Pub Date : 2022-04-18DOI: 10.1177/20514158221084828
Andrew R H Shepherd, Zachary Bunjo, P. Sutherland, Andrew Fuller
The aim of this study was to describe the initial experience with robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) performed by two robotic surgeons at a single, Australian centre. Retrospective analysis was conducted on 30 consecutive patients who underwent RARC with ICUD with curative intent for muscle-invasive and high-risk non-muscle-invasive bladder cancer between 2017 and 2021. Variables analysed included patient baseline characteristics, operative and peri-operative outcomes, as well as short-term pathological outcomes. A total 30 patients were included; 87% were male and the median age was 71 years. Half of patients had muscle-invasive bladder cancer and 93% had ileal conduit formation (with the remaining two patients undergoing neobladder formation). The median operating time was 247 minutes. The median estimated blood loss was 450 mL and 20% of patients received a blood transfusion. A high-grade complication (Clavien III–V) was encountered in 13% of patients post-operatively. At 90 days, 30 overall complications (Clavien I–V) occurred across 67% of the patients. This series provides further support for the safe introduction of RARC with ICUD in Australia. Further studies with extended duration of follow-up, including oncological outcomes, are required to support widespread adoption of RARC. Level 4 (case series)
{"title":"Robotic-assisted radical cystectomy with intracorporeal urinary diversion: Initial South Australian experience","authors":"Andrew R H Shepherd, Zachary Bunjo, P. Sutherland, Andrew Fuller","doi":"10.1177/20514158221084828","DOIUrl":"https://doi.org/10.1177/20514158221084828","url":null,"abstract":"The aim of this study was to describe the initial experience with robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) performed by two robotic surgeons at a single, Australian centre. Retrospective analysis was conducted on 30 consecutive patients who underwent RARC with ICUD with curative intent for muscle-invasive and high-risk non-muscle-invasive bladder cancer between 2017 and 2021. Variables analysed included patient baseline characteristics, operative and peri-operative outcomes, as well as short-term pathological outcomes. A total 30 patients were included; 87% were male and the median age was 71 years. Half of patients had muscle-invasive bladder cancer and 93% had ileal conduit formation (with the remaining two patients undergoing neobladder formation). The median operating time was 247 minutes. The median estimated blood loss was 450 mL and 20% of patients received a blood transfusion. A high-grade complication (Clavien III–V) was encountered in 13% of patients post-operatively. At 90 days, 30 overall complications (Clavien I–V) occurred across 67% of the patients. This series provides further support for the safe introduction of RARC with ICUD in Australia. Further studies with extended duration of follow-up, including oncological outcomes, are required to support widespread adoption of RARC. Level 4 (case series)","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49400635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-18DOI: 10.1177/20514158221081814
T. Manasa, Vivek Meyyappan, P. Sandeep, P. Mylarappa, D. Ramesh, V. Jayakumar, Gowtham Krishna Penmetsa
Although the incidence of malignancy in renal transplant recipients is on the rise owing to boom in the post-transplant immunosuppressive therapy, there is paucity of literature regarding their reporting and management. In this study, we report the incidence of de novo renal malignancies, post-renal transplantation at our centre over a 16-year period and discuss their management. All patients who underwent renal transplantation at our department between March 2004 and February 2020 were included and retrospectively reviewed. We analysed the incidence of renal malignancy both in the native kidney and the graft, histological subtype, time to and type of treatment. A total of 376 patients underwent renal transplantation. Mean age of recipients was 48.2 and 52.15 years among those who developed cancer. 13 (2.93%) of 376 recipients developed urogenital malignancy, of whom 8 had renal cell carcinoma (RCC) in their native kidneys and 1 in the allograft. Transitional cell carcinoma (TCC) of renal pelvis was noted in three patients with one concomitant TCC of bladder. No treatment-related graft losses occurred in the native kidney malignancy. Patients with RCC underwent nephrectomy while TCC of renal pelvis underwent nephroureterectomy with bladder cuff excision. Transurethral resection was done for bladder tumour. All patients were followed up as per standard protocol. A rise in urological post-transplant malignancies mandates regular surveillance after renal transplantation to ensure early detection of de novo malignancies and early initiation of treatment. Goal should be to minimise adverse graft outcomes with no compromise on oncological outcomes. Not applicable
{"title":"Incidence, management and treatment outcomes of renal malignancy in a post-transplant recipient at a tertiary care centre: A 16-year experience","authors":"T. Manasa, Vivek Meyyappan, P. Sandeep, P. Mylarappa, D. Ramesh, V. Jayakumar, Gowtham Krishna Penmetsa","doi":"10.1177/20514158221081814","DOIUrl":"https://doi.org/10.1177/20514158221081814","url":null,"abstract":"Although the incidence of malignancy in renal transplant recipients is on the rise owing to boom in the post-transplant immunosuppressive therapy, there is paucity of literature regarding their reporting and management. In this study, we report the incidence of de novo renal malignancies, post-renal transplantation at our centre over a 16-year period and discuss their management. All patients who underwent renal transplantation at our department between March 2004 and February 2020 were included and retrospectively reviewed. We analysed the incidence of renal malignancy both in the native kidney and the graft, histological subtype, time to and type of treatment. A total of 376 patients underwent renal transplantation. Mean age of recipients was 48.2 and 52.15 years among those who developed cancer. 13 (2.93%) of 376 recipients developed urogenital malignancy, of whom 8 had renal cell carcinoma (RCC) in their native kidneys and 1 in the allograft. Transitional cell carcinoma (TCC) of renal pelvis was noted in three patients with one concomitant TCC of bladder. No treatment-related graft losses occurred in the native kidney malignancy. Patients with RCC underwent nephrectomy while TCC of renal pelvis underwent nephroureterectomy with bladder cuff excision. Transurethral resection was done for bladder tumour. All patients were followed up as per standard protocol. A rise in urological post-transplant malignancies mandates regular surveillance after renal transplantation to ensure early detection of de novo malignancies and early initiation of treatment. Goal should be to minimise adverse graft outcomes with no compromise on oncological outcomes. Not applicable","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47682807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-18DOI: 10.1177/20514158221086401
H. Yao, Jan Fletcher, J. Grummet, P. Royce, M. Fitzgerald, U. Hanegbi
To review the contemporary bladder trauma epidemiology, diagnosis and management over a 12-year period at a level 1 trauma centre in Australia. From July 2001 through June 2013, 97 multi-trauma patients at a level 1 trauma centre in Australia were identified to have sustained bladder rupture. Data on demographics, clinical presentation, diagnosis, management and complications were extracted from the TraumaNET database, medical records and health-coding database. Of the 97 patients, 98% of bladder ruptures resulted from blunt trauma mostly from road accidents. There was a male preponderance of 64%. Intra-peritoneal bladder rupture (51%) was the most common type of injury followed by extra-peritoneal bladder ruptures (42%) and combined intra- and extra-peritoneal bladder ruptures (7%). Concomitant pelvic fractures occurred in 78% of patients and concurrent intra-abdominal injuries in 68%. Initial imaging missed 28% of bladder ruptures, with computed tomography with intravenous contrast missing 65% of bladder ruptures. The majority of intra-peritoneal bladder ruptures and 56% of extra-peritoneal bladder ruptures were repaired surgically, with 83% of repairs performed in conjunction with another surgical procedure. The in-hospital mortality rate was 9%, and all deaths were due to concomitant injuries. Traumatic bladder rupture is associated with a 9% mortality rate due to the frequently associated significant concurrent injuries. Computed tomography cystogram or plain cystogram is the imaging modality of choice in diagnosing bladder rupture. Intra-peritoneal bladder ruptures should be repaired surgically, while extra-peritoneal bladder ruptures can be treated conservatively in selected patients. The timing of surgical repair should be coordinated with other specialties. 4
{"title":"A 12-year experience in the management of traumatic bladder rupture at an Australian level 1 trauma centre","authors":"H. Yao, Jan Fletcher, J. Grummet, P. Royce, M. Fitzgerald, U. Hanegbi","doi":"10.1177/20514158221086401","DOIUrl":"https://doi.org/10.1177/20514158221086401","url":null,"abstract":"To review the contemporary bladder trauma epidemiology, diagnosis and management over a 12-year period at a level 1 trauma centre in Australia. From July 2001 through June 2013, 97 multi-trauma patients at a level 1 trauma centre in Australia were identified to have sustained bladder rupture. Data on demographics, clinical presentation, diagnosis, management and complications were extracted from the TraumaNET database, medical records and health-coding database. Of the 97 patients, 98% of bladder ruptures resulted from blunt trauma mostly from road accidents. There was a male preponderance of 64%. Intra-peritoneal bladder rupture (51%) was the most common type of injury followed by extra-peritoneal bladder ruptures (42%) and combined intra- and extra-peritoneal bladder ruptures (7%). Concomitant pelvic fractures occurred in 78% of patients and concurrent intra-abdominal injuries in 68%. Initial imaging missed 28% of bladder ruptures, with computed tomography with intravenous contrast missing 65% of bladder ruptures. The majority of intra-peritoneal bladder ruptures and 56% of extra-peritoneal bladder ruptures were repaired surgically, with 83% of repairs performed in conjunction with another surgical procedure. The in-hospital mortality rate was 9%, and all deaths were due to concomitant injuries. Traumatic bladder rupture is associated with a 9% mortality rate due to the frequently associated significant concurrent injuries. Computed tomography cystogram or plain cystogram is the imaging modality of choice in diagnosing bladder rupture. Intra-peritoneal bladder ruptures should be repaired surgically, while extra-peritoneal bladder ruptures can be treated conservatively in selected patients. The timing of surgical repair should be coordinated with other specialties. 4","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42047764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-18DOI: 10.1177/20514158221088451
A. Ng, A. Nathan, N. Campain, M. Fortune-Ely, Siddhant Patki, Y. Yuminaga, F. Mumtaz, A. Gulamhusein, M. Tran, S. Nathan, R. Barod, A. Bex, P. Patki
We assessed the safety and feasibility of minimally invasive robot-assisted surgery for horseshoe kidney (HSK). A prospectively maintained data set for consecutive patients undergoing robotic kidney surgery was reviewed for patients with HSK. Cases were performed by experienced robotic surgeons, across two high-volume centres between 2016 and 2020. Seven patients underwent robotic surgery for HSK, comprising three partial nephrectomies for renal masses, one nephroureterectomy and three benign nephrectomies for non-functioning kidneys. The median age was 53 (interquartile range (IQR) = 47–60) years and median body mass index (BMI) was 25 (IQR = 25–26.5). Median console time was 120 (IQR = 118–215) minutes and median estimated blood loss was 150 (IQR = 125–250) mL. The median pre- and post-operative estimated glomerular filtration rate (eGFR) was 76 (IQR = 72–90) and 71 (IQR = 60–81), respectively. There were no higher-grade complications (Clavien–Dindo III–IV) and one Clavien–Dindo grade II complication (wound infection treated with IV antibiotics). Median length of stay (LOS) was 2 days and there were no 30-day readmissions. Negative margins were achieved in 75% of tumour resections. We report one the largest series of robot-assisted surgery on HSK. Robotic surgery is safe and feasible for HSK in centralised high-volume centres with acceptable perioperative outcomes. Established benefits of minimally invasive surgery, such as reduced LOS and low complication rates, were demonstrated. 4
{"title":"Robot-assisted surgery in horseshoe kidneys: A safety and feasibility multi-centre case series","authors":"A. Ng, A. Nathan, N. Campain, M. Fortune-Ely, Siddhant Patki, Y. Yuminaga, F. Mumtaz, A. Gulamhusein, M. Tran, S. Nathan, R. Barod, A. Bex, P. Patki","doi":"10.1177/20514158221088451","DOIUrl":"https://doi.org/10.1177/20514158221088451","url":null,"abstract":"We assessed the safety and feasibility of minimally invasive robot-assisted surgery for horseshoe kidney (HSK). A prospectively maintained data set for consecutive patients undergoing robotic kidney surgery was reviewed for patients with HSK. Cases were performed by experienced robotic surgeons, across two high-volume centres between 2016 and 2020. Seven patients underwent robotic surgery for HSK, comprising three partial nephrectomies for renal masses, one nephroureterectomy and three benign nephrectomies for non-functioning kidneys. The median age was 53 (interquartile range (IQR) = 47–60) years and median body mass index (BMI) was 25 (IQR = 25–26.5). Median console time was 120 (IQR = 118–215) minutes and median estimated blood loss was 150 (IQR = 125–250) mL. The median pre- and post-operative estimated glomerular filtration rate (eGFR) was 76 (IQR = 72–90) and 71 (IQR = 60–81), respectively. There were no higher-grade complications (Clavien–Dindo III–IV) and one Clavien–Dindo grade II complication (wound infection treated with IV antibiotics). Median length of stay (LOS) was 2 days and there were no 30-day readmissions. Negative margins were achieved in 75% of tumour resections. We report one the largest series of robot-assisted surgery on HSK. Robotic surgery is safe and feasible for HSK in centralised high-volume centres with acceptable perioperative outcomes. Established benefits of minimally invasive surgery, such as reduced LOS and low complication rates, were demonstrated. 4","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45114334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-18DOI: 10.1177/20514158221086409
Bob Yang, Francesca Lewis, C. Jelley, S. Foley
To investigate the first experience in the United Kingdom of using the Adjustable Transobturator Male System® (ATOMS) in treating men with stress urinary incontinence (SUI). Between 2015 and 2021, 71 men (average age: 70.3, range: 50–81 years) were recruited and followed up. Of these, 67 (94%) had SUI secondary to a radical prostatectomy and 16 (23%) had previous radiotherapy post-prostatectomy. Seventy men underwent an insertion of ATOMS® under general anaesthetic. In one patient, due to his underlying morbid obesity, it was not possible to insert ATOMS and thus he was excluded from the study. Follow-up was up to 6 years (mean: 4 years, range: 2–6 years). Out of 70 men, 53 (76%) were dry after ATOMS insertion (defined as using a maximum of one pad per day for reassurance only). Dryness was achieved within 6 months for 34/53 patients (range: 1–24 months). The average pad use was 3.4 pre-operatively and 0.7 post-operatively. Of the men who did not achieve dryness, 7/17 (41%) had previously undergone radiotherapy. There were 11 (16%) complications: two cases of infected device requiring removal, one case of balloon mechanism erosion requiring re-implantation, one case of balloon mechanism require repositioning, four cases of persistent perineal or scrotal pain, two cases of urinary retention and one case of a superficial wound infection treated medically. Overall, five devices were removed. The ATOMS appears to be a safe and efficacious treatment for men with SUI. Previous radiotherapy decreased the efficacy of ATOMS. Further studies on ATOMS with larger numbers of patients and longer follow-ups are required. In particular, establishing randomised control trials to confirm these positive outcomes as well as ascertain its long-term safety profile. 4
{"title":"Adjustable Transobturator Male System® (ATOMS) as a novel treatment for men with stress urinary incontinence in the United Kingdom","authors":"Bob Yang, Francesca Lewis, C. Jelley, S. Foley","doi":"10.1177/20514158221086409","DOIUrl":"https://doi.org/10.1177/20514158221086409","url":null,"abstract":"To investigate the first experience in the United Kingdom of using the Adjustable Transobturator Male System® (ATOMS) in treating men with stress urinary incontinence (SUI). Between 2015 and 2021, 71 men (average age: 70.3, range: 50–81 years) were recruited and followed up. Of these, 67 (94%) had SUI secondary to a radical prostatectomy and 16 (23%) had previous radiotherapy post-prostatectomy. Seventy men underwent an insertion of ATOMS® under general anaesthetic. In one patient, due to his underlying morbid obesity, it was not possible to insert ATOMS and thus he was excluded from the study. Follow-up was up to 6 years (mean: 4 years, range: 2–6 years). Out of 70 men, 53 (76%) were dry after ATOMS insertion (defined as using a maximum of one pad per day for reassurance only). Dryness was achieved within 6 months for 34/53 patients (range: 1–24 months). The average pad use was 3.4 pre-operatively and 0.7 post-operatively. Of the men who did not achieve dryness, 7/17 (41%) had previously undergone radiotherapy. There were 11 (16%) complications: two cases of infected device requiring removal, one case of balloon mechanism erosion requiring re-implantation, one case of balloon mechanism require repositioning, four cases of persistent perineal or scrotal pain, two cases of urinary retention and one case of a superficial wound infection treated medically. Overall, five devices were removed. The ATOMS appears to be a safe and efficacious treatment for men with SUI. Previous radiotherapy decreased the efficacy of ATOMS. Further studies on ATOMS with larger numbers of patients and longer follow-ups are required. In particular, establishing randomised control trials to confirm these positive outcomes as well as ascertain its long-term safety profile. 4","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45003357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-18DOI: 10.1177/20514158221086399
Jake Sellers, E. Ward, Preston Weaver, J. Garza, Luis Brandi, W. D. de Riese
Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are the two most common urologic diseases in aging males. The negative association between prostate/BPH size and incidence of PCa is well documented in the literature. However, the exact mechanism is not well understood. This study aims to further investigate the possible effect of prostate volume on prostate capsule thickness and glandular cell density in the prostatic peripheral zone (PZ). A total of 100 patients were selected that had undergone radical prostatectomy with prostate sizes ranging from 20 to 160 mL. Quantitative measurements of capsule thickness and density of epithelial glands within the peripheral zone not affected by cancer were analysed and calculated on histo-anatomical slides using computer-based imaging software. Associations between the different variables were calculated using Spearman correlation with 95% confidence intervals (CIs). In the non-cancerous areas of the PZ, prostate volume and average capsule thickness are positively associated ( rs = +0.6526, 95% CI +0.5233 to +0.7526, p < 0.0001), while prostate volume and average glandular epithelial cell density of the PZ are negatively associated ( rs = −0.6011, 95% CI −0.7133 to −0.4589, p < 0.0001). These associations remain consistent on subgroup analysis. The findings of this study support the hypothesis that transition zone (TZ) growth in large BPH prostates may cause pressure on the outer PZ, leading to fibrosis and atrophy of the glandular tissue. This may provide a protective effect against PCa, as most PCa originates in the PZ of the prostate. Not applicable
{"title":"Association of prostate size with capsule thickness and glandular epithelial cell density: The possible clinical implications on prostate cancer development","authors":"Jake Sellers, E. Ward, Preston Weaver, J. Garza, Luis Brandi, W. D. de Riese","doi":"10.1177/20514158221086399","DOIUrl":"https://doi.org/10.1177/20514158221086399","url":null,"abstract":"Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are the two most common urologic diseases in aging males. The negative association between prostate/BPH size and incidence of PCa is well documented in the literature. However, the exact mechanism is not well understood. This study aims to further investigate the possible effect of prostate volume on prostate capsule thickness and glandular cell density in the prostatic peripheral zone (PZ). A total of 100 patients were selected that had undergone radical prostatectomy with prostate sizes ranging from 20 to 160 mL. Quantitative measurements of capsule thickness and density of epithelial glands within the peripheral zone not affected by cancer were analysed and calculated on histo-anatomical slides using computer-based imaging software. Associations between the different variables were calculated using Spearman correlation with 95% confidence intervals (CIs). In the non-cancerous areas of the PZ, prostate volume and average capsule thickness are positively associated ( rs = +0.6526, 95% CI +0.5233 to +0.7526, p < 0.0001), while prostate volume and average glandular epithelial cell density of the PZ are negatively associated ( rs = −0.6011, 95% CI −0.7133 to −0.4589, p < 0.0001). These associations remain consistent on subgroup analysis. The findings of this study support the hypothesis that transition zone (TZ) growth in large BPH prostates may cause pressure on the outer PZ, leading to fibrosis and atrophy of the glandular tissue. This may provide a protective effect against PCa, as most PCa originates in the PZ of the prostate. Not applicable","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49213809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-14DOI: 10.1177/20514158221084821
P. Jain, A. Prasad, Rachna Sharma, Sarika Jain
Renal abscess (RA) is rarely seen in the paediatric age group. The proposed management protocols are mainly derived from the adult series which may not be appropriate in children. In this retrospective analysis of cases with renal and perinephric abscesses, the objective is to correlate the clinical presentation, radiological findings and treatment options and also to propose a paediatric-specific practical management algorithm. This is a retrospective study of cases with renal and perinephric abscesses admitted between March 2012 and February 2020. The patients were reviewed for demographics, presentation, predisposing factors, laboratory investigations, imaging, management and outcome. Analysis of 12 paediatric patients (13 renal units) with RA (median age 4 years) was done. Organisms were isolated in 8 of 12 (66.6%) patients with Gram-negative organisms being the commonest. On admission, all patients were started on empirical broad-spectrum antibiotics. Except for two patients who were critically ill with frank sepsis and had a tender renal lump, the rest of them were initially offered conservative management with intravenous antibiotics, and the response was reviewed after 48–72 hours. Of five units with abscess size of ⩽3 cm, two units (40%) responded to conservative management, while three units (60%) required intervention, and of eight units of size >3 cm, three units (37.5%) responded to conservative management and five units (62.5%) required intervention. None of the abscesses with perinephric collection (30.7%) responded to antibiotics and required intervention. A protocol based on the size of RA as recommended in most of the adult series may not be appropriate in the paediatric age group because of the differences in clinical presentation, predisposing factors and immune response. The clinical condition on presentation, response to antibiotic therapy and the presence of perinephric collection should be considered as an important determinant in deciding the need for intervention. 4
{"title":"Renal abscess in children: Is size an important determinant in deciding treatment options?","authors":"P. Jain, A. Prasad, Rachna Sharma, Sarika Jain","doi":"10.1177/20514158221084821","DOIUrl":"https://doi.org/10.1177/20514158221084821","url":null,"abstract":"Renal abscess (RA) is rarely seen in the paediatric age group. The proposed management protocols are mainly derived from the adult series which may not be appropriate in children. In this retrospective analysis of cases with renal and perinephric abscesses, the objective is to correlate the clinical presentation, radiological findings and treatment options and also to propose a paediatric-specific practical management algorithm. This is a retrospective study of cases with renal and perinephric abscesses admitted between March 2012 and February 2020. The patients were reviewed for demographics, presentation, predisposing factors, laboratory investigations, imaging, management and outcome. Analysis of 12 paediatric patients (13 renal units) with RA (median age 4 years) was done. Organisms were isolated in 8 of 12 (66.6%) patients with Gram-negative organisms being the commonest. On admission, all patients were started on empirical broad-spectrum antibiotics. Except for two patients who were critically ill with frank sepsis and had a tender renal lump, the rest of them were initially offered conservative management with intravenous antibiotics, and the response was reviewed after 48–72 hours. Of five units with abscess size of ⩽3 cm, two units (40%) responded to conservative management, while three units (60%) required intervention, and of eight units of size >3 cm, three units (37.5%) responded to conservative management and five units (62.5%) required intervention. None of the abscesses with perinephric collection (30.7%) responded to antibiotics and required intervention. A protocol based on the size of RA as recommended in most of the adult series may not be appropriate in the paediatric age group because of the differences in clinical presentation, predisposing factors and immune response. The clinical condition on presentation, response to antibiotic therapy and the presence of perinephric collection should be considered as an important determinant in deciding the need for intervention. 4","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44439612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-12DOI: 10.1177/20514158221088680
J. Natale, J. Pascoe, C. Horn, J. Coode‐Bate, A. Dickinson
To determine whether standalone teleconsultation is an effective alternative to face-to-face assessment of patients requiring circumcision. To determine what environmental and efficiency benefits may arise as a result of service alteration. All cases listed for circumcision during first UK lockdown (1 February to 30 September 2020) were reviewed. Cases were collated from operative lists, theatre logs and secretarial records. Cancellations and rationale were recorded. Local audit approval was granted for conduct of this study. Statistical analysis was conducted in JASP. A total of 101 patients were listed for circumcision during the study period. The overall odds of cancellation was 0.063. There was no significant difference in odds of cancellation between telephone clinic and face-to-face clinic odds ratio 0.371 (confidence interval (CI): 0.039–3.46). Telephone clinic could achieve a per-patient cost reduction of £81 and a total reduction in CO2 emissions of 637 kg. This is the first study to demonstrate teleconsultation as a suitable method to list patients for circumcision without a face-to-face appointment. The COVID pandemic has accelerated transformational change in outpatient service design instigated by the National Health Service (NHS) Long-Term plan. The environmental and efficiency savings demonstrated suggest sustainable change beyond the pandemic. Level 3 (cohort study)
{"title":"Teleconsultation versus traditional clinical assessment of patients undergoing circumcision: A retrospective cohort study","authors":"J. Natale, J. Pascoe, C. Horn, J. Coode‐Bate, A. Dickinson","doi":"10.1177/20514158221088680","DOIUrl":"https://doi.org/10.1177/20514158221088680","url":null,"abstract":"To determine whether standalone teleconsultation is an effective alternative to face-to-face assessment of patients requiring circumcision. To determine what environmental and efficiency benefits may arise as a result of service alteration. All cases listed for circumcision during first UK lockdown (1 February to 30 September 2020) were reviewed. Cases were collated from operative lists, theatre logs and secretarial records. Cancellations and rationale were recorded. Local audit approval was granted for conduct of this study. Statistical analysis was conducted in JASP. A total of 101 patients were listed for circumcision during the study period. The overall odds of cancellation was 0.063. There was no significant difference in odds of cancellation between telephone clinic and face-to-face clinic odds ratio 0.371 (confidence interval (CI): 0.039–3.46). Telephone clinic could achieve a per-patient cost reduction of £81 and a total reduction in CO2 emissions of 637 kg. This is the first study to demonstrate teleconsultation as a suitable method to list patients for circumcision without a face-to-face appointment. The COVID pandemic has accelerated transformational change in outpatient service design instigated by the National Health Service (NHS) Long-Term plan. The environmental and efficiency savings demonstrated suggest sustainable change beyond the pandemic. Level 3 (cohort study)","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41840433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-12DOI: 10.1177/20514158221088689
K. Yao, Shun Li, Qingyong Liu, Fei Wu
To date, the number of prostate cancer ranked first among newly diagnosed malignant tumors in men from multiple countries. Localized prostate cancer could be controlled by curative therapy. However, for patients with metastatic prostate cancer (mPC), the prognosis is poor. As among first-line treatments of systemic therapies for mPC, docetaxel and androgen receptor (AR)-targeted therapies have been widely used. However, mPC patients inevitably developed resistance to the current therapy. More importantly, there is a cross-resistance between docetaxel-based chemotherapy and AR-targeting therapy during the treatment process, which could impair the overall survival benefits without proper administration. Therefore, it is urgent to elucidate the mechanism of cross-resistance and explore the optimal sequential strategy. Here, in this review, we systematically reviewed and summarised the updated literature on clinical evidence and mechanistic research of treatment resistance in mPC. Emerging evidence indicated that AR splice variants, AR overexpression or mutations, AR nuclear translocation, as well as AR signaling reactivation collectively contributed to the cross-resistance. With the current understanding of cross-resistance, multiple solutions are promising for improving the benefits, including refining the sequencing of available therapies for mPC, in combination with potential targeted inhibitors or immune checkpoint inhibitors. Further studies are needed to explore the combination of emerging strategies and eventually control the progression of prostate cancer. This review defined the mutual and unique resistant mechanism of these treatments, which might help to focus and accelerate therapeutic research that may ultimately improve clinical outcomes for patients with prostate cancer. Not applicable
{"title":"The emerging role of cross-resistance between taxanes and AR-targeting therapy in metastatic prostate cancer","authors":"K. Yao, Shun Li, Qingyong Liu, Fei Wu","doi":"10.1177/20514158221088689","DOIUrl":"https://doi.org/10.1177/20514158221088689","url":null,"abstract":"To date, the number of prostate cancer ranked first among newly diagnosed malignant tumors in men from multiple countries. Localized prostate cancer could be controlled by curative therapy. However, for patients with metastatic prostate cancer (mPC), the prognosis is poor. As among first-line treatments of systemic therapies for mPC, docetaxel and androgen receptor (AR)-targeted therapies have been widely used. However, mPC patients inevitably developed resistance to the current therapy. More importantly, there is a cross-resistance between docetaxel-based chemotherapy and AR-targeting therapy during the treatment process, which could impair the overall survival benefits without proper administration. Therefore, it is urgent to elucidate the mechanism of cross-resistance and explore the optimal sequential strategy. Here, in this review, we systematically reviewed and summarised the updated literature on clinical evidence and mechanistic research of treatment resistance in mPC. Emerging evidence indicated that AR splice variants, AR overexpression or mutations, AR nuclear translocation, as well as AR signaling reactivation collectively contributed to the cross-resistance. With the current understanding of cross-resistance, multiple solutions are promising for improving the benefits, including refining the sequencing of available therapies for mPC, in combination with potential targeted inhibitors or immune checkpoint inhibitors. Further studies are needed to explore the combination of emerging strategies and eventually control the progression of prostate cancer. This review defined the mutual and unique resistant mechanism of these treatments, which might help to focus and accelerate therapeutic research that may ultimately improve clinical outcomes for patients with prostate cancer. Not applicable","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45253804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-12DOI: 10.1177/20514158221086405
Sana Patel, H. Lazarowicz, R. Hamm
Bulking agents have been used for decades as an alternative treatment for patients with stress urinary incontinence who are not appropriate for surgery. Despite this their long-term complications are poorly documented and can be misdiagnosed. This paper presents a literature review and the results of a national survey of members of the Section of Female, Neurological and Urodynamic Urology (FNUU) of the British Association of Urological Surgeons (BAUS) identifying the common long-term complications of widely used bulking agents in clinical practice. Following a comprehensive literature review an electronic survey was sent to members of the BAUS Section of FNUU. Data included hospital trust, use of urethral bulking agents (including type), the approximate number of procedures performed and whether any long-term complications had been observed and managed in their practice. Long-term complications were defined as those arising more than 12 months after treatment. The literature review revealed multiple case reports of complications secondary to bulking agent injection but no high-level evidence regarding frequency or severity. The survey revealed complications including granulomas, erosions, abscesses and misdiagnoses of urethral diverticula and calculi formation. 88% of urologists who responded to the survey had performed a urethral bulking agent injection and 51% of urologists had observed or treated a long-term complication, some many decades after injection. Patients should be made aware of possible long-term complications of what appears to be a minimally invasive procedure in order for them to make an informed choice about treatment options. Not applicable
{"title":"Long-term complications of bulking agents in the treatment of stress urinary incontinence: Results of a national survey","authors":"Sana Patel, H. Lazarowicz, R. Hamm","doi":"10.1177/20514158221086405","DOIUrl":"https://doi.org/10.1177/20514158221086405","url":null,"abstract":"Bulking agents have been used for decades as an alternative treatment for patients with stress urinary incontinence who are not appropriate for surgery. Despite this their long-term complications are poorly documented and can be misdiagnosed. This paper presents a literature review and the results of a national survey of members of the Section of Female, Neurological and Urodynamic Urology (FNUU) of the British Association of Urological Surgeons (BAUS) identifying the common long-term complications of widely used bulking agents in clinical practice. Following a comprehensive literature review an electronic survey was sent to members of the BAUS Section of FNUU. Data included hospital trust, use of urethral bulking agents (including type), the approximate number of procedures performed and whether any long-term complications had been observed and managed in their practice. Long-term complications were defined as those arising more than 12 months after treatment. The literature review revealed multiple case reports of complications secondary to bulking agent injection but no high-level evidence regarding frequency or severity. The survey revealed complications including granulomas, erosions, abscesses and misdiagnoses of urethral diverticula and calculi formation. 88% of urologists who responded to the survey had performed a urethral bulking agent injection and 51% of urologists had observed or treated a long-term complication, some many decades after injection. Patients should be made aware of possible long-term complications of what appears to be a minimally invasive procedure in order for them to make an informed choice about treatment options. Not applicable","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43315869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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