use of bowel preparation, antibiotic prophylaxis and ERP for urinary diversion surgery.
    The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 10/2013; · 1.97 Impact Factor
  • International Journal of Surgery (London, England) 10/2013; 11(8):732. · 1.44 Impact Factor
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    ABSTRACT: Fracture of the penis is a rare urological emergency which occurs as a result of abrupt trauma to an erect penis. There is paucity of data regarding long-term sexual function or erectile potency following fracture of the penis. The aim of this study is to objectively assess the overall sexual function following fracture of the penis. A retrospective analysis of 21 penile fractures was performed. A voluntary telephone questionnaire was performed to assess long term outcomes using three validated questionnaires-the Erection Hardness Grading Scale, the International Index of Erectile Function (IIEF-5) and the Brief Male Sexual Function inventory (BMSFI). The mean age was 33.1 years (range: 19-63). The median follow up was 46 months (range: 3-144). All fractures were a result of sexual misadventure and all were surgically repaired. There were two concomitant urethral injuries. Seventeen patients were contactable. Fourteen patients demonstrated no evidence of erectile dysfunction (ED) (IIEF-5>22), 1 patient reported symptoms of mild ED (IIEF-5, 17-21) and one patient reported mild to moderate ED (IIEF-5, 12-16). No patients reported insufficient erection for penetration (EHGS: 1 or 2). Regarding the overall BMSFI, 13 (83%) patients were mostly satisfied or very satisfied with their sex life within the previous month. In a small surgical series of men with penile fracture managed within a short time frame from presentation, we demonstrate erectile potency is maintained. Long-term overall sexual satisfaction is promising.
    Canadian Urological Association journal = Journal de l'Association des urologues du Canada 07/2013; 7(7-8):252-7. · 1.66 Impact Factor
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    ABSTRACT: PURPOSE: There is growing conflict in the literature describing the effect of delayed treatment on outcomes following radical prostatectomy. There is also evidence to suggest progression of low-risk prostate cancer to develop higher grades and volumes of prostate cancer during active surveillance. It is unknown as to what affect a delay in referral of those men with abnormal screened-PSA levels have on subsequent Gleason grade. METHODS: We identified 350 men through our rapid access prostate clinic who underwent TRUS biopsy for abnormal age-related PSA and/or abnormal clinical examination. Clinicopathological findings were compared for those with positive versus negative TRUS biopsies, and for those with initial delays in referral (<12 months, 12-18 months, and >18 months). We used ANOVA and Student's t-tests amongst other statistical tools to examine significance of clinical findings. RESULTS: Of the 350 men who underwent TRUS biopsy, those with a delay in referral of 12 months or more were significantly associated with higher PSA titers, clinically palpable disease and likelihood of diagnosis with prostate cancer. A delay of 18 months or more led to a significantly higher risk of being diagnosed with a leading grade 4 prostate cancer, which was further supported using PSA velocity as a diagnostic tool (change >0.4 ng/ml/year). CONCLUSION: We recommend that repeated asymptomatic abnormal age-related PSA readings and/or abnormal clinical examination in the screened population be referred without delay to a urologist for further assessment, enrolment into an active surveillance program or definitive subsequent treatment. Prostate 9999: XX-XX, 2013. © 2013 Wiley Periodicals, Inc.
    The Prostate 05/2013; · 3.84 Impact Factor
  • John Brennan, Fardod O'kelly, David M Quinlan
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    ABSTRACT: Abstract Spontaneous abscess of the corpus cavernosum is an extremely rare presentation. This is the first documented case of corpus cavernosal abscess caused exclusively by organisms from the Streptococcus milleri group, which have previously been described as being associated with abscess formation. This report outlines the case of a 56-year-old alcoholic male with no risk factors who presented with an 8-day history of penile pain, swelling and sepsis. A diagnosis of abscess of the right corpus cavernosum was confirmed by magnetic resonance imaging. Management required intravenous antibiotics, penile exploration, incision and drainage. Streptococcus constellatus and Streptococcus intermedius were isolated. The aetiology, diagnosis, management and microbiology of this unusual presentation are discussed, and the few previously documented cases of abscess of the corpus cavernosum are reviewed.
    Scandinavian journal of urology. 03/2013;
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    ABSTRACT: Management of the surgically unfit patient with symptomatic cholelithiasis can be fraught with difficulty. We describe the case of on such gentleman in whom percutaneous transhepatic cholecystoscopy was used to completely fragment a large gallbladder calculus through the use of a nephroscope and Swiss lithoclast Master.
    Irish medical journal 03/2013; 106(3):88-9. · 0.51 Impact Factor
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    ABSTRACT: BACKGROUND: Recent evidence has suggested that the introduction of rapid access prostate cancer programs has led to a more streamlined pathway for patients, and was designed to ultimately reduce referral delays AIMS: To identify the initial impact of the introduction of the rapid access prostate clinic on Gleason grading within the prostate cancer cohort, as well as the impact of distance from a tertiary referral center on subsequent Gleason grading METHODS: A prospective database was maintained from those men attended the rapid access prostate clinic in St. Vincent's University Hospital. Data relating to demographics, biopsy results, retrospective PSA readings, and subsequent treatment pathways were all recorded and analyzed. Statistical significance was taken at p < 0.05 RESULTS: Prospective data from the rapid access prostate clinic illustrated similar results in patient demographics, Gleason grade and choice of treatment outcomes to other published institutions, however, for the first time demonstrate emerging evidence of the effect of the rapid access prostate clinic leading to a downward shift in Gleason grade over a 2-year period, as well as data showing an inverse correlation between leading Gleason grade and distance from our tertiary referral center CONCLUSION: These results suggest that the introduction of the rapid access prostate clinic has initially begun to demonstrate an initial downgrading in Gleason scoring patterns. Our data also reflects a poorer Gleason score in those patients living further away from the rapid access prostate clinic. This may be in part attributed to a surge in referrals of those patients previously managed outside a tertiary institution, and suggests that patients should undergo prompt referral following suspicion for prostate cancer.
    Irish Journal of Medical Science 02/2013; · 0.51 Impact Factor
  • G C O'Toole, S M Khan, D G Kelly, D M Quinlan
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    ABSTRACT: Extracorporeal shock-wave lithotripsy (ESWL) is a relatively new technological adjunct in the treatment of renal calculi, but availability is limited. The aim of this study was to assess the outcome of ureteroscopic procedures in a unit without on-site ESWL facility. A retrospective study of all cases of ureteric calculi presenting to this hospital during the period 1991 to 1997 was performed. One hundred and thirty five patients with a mean age of 46.8 years were evaluated. Ninety-four (69.5%) had their stone successfully manipulated and/or extracted at ureteroscopy. Using strict criteria, 41 patients (30.5%) had failed ureteroscopies. Fourteen (10.4%) suffered complications related to their ureteroscopy, thirteen had their complications treated conservatively and three (2.3%) needed open procedures. Ureteroscopy has a high success rate and low morbidity. We continue to advocate ureteroscopy in the initial management of ureteric calculi.
    Irish Journal of Medical Science 04/2012; 169(2):119-21. · 0.51 Impact Factor
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    ABSTRACT: Although well described, there is limited published data related to management on the coexistence of prostate and rectal cancer. The aim of this study was to describe a single institution's experience with this and propose a treatment algorithm based on the best available evidence. From 2000 to 2011, a retrospective review of institutional databases was performed to identify patients with synchronous prostate and rectal cancers where the rectal cancer lay in the lower two thirds of the rectum. Operative and non-operative outcomes were analysed and a management algorithm is proposed. Twelve patients with prostate and rectal cancer were identified. Three were metachronous diagnoses (>3-month time interval) and nine were synchronous diagnoses. In the synchronous group, four had metastatic disease at presentation and were treated symptomatically, while five were treated with curative intent. Treatment included pelvic radiotherapy (74 Gy) followed by pelvic exenteration (three) and watchful waiting for rectal cancer (one). The remaining patient had a prostatectomy, long-course chemoradiotherapy and anterior resection. There were no operative mortalities and acceptable morbidity. Three remain alive with two patients disease-free. Synchronous detection of prostate cancer and cancer of the lower two thirds of the rectum is uncommon, but likely to increase with rigorous preoperative staging of rectal cancer and increased awareness of the potential for synchronous disease. Treatment must be individualized based on the stage of the individual cancers taking into account the options for both cancers including EBRT (both), surgery (both), hormonal therapy (prostate), surgery (both) and watchful waiting (both).
    International Journal of Colorectal Disease 03/2012; 27(11):1501-8. · 2.24 Impact Factor
  • Lisa G Smyth, Ivor M Cullen, David M Quinlan
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    ABSTRACT: INTRODUCTION: In the event of the implementation of prostate cancer screening, younger men will be diagnosed more frequently. Erectile dysfunction (ED) is a frequent long-term complication in men post-radical prostatectomy (RP). Since the introduction of RP, urologists have strived to improve postoperative sexual function. There is little literature, however, in the area of ED prescribing and sexual pursuit in men post-RP. We assessed the pursuit of sexual function in this group of patients. METHODS: The study involved a detailed questionnaire sent to patients who have undergone radical retropublic prostatectomy (RRP) by one surgeon in one institution to ascertain the impact of ED on lifestyle and ED therapy prescription use. RESULTS: There was a response rate of 59%; most patients who responded were in the 61 to 70 year age group at the time of the survey. About 25% of patients had intercourse more than once in the 4 weeks prior to the survey. A total 50% of patients had no problem or a very small problem with their sexual function. Overall 80% of patients were prescribed ED therapy, but less than 35% of them used it. CONCLUSION: Sexual frequency peaked in younger patients who were 3 years or more from surgery. Of note, 46% of men either declined the offer of ED therapy or got the prescription and never used it. Only 34% of men had used their ED prescription in the last 4 weeks. Urologists frequently find that patients behave differently postoperatively, with less interest in sexual activity. Interestingly, we found that 50% of our patients classified their sexual function, as at most a small problem.
    Canadian Urological Association journal = Journal de l'Association des urologues du Canada 01/2012; · 1.66 Impact Factor
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    ABSTRACT: Many centres currently do not offer radical prostatectomy (RP) to men with high-risk localised prostate cancer due to concerns regarding poor outcome, despite evidence to the contrary. We identified 18 men undergoing RP with serum PSA >20 ng/ml (high-risk by National Comprehensive Cancer Network definition) and minimum follow-up of 12 years (mean 13.5). Mean preoperative PSA was 37.0 ng/ml (Range 21.1-94.0). Prostatectomy pathology reported extracapsular disease in 16 (88.9%), positive surgical margins in 15 (83%) and positive pelvic lymph nodes in 5 (27.8%). Overall and cancer-specific survival at 5 and 10-years was 83.3%, 88.2%, 72% and 76.5% respectively. With complete follow-up 11 (61.1%) are alive, and 5 (27.8%) avoided any adjuvant therapy. Complete continence (defined as no involuntary urine leakage and no use of pads) was achieved in 60%, with partial continence in the remainder. We conclude that surgery for this aggressive variant of localised prostate cancer can result in satisfactory outcome.
    Irish medical journal 04/2011; 104(4):108-11. · 0.51 Impact Factor
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    Lisa G Smyth, Rowan G Casey, David M Quinlan
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    ABSTRACT: Renal cell carcinoma (RCC) accounts for 3% all of solid organ tumours and is slightly more common in men in the age range of 60 to 70 years. Skin metastases occur in 3% to 6% of RCCs. There are only approximately 30 cases of scalp metastases secondary to RCC in the literature. They usually occur late in metastatic disease and are a bad prognostic marker. A 67-year-old Caucasian male presented with a metastatic scalp lesion, 10 years post-radical treatment for RCC. His initial diagnosis was a T3bN0M0 RCC. He presented with a raised erythematous lesion on his parietal scalp, the histology of which demonstrated late metastatic recurrence. Shortly after this, he developed diffuse metastatic disease. Metastatic RCC can occur many years after initial diagnosis and present in many forms. Cutaneous metastatic lesions of RCC can mimic many other dermatologic conditions and carries an ominous prognosis. It is therefore important not only for the urologist, but also general practitioners and patients to be vigilant of any new skin lesion as a portent of impending metastatic disease.
    Canadian Urological Association journal = Journal de l'Association des urologues du Canada 06/2010; 4(3):E64-6. · 1.66 Impact Factor
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    ABSTRACT: Outpatient non-attendance is a considerable source of inefficiency in the health service, wasting time, resources and potentially lengthening waiting lists, Given the current economic climate, methods need to be employed to reduce non-attendance. The aim was to analyse outpatient non-attendance and determine what factors influence attendance. A prospective audit over a two-month period to a tertiary-referral Urological service was performed to determine the clinical and demographic profile of non-attendees. Of 737 appointments, 148 (20%) patients did not attend (DNA). A benign urological condition was evident in 116 cases (78%). This group of patients also accounted for the majority of new patients not attending 40/47, returning patients not attending 101/148 and the majority of patients who missed multiple appointments 43/49. Patients with benign conditions make up the majority of clinic non-attendance. Consideration may be given to discharging such patients back to their general practitioner after one unexplained non-attendance until other alternatives of follow up are available.
    Irish medical journal 03/2010; 103(3):80-2. · 0.51 Impact Factor
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    ABSTRACT: There are only 7 cases reported in the literature of squamous cell cancer of the bladder in patients performing intermittent self-catheterization (ISC). We report on an eighth case, and the first case described in a patient with a Mitrofanoff continent appendicovesicostomy. A description of the case and review of the literature are presented. Risk factors for squamous cell cancer include recurrent urinary tract infections, keratinising squamous metaplasia (leukoplakia) and local mucosal trauma from intermittent self-catheterization. There is no recognized or validated monitoring program for patients performing ISC who may also have these risk factors. Reasonable protocols may include regular urinary cytology and cystoscopy with random or targeted bladder biopsies. Squamous cell cancer may present late in this cohort of patients and is associated with a dismal prognosis.
    Canadian Urological Association journal = Journal de l'Association des urologues du Canada 10/2009; 3(5):E51-4. · 1.66 Impact Factor
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    ABSTRACT: Referrals to Urology OPD of men with a likely diagnosis of BPH are common. To review referrals to OPD of men with lower urinary tract symptoms (LUTS) to establish how many could have been managed without specialist assessment. We reviewed records of 200 male patients referred to OPD with LUTS. We assessed whether the referral source had performed digital rectal examination (DRE), International Prostate Symptom Score (IPSS), Bother Score or PSA level. 74% of patients were referred by GPs. In 31.5% of cases DRE was performed prior to referral. One GP had completed an IPSS, none a Bother Score. 96% had a PSA checked before OPD. Ultimately, 88.5% of our patients were diagnosed with BPH. With better pre-assessment in the form of DRE, IPSS and Bother Score, allied to a PSA check, many patients with LUTS could be managed in a primary care setting.
    Irish Journal of Medical Science 05/2009; 178(3):281-5. · 0.51 Impact Factor
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    ABSTRACT: Among the entero-urinary fistulae, those between the ureter and colon are rare. Most spontaneous ureterocolic fistulae are caused by urinary calculi. We report a case of a spontaneous ureterocolic fistula which occurred as a consequence of diverticular disease. This rare presentation was further complicated as it occurred in the presence of a solitary kidney. The patient underwent a laparoscopic defunctioning loop ileostomy and after 6 weeks underwent definitive surgical treatment of the ureterocolic fistula. We describe the presentation and management of this fistula and review the current literature.
    Case Reports 01/2009; 2009.

Publication Stats

132 Citations
73.87 Total Impact Points

Institutions

  • 2004–2014
    • St Vincent's University Hospital
      Dublin, Leinster, Ireland
    • St. Vincents University Hospital
      Dublin, Leinster, Ireland
  • 2013
    • Dublin Dental University Hospital
      Dublin, Leinster, Ireland