Pub Date : 2022-11-23DOI: 10.1177/20514158221137110
D. Whiting, S. Giona, M. Yao, Roa Hassan, Hong Doan, Rustam Karanjia, J. Hicks, B. Eddy, S. Madaan, S. Bott
Studies reporting increased risk of metastases in T3a disease are based on clinical staging (Digital rectal examination) in the pre-multiparametric–magnetic resonance imaging (MRI) (mp-MRI) era. The aim of our study was to assess the rate of positive bone scans in patients ascribed with T3a prostate cancer on a pre-biopsy mp-MRI. We performed a multicentre, retrospective analysis of all patients with T3a prostate cancer staged by mp-MRI who had a bone scan between January 2017 and April 2020. A total of 586 patients were diagnosed with T3a prostate cancer on mp-MRI, with a median age of 71 years (range: 47–87). The median presenting PSA was 11 ng/mL (range: 1–537); 125 patients (21.3%) had a PSA ⩽ 20 and either grade group (GG) 1 or 2 in their prostate biopsy; none of these patients had bone metastases. Eighteen patients (3.1%) were found to have bone metastases: 11 patients had GG ⩾ 3 disease on biopsy and nodal disease, 6 had GG ⩾ 3 without evidence of nodal disease and 1 had a PSA of 103. The use of bone scans in patients with T3a prostate cancer staged on mp-MRI but without other evidence of high-risk disease (GG ⩾ 3 and PSA > 20 ng/mL) appears to be unnecessary and could be safely avoided. 2b
{"title":"Are staging bone scans necessary in patients with T3a prostate cancer? A multicentre study","authors":"D. Whiting, S. Giona, M. Yao, Roa Hassan, Hong Doan, Rustam Karanjia, J. Hicks, B. Eddy, S. Madaan, S. Bott","doi":"10.1177/20514158221137110","DOIUrl":"https://doi.org/10.1177/20514158221137110","url":null,"abstract":"Studies reporting increased risk of metastases in T3a disease are based on clinical staging (Digital rectal examination) in the pre-multiparametric–magnetic resonance imaging (MRI) (mp-MRI) era. The aim of our study was to assess the rate of positive bone scans in patients ascribed with T3a prostate cancer on a pre-biopsy mp-MRI. We performed a multicentre, retrospective analysis of all patients with T3a prostate cancer staged by mp-MRI who had a bone scan between January 2017 and April 2020. A total of 586 patients were diagnosed with T3a prostate cancer on mp-MRI, with a median age of 71 years (range: 47–87). The median presenting PSA was 11 ng/mL (range: 1–537); 125 patients (21.3%) had a PSA ⩽ 20 and either grade group (GG) 1 or 2 in their prostate biopsy; none of these patients had bone metastases. Eighteen patients (3.1%) were found to have bone metastases: 11 patients had GG ⩾ 3 disease on biopsy and nodal disease, 6 had GG ⩾ 3 without evidence of nodal disease and 1 had a PSA of 103. The use of bone scans in patients with T3a prostate cancer staged on mp-MRI but without other evidence of high-risk disease (GG ⩾ 3 and PSA > 20 ng/mL) appears to be unnecessary and could be safely avoided. 2b","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48171544","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 : 2022-11-18DOI: 10.1177/20514158221136351
D. Micallef, Stuart Wightman, M. Naqi, V. Modgil, I. Pearce
Inflatable penile prosthesis (IPP) surgery is an effective treatment for patients with erectile dysfunction (ED). The two most used surgical approaches are infrapubic (IP) and penoscrotal (PS). Concerns exist whether raised Body Mass Index (BMI) or poor glycaemic control negatively affect outcome. We conducted a retrospective review of 50 consecutive virgin IP IPP cases investigating the effect of BMI and glycaemic control on post-operative complications and implant utilisation. Data collected included demographics, ED aetiology and risk factors, diabetic status, HbA1c and post-operative complications focusing on infection and re-operation. Telephone survey provided implant usage at 3, 6, 12 and 24 months post-operatively. All patients followed the same pre-, peri- and post-operative pathway, including antibiotic prophylaxis and implant preparation. Complication rates of patients with BMI ⩾ 30 (2/20; 10%) and BMI < 30 (0/28, 0%) ( p = 0.169) and of patients with poorly controlled diabetes mellitus (DM), HbA1c > 69 mmol/mol (0/6, 0%) versus HbA1c ⩽ 69 (2/21, 9.52%) ( p = 1) were not significantly different. Two patients reported complications. Implant utilisation did not differ significantly between low or high BMI and HbA1c cohorts. Our study shows pre-operative HbA1c and BMI do not significantly impact complication rates or implant utilisation in patients undergoing IP IPP insertion. 2b
{"title":"Is the infrapubic approach a safe option for patients with poorly controlled diabetes mellitus and obesity undergoing inflatable penile prosthesis surgery?","authors":"D. Micallef, Stuart Wightman, M. Naqi, V. Modgil, I. Pearce","doi":"10.1177/20514158221136351","DOIUrl":"https://doi.org/10.1177/20514158221136351","url":null,"abstract":"Inflatable penile prosthesis (IPP) surgery is an effective treatment for patients with erectile dysfunction (ED). The two most used surgical approaches are infrapubic (IP) and penoscrotal (PS). Concerns exist whether raised Body Mass Index (BMI) or poor glycaemic control negatively affect outcome. We conducted a retrospective review of 50 consecutive virgin IP IPP cases investigating the effect of BMI and glycaemic control on post-operative complications and implant utilisation. Data collected included demographics, ED aetiology and risk factors, diabetic status, HbA1c and post-operative complications focusing on infection and re-operation. Telephone survey provided implant usage at 3, 6, 12 and 24 months post-operatively. All patients followed the same pre-, peri- and post-operative pathway, including antibiotic prophylaxis and implant preparation. Complication rates of patients with BMI ⩾ 30 (2/20; 10%) and BMI < 30 (0/28, 0%) ( p = 0.169) and of patients with poorly controlled diabetes mellitus (DM), HbA1c > 69 mmol/mol (0/6, 0%) versus HbA1c ⩽ 69 (2/21, 9.52%) ( p = 1) were not significantly different. Two patients reported complications. Implant utilisation did not differ significantly between low or high BMI and HbA1c cohorts. Our study shows pre-operative HbA1c and BMI do not significantly impact complication rates or implant utilisation in patients undergoing IP IPP insertion. 2b","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44238022","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 : 2022-11-18DOI: 10.1177/20514158221135692
W. Thompson, S. Tolofari, B. Starmer, J. Broome, H. Garrod, K. Agarwal, Kee Y Wong, Z. Panayi, K. Hughes, M. Iskander, S. Javed, P. Kelly, H. Lazarowicz, R. Calvert
To compare patient-reported outcome measures (PROMs) for patients with symptomatic renal stone disease treated by flexible ureterorenoscopy (fURS) and shockwave lithotripsy (SWL) Historically, surgical outcomes are measured by surgeon-specific outcomes such as ‘stone-free rates’. More recently, there is increasing emphasis on PROMs to ascertain a patient’s perspective of their own surgical outcome. Despite this, the literature in reference to renal stone-specific PROMs following stone treatment remains limited. Data were collected in a prospective multi-centre study. Patients undergoing fURS or SWL were asked to complete the validated Cambridge Renal Stone Patient Reported Outcome Measure ( CReSP) on the day of initial treatment and at weeks 1, 6 and 12 post-operatively. Data were collected for 119 patients. Three were excluded as stone metric and demographic details were incomplete. Sixty underwent SWL and 56 underwent fURS. Median stone size was 7.52 mm. There were no significant differences in baseline PROM scores between the treatment groups. At 1 week, the PROM scores were significantly higher in the fURS group compared to SWL (27.40 ± 0.85sd versus 22.51 ± 1.07sd; p < 0.05). However, at 6 and 12 weeks, the PROM scores were significantly lower in the fURS group (18.51 ± 2.27sd versus 23.67 ± 1.30sd; p < 0.05) and (17.01 ± 2.29sd versus 22.49 ± 1.49sd; p < 0.05), respectively. By week 12, overall scores for anxiety and social factors were more favourable in the fURS cohort. Our study suggests that fURS is associated with a short-lived increase in morbidity in comparison with SWL, which may be due to ureteric stenting in the majority of patients post-operatively. However, fURS patients appear to report significantly better PROM scores in the longer term. This appears to be associated with more favourable anxiety and social factor scoring over the treatment period. Not applicable.
{"title":"Patient-reported outcome measures (PROMs) in stone surgery: A multi-centre study of patient experience of flexible ureteroscopy (fURS) versus extracorporeal shockwave lithotripsy (SWL)","authors":"W. Thompson, S. Tolofari, B. Starmer, J. Broome, H. Garrod, K. Agarwal, Kee Y Wong, Z. Panayi, K. Hughes, M. Iskander, S. Javed, P. Kelly, H. Lazarowicz, R. Calvert","doi":"10.1177/20514158221135692","DOIUrl":"https://doi.org/10.1177/20514158221135692","url":null,"abstract":"To compare patient-reported outcome measures (PROMs) for patients with symptomatic renal stone disease treated by flexible ureterorenoscopy (fURS) and shockwave lithotripsy (SWL) Historically, surgical outcomes are measured by surgeon-specific outcomes such as ‘stone-free rates’. More recently, there is increasing emphasis on PROMs to ascertain a patient’s perspective of their own surgical outcome. Despite this, the literature in reference to renal stone-specific PROMs following stone treatment remains limited. Data were collected in a prospective multi-centre study. Patients undergoing fURS or SWL were asked to complete the validated Cambridge Renal Stone Patient Reported Outcome Measure ( CReSP) on the day of initial treatment and at weeks 1, 6 and 12 post-operatively. Data were collected for 119 patients. Three were excluded as stone metric and demographic details were incomplete. Sixty underwent SWL and 56 underwent fURS. Median stone size was 7.52 mm. There were no significant differences in baseline PROM scores between the treatment groups. At 1 week, the PROM scores were significantly higher in the fURS group compared to SWL (27.40 ± 0.85sd versus 22.51 ± 1.07sd; p < 0.05). However, at 6 and 12 weeks, the PROM scores were significantly lower in the fURS group (18.51 ± 2.27sd versus 23.67 ± 1.30sd; p < 0.05) and (17.01 ± 2.29sd versus 22.49 ± 1.49sd; p < 0.05), respectively. By week 12, overall scores for anxiety and social factors were more favourable in the fURS cohort. Our study suggests that fURS is associated with a short-lived increase in morbidity in comparison with SWL, which may be due to ureteric stenting in the majority of patients post-operatively. However, fURS patients appear to report significantly better PROM scores in the longer term. This appears to be associated with more favourable anxiety and social factor scoring over the treatment period. Not applicable.","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41621018","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 : 2022-11-18DOI: 10.1177/20514158221135622
Rowan V. David, Arman A. Kahokehr
Artificial urinary sphincter (AUS) activation is usually deferred until 6 weeks following insertion. However, this timeframe for activation is based on traditional dogma. This study aims to assess the feasibility, efficacy and safety of earlier activation of AUS. A prospective database was established on consecutive patients undergoing AUS implantation (AMS-800 Boston Scientific) from March 2019 to March 2022 by a single fellowship-trained urologist. Early activation was defined as <30 days from the date of implantation. Twenty-one patients were included in the study with a median follow-up of 34 (range: 3–96) months. The most common indication for AUS insertion was post-prostatectomy stress urinary incontinence ( n = 19, 90%). All 21 patients had their AUS successfully activated and used before 30 days, with a median of 14 (range: 9–28) days. Median (range) pre-operative continence pad numbers were 3 (2–6) and 0 (0–1) at 4 weeks post-operatively. Median (range) pad weight per day was 600 g (190–1310 g) pre-operatively and 6 g (0–6 g) at 4 weeks post-operatively. There were no adverse events associated with early activation. To our knowledge, this is the first description of the early activation of the AMS-800 AUS device. Our preliminary experience indicates early activation is safe and acceptable for patients. II
{"title":"Early activation of artificial urinary sphincter for stress incontinence is safe: A pilot study","authors":"Rowan V. David, Arman A. Kahokehr","doi":"10.1177/20514158221135622","DOIUrl":"https://doi.org/10.1177/20514158221135622","url":null,"abstract":"Artificial urinary sphincter (AUS) activation is usually deferred until 6 weeks following insertion. However, this timeframe for activation is based on traditional dogma. This study aims to assess the feasibility, efficacy and safety of earlier activation of AUS. A prospective database was established on consecutive patients undergoing AUS implantation (AMS-800 Boston Scientific) from March 2019 to March 2022 by a single fellowship-trained urologist. Early activation was defined as <30 days from the date of implantation. Twenty-one patients were included in the study with a median follow-up of 34 (range: 3–96) months. The most common indication for AUS insertion was post-prostatectomy stress urinary incontinence ( n = 19, 90%). All 21 patients had their AUS successfully activated and used before 30 days, with a median of 14 (range: 9–28) days. Median (range) pre-operative continence pad numbers were 3 (2–6) and 0 (0–1) at 4 weeks post-operatively. Median (range) pad weight per day was 600 g (190–1310 g) pre-operatively and 6 g (0–6 g) at 4 weeks post-operatively. There were no adverse events associated with early activation. To our knowledge, this is the first description of the early activation of the AMS-800 AUS device. Our preliminary experience indicates early activation is safe and acceptable for patients. II","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46512339","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 : 2022-11-16DOI: 10.1177/20514158221129743
Ghanshyam Kumawat, SS Yadav, Sanjeev Jaiswal, Ramdayal Sahu, Anurag Garg, V. Tomar
In the current era, abiraterone acetate is mainstay of the treatment strategies of castration-resistant prostate cancer and proven to prolong overall survival. We aimed to prospectively identify factors associated with duration of response to abiraterone. All metastatic castration-resistant prostate cancer patients eligible for abiraterone were included in the study from February 2019 till March 2020. All baseline data and potential factors associated recorded and follow-up with prostate-specific antigen (PSA), and required investigations were done at 1 month interval. Duration of PSA response was recorded, and patients were divided in five groups on the basis of duration of response. Univariate and multivariate analyses of potential factors were done, and data analysis was done with SPSS (Statistical Package for the Social Sciences) version 21.0. In this study, after univariate analysis, seven factors were associated with longer duration of response to abiraterone. These were PSA at diagnosis (hazard ratio (HR) = −1.011 (95% confidence interval (CI) = 1.003–1.020), p-value = 0.008), PSA at start of abiraterone (HR = −1.018 (95% CI = 1.011–1.025), p-value = 0.0001), nadir PSA (HR = −1.063 (95% CI = 1.024–1.104), p-value = 0.001), prostate-specific antigen doubling (PSAD) time (HR = −0.745 (95% CI = 0.672–0.827), p-value = 0.001), raised alkaline phosphatase (ALP) (HR = −1.002 (95% CI = 1.001–1.003), p-value = 0.001), neutrophil/lymphocyte ratio (NLR) (HR = −2.16 (95% CI = 1.672–2.81), p-value = 0.001) and <5 bone metastasis (HR = −0.235 (95% CI = 0.130–0.422), p-value = 0.01). But after multivariate analysis, nadir PSA achieved, PSAD, NLR and ⩽5 bone metastasis were predictors of better response to abiraterone. This study had identified that less nadir PSA achieved, long PSAD time, low NLR and limited number of skeletal metastases were potential factors for better PSA response to abiraterone. 1
在当今时代，醋酸阿比特龙是去势抵抗性前列腺癌的主要治疗策略，并被证明可以延长总生存期。我们的目的是前瞻性地确定与阿比特龙反应持续时间相关的因素。2019年2月至2020年3月期间，所有符合阿比特龙治疗条件的转移性去势抵抗性前列腺癌患者均被纳入研究。所有基线数据和潜在相关因素的记录和随访与前列腺特异性抗原(PSA)，并在1个月的间隔进行必要的调查。记录PSA反应持续时间，根据反应持续时间将患者分为五组。对潜在因素进行单因素和多因素分析，使用SPSS (Statistical Package for Social Sciences) 21.0版本进行数据分析。在这项研究中，经过单因素分析，七个因素与阿比特龙反应持续时间较长有关。诊断时PSA(风险比(HR) = - 1.011(95%可信区间(CI) = 1.003-1.020)， p值= 0.008)，阿比龙开始时PSA (HR = - 1.018 (95% CI = 1.011 - 1.025)， p值= 0.0001)，最低点PSA (HR = - 1.063 (95% CI = 1.024-1.104)， p值= 0.001)，前列腺特异性抗原加倍(PSAD)时间(HR = - 0.745 (95% CI = 0.672-0.827)， p值= 0.001)，碱性磷酸酶(ALP)升高(HR = - 1.002 (95% CI = 1.001-1.003)， p值= 0.001)，嗜中性粒细胞和淋巴细胞比率(NLR) (HR =−2.16 (95% CI = 1.672 - -2.81),假定值= 0.001)和< 5骨转移(HR =−0.235 (95% CI = 0.130 - -0.422),假定值= 0.01)。但在多因素分析后，最低PSA达到，PSAD, NLR和骨转移≥5是阿比特龙治疗效果更好的预测因素。本研究发现，较低的最低PSA，较长的PSAD时间，较低的NLR和有限的骨骼转移是阿比特龙对PSA更好的潜在因素。1
{"title":"Evaluation of factors predicting response to abiraterone acetate in metastatic castration-resistant prostate cancer: A prospective study","authors":"Ghanshyam Kumawat, SS Yadav, Sanjeev Jaiswal, Ramdayal Sahu, Anurag Garg, V. Tomar","doi":"10.1177/20514158221129743","DOIUrl":"https://doi.org/10.1177/20514158221129743","url":null,"abstract":"In the current era, abiraterone acetate is mainstay of the treatment strategies of castration-resistant prostate cancer and proven to prolong overall survival. We aimed to prospectively identify factors associated with duration of response to abiraterone. All metastatic castration-resistant prostate cancer patients eligible for abiraterone were included in the study from February 2019 till March 2020. All baseline data and potential factors associated recorded and follow-up with prostate-specific antigen (PSA), and required investigations were done at 1 month interval. Duration of PSA response was recorded, and patients were divided in five groups on the basis of duration of response. Univariate and multivariate analyses of potential factors were done, and data analysis was done with SPSS (Statistical Package for the Social Sciences) version 21.0. In this study, after univariate analysis, seven factors were associated with longer duration of response to abiraterone. These were PSA at diagnosis (hazard ratio (HR) = −1.011 (95% confidence interval (CI) = 1.003–1.020), p-value = 0.008), PSA at start of abiraterone (HR = −1.018 (95% CI = 1.011–1.025), p-value = 0.0001), nadir PSA (HR = −1.063 (95% CI = 1.024–1.104), p-value = 0.001), prostate-specific antigen doubling (PSAD) time (HR = −0.745 (95% CI = 0.672–0.827), p-value = 0.001), raised alkaline phosphatase (ALP) (HR = −1.002 (95% CI = 1.001–1.003), p-value = 0.001), neutrophil/lymphocyte ratio (NLR) (HR = −2.16 (95% CI = 1.672–2.81), p-value = 0.001) and <5 bone metastasis (HR = −0.235 (95% CI = 0.130–0.422), p-value = 0.01). But after multivariate analysis, nadir PSA achieved, PSAD, NLR and ⩽5 bone metastasis were predictors of better response to abiraterone. This study had identified that less nadir PSA achieved, long PSAD time, low NLR and limited number of skeletal metastases were potential factors for better PSA response to abiraterone. 1","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46839239","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 : 2022-10-31DOI: 10.1177/20514158221132102
J. Loloi, Sarah Wang, K. Labagnara, M. Plummer, Laura A Douglass, K. Watts, N. Abraham, E. Ohmann
To evaluate predictors of reoperation after transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) in a diverse patient population. A retrospective chart review was performed on men who underwent TURP between 2013 and 2016 at our institution with follow-up data post-operatively. Variables collected included patient demographics and clinical characteristics. Primary outcomes included whether the patient underwent repeat TURP and months elapsed since initial TURP. A total of 304 men underwent TURP during the study period. Thirty men (10%) underwent repeat TURP at a mean interval of 26 months. Reoperation after TURP was not associated with race, body mass index (BMI), 5-alpha-reductase inhibitor (5-ARI) use, or pre-operative prostate volume. An elevated pre-operative haemoglobin A1c (HbA1c) was associated with both reoperation (odds ratio (OR) = 1.32, 95% confidence interval (CI): 1.03–1.69), 30 day readmission (OR = 1.96, 95% CI: 1.17–3.28) and 30-day hematuria (OR: 2.37, 95% CI: 1.29–4.38). Pre-operative prostate specific antigen (PSA) levels > 4 and hydronephrosis on imaging were also associated with a higher risk of reoperation. Reoperation after TURP occurred in 10% of our study cohort at a median of 26 months after surgery. Elevated HbA1c prior to surgery was associated with reoperation, 30-day readmission and 30-day hematuria. Higher risk of post-operative complications in patients with poorly controlled diabetes should be communicated at the time of decision for surgery. Future studies should evaluate whether optimising diabetes control prior to TURP reduces risk of reoperation or whether this risk is non-modifiable due to permanent changes in the lower urinary tract due to chronic hyperglycaemia. III
{"title":"Predictors of reoperation after transurethral resection of the prostate in a diverse, urban academic centre","authors":"J. Loloi, Sarah Wang, K. Labagnara, M. Plummer, Laura A Douglass, K. Watts, N. Abraham, E. Ohmann","doi":"10.1177/20514158221132102","DOIUrl":"https://doi.org/10.1177/20514158221132102","url":null,"abstract":"To evaluate predictors of reoperation after transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) in a diverse patient population. A retrospective chart review was performed on men who underwent TURP between 2013 and 2016 at our institution with follow-up data post-operatively. Variables collected included patient demographics and clinical characteristics. Primary outcomes included whether the patient underwent repeat TURP and months elapsed since initial TURP. A total of 304 men underwent TURP during the study period. Thirty men (10%) underwent repeat TURP at a mean interval of 26 months. Reoperation after TURP was not associated with race, body mass index (BMI), 5-alpha-reductase inhibitor (5-ARI) use, or pre-operative prostate volume. An elevated pre-operative haemoglobin A1c (HbA1c) was associated with both reoperation (odds ratio (OR) = 1.32, 95% confidence interval (CI): 1.03–1.69), 30 day readmission (OR = 1.96, 95% CI: 1.17–3.28) and 30-day hematuria (OR: 2.37, 95% CI: 1.29–4.38). Pre-operative prostate specific antigen (PSA) levels > 4 and hydronephrosis on imaging were also associated with a higher risk of reoperation. Reoperation after TURP occurred in 10% of our study cohort at a median of 26 months after surgery. Elevated HbA1c prior to surgery was associated with reoperation, 30-day readmission and 30-day hematuria. Higher risk of post-operative complications in patients with poorly controlled diabetes should be communicated at the time of decision for surgery. Future studies should evaluate whether optimising diabetes control prior to TURP reduces risk of reoperation or whether this risk is non-modifiable due to permanent changes in the lower urinary tract due to chronic hyperglycaemia. III","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44667272","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 : 2022-10-17DOI: 10.1177/20514158221129952
Nicola Holloway, Luís Ribeiro, Cecilia Bosco, M. van Hemelrijck, J. Seth, T. Nitkunan, D. Nicol, D. Cahill, J. Withington, J. Kinsella, K. Wong
To report on the experience of the management of lower urinary tract symptoms (LUTS) in men referred for prostate radiotherapy (RT) in a large tertiary referral centre. Between February and November 2018, 156 men referred for radiotherapy were seen and assessed according to their LUTS history: International Prostate Symptom Score (IPSS), flow rate (FR) and post-void residual (PVR). Patients with LUTS were offered management options depending on severity including lifestyle advice, oral medication or surgery. A subset of patients ( n = 102) were reassessed post-RT, and univariate and multivariate logistic regression was performed to predict symptoms improvement. Prior to referral for RT and assessment at our dedicated LUTS clinic, 65% of men had a documented history of LUTS, 14% had completed an IPSS questionnaire and only 13% had a urinary FR; 17% (27/156) had prior treatment in the form of medication or surgery. In our assessment, 77/156 (49%) had mild, 66/156 (42%) moderate and 13/156 (8%) severe LUTS determined by IPSS. Out of 156, 71 (46%) had a quality-of-life score >3. Of the men, 81% were offered lifestyle advice, 47 patients were started on alpha blockers and 20 (12.8%) went onto Transurethral Resection of the Prostate prior to RT; 6 weeks following RT, 61 (50%) patients had higher IPSS scores. Patients who were started on alpha blockers ( p = 0.022) or had TURP ( p = 0.015) were less likely to have an increase in IPSS score on multivariate analysis. Men undergoing RT for prostate cancer often have co-existing LUTS. Consideration and evaluation of their LUTS and offer of treatment either medication or surgery could improve urinary symptoms in men undergoing prostate radiotherapy in the short term. Longer term data are still needed to understand the full long-term impact on patient’s symptoms and quality of life. We recommend that patients have formal LUTS assessment pre-RT. Not applicable.
{"title":"Management of men with lower urinary tract symptoms referred for prostate radiotherapy","authors":"Nicola Holloway, Luís Ribeiro, Cecilia Bosco, M. van Hemelrijck, J. Seth, T. Nitkunan, D. Nicol, D. Cahill, J. Withington, J. Kinsella, K. Wong","doi":"10.1177/20514158221129952","DOIUrl":"https://doi.org/10.1177/20514158221129952","url":null,"abstract":"To report on the experience of the management of lower urinary tract symptoms (LUTS) in men referred for prostate radiotherapy (RT) in a large tertiary referral centre. Between February and November 2018, 156 men referred for radiotherapy were seen and assessed according to their LUTS history: International Prostate Symptom Score (IPSS), flow rate (FR) and post-void residual (PVR). Patients with LUTS were offered management options depending on severity including lifestyle advice, oral medication or surgery. A subset of patients ( n = 102) were reassessed post-RT, and univariate and multivariate logistic regression was performed to predict symptoms improvement. Prior to referral for RT and assessment at our dedicated LUTS clinic, 65% of men had a documented history of LUTS, 14% had completed an IPSS questionnaire and only 13% had a urinary FR; 17% (27/156) had prior treatment in the form of medication or surgery. In our assessment, 77/156 (49%) had mild, 66/156 (42%) moderate and 13/156 (8%) severe LUTS determined by IPSS. Out of 156, 71 (46%) had a quality-of-life score >3. Of the men, 81% were offered lifestyle advice, 47 patients were started on alpha blockers and 20 (12.8%) went onto Transurethral Resection of the Prostate prior to RT; 6 weeks following RT, 61 (50%) patients had higher IPSS scores. Patients who were started on alpha blockers ( p = 0.022) or had TURP ( p = 0.015) were less likely to have an increase in IPSS score on multivariate analysis. Men undergoing RT for prostate cancer often have co-existing LUTS. Consideration and evaluation of their LUTS and offer of treatment either medication or surgery could improve urinary symptoms in men undergoing prostate radiotherapy in the short term. Longer term data are still needed to understand the full long-term impact on patient’s symptoms and quality of life. We recommend that patients have formal LUTS assessment pre-RT. Not applicable.","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42132348","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 : 2022-09-19DOI: 10.1177/20514158221123997
Je Song Shin, Duncan G Middleton, D. Small, Lisa Cochrane, S. Morton, I. G. Conn
To retrospectively compare the efficacy and technical performance of a novel lead used for percutaneous nerve evaluation (PNE) during the testing phase for sacral nerve neuromodulation with the existing lead currently used. Sixty-three PNE leads were inserted in 45 consecutive patients who underwent PNE with the novel helical electrodes, and the intra-operative and return clinic sensory threshold currents were recorded. This resulted in current measurements for 63 individual electrodes. Measurements were compared with 46 consecutive patients who previously underwent PNE using the standard lead with measurements for 63 individual electrodes. Current difference distributions for the two leads were compared using a Wilcoxon signed-rank test. There was a statistically significant difference observed between the two types of PNE electrode. The new PNE lead demonstrated less drift in sensory threshold current during a 12-day test period in comparison to the old lead. The novel helical PNE electrodes demonstrate a significant improvement in current drift compared with the old style leads over a 12-day test period. Level III
{"title":"Novel electrode design reduces sensory threshold current drift during peripheral nerve evaluation in patients considered for sacral nerve stimulation","authors":"Je Song Shin, Duncan G Middleton, D. Small, Lisa Cochrane, S. Morton, I. G. Conn","doi":"10.1177/20514158221123997","DOIUrl":"https://doi.org/10.1177/20514158221123997","url":null,"abstract":"To retrospectively compare the efficacy and technical performance of a novel lead used for percutaneous nerve evaluation (PNE) during the testing phase for sacral nerve neuromodulation with the existing lead currently used. Sixty-three PNE leads were inserted in 45 consecutive patients who underwent PNE with the novel helical electrodes, and the intra-operative and return clinic sensory threshold currents were recorded. This resulted in current measurements for 63 individual electrodes. Measurements were compared with 46 consecutive patients who previously underwent PNE using the standard lead with measurements for 63 individual electrodes. Current difference distributions for the two leads were compared using a Wilcoxon signed-rank test. There was a statistically significant difference observed between the two types of PNE electrode. The new PNE lead demonstrated less drift in sensory threshold current during a 12-day test period in comparison to the old lead. The novel helical PNE electrodes demonstrate a significant improvement in current drift compared with the old style leads over a 12-day test period. Level III","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41728640","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 : 2022-09-16DOI: 10.1177/20514158221122521
S. Neu, J. Locke, K. Rebullar, L. Carr, S. Herschorn
To determine if periodic triamcinolone injections into Hunner’s lesion in patients with bladder pain syndrome (BPS) reduces the need for opioids and other pain treatments. This is a retrospective analysis of 28 patients receiving endoscopic injections of 0.5–1.0 cc of triamcinolone acetate into Hunner’s lesions between 2010 and 2018. Wilcoxon signed-rank test was used to compare pain regimens before and after injections. Median age at first triamcinolone injection was 63 (IQR 54–73). Median number of injections/patient was 3 (IQR 2–5.5), at a mean of 8-month intervals (2–80). The median number of pain treatments prior to triamcinolone was 4 (0–13), and 25% of patients were using opioids. With one or more injections, 92.9% had improvement in pain symptoms. There was a significant decrease in number of pain treatments following triamcinolone injections (4.1 vs 0.8, p = 0.006). Fifty-seven percent managed with triamcinolone injections alone, with no other pain treatments. Of the seven patients using opioids, four discontinued opioids altogether. Repeat triamcinolone injections into Hunner’s lesions are associated with a significant reduction in the number of pain treatments used for BPS, with an associated decrease in opioid use. 4
确定在膀胱疼痛综合征(BPS)患者的Hunner病变处定期注射曲安奈德酮是否减少了阿片类药物和其他疼痛治疗的需要。这是对2010年至2018年间接受内窥镜注射0.5-1.0 cc醋酸曲安奈德酮到Hunner病变的28例患者的回顾性分析。采用Wilcoxon sign -rank检验比较注射前后的疼痛方案。首次注射曲安奈德的中位年龄为63岁(IQR 54-73)。中位注射次数/患者为3次(IQR 2-5.5)，平均间隔8个月(2-80)。在使用曲安奈德之前，疼痛治疗的中位数为4次(0-13次)，25%的患者使用阿片类药物。注射一次或多次后，92.9%的患者疼痛症状得到改善。注射曲安奈德后疼痛治疗次数显著减少(4.1 vs 0.8, p = 0.006)。57%的患者仅接受曲安奈德注射，没有其他疼痛治疗。在使用阿片类药物的7名患者中，有4名患者完全停用了阿片类药物。反复向Hunner病变部位注射曲安奈德可显著减少用于BPS的疼痛治疗次数，并减少阿片类药物的使用。4
{"title":"Recurrent triamcinolone injections for the treatment of Hunner’s lesions in bladder pain syndrome","authors":"S. Neu, J. Locke, K. Rebullar, L. Carr, S. Herschorn","doi":"10.1177/20514158221122521","DOIUrl":"https://doi.org/10.1177/20514158221122521","url":null,"abstract":"To determine if periodic triamcinolone injections into Hunner’s lesion in patients with bladder pain syndrome (BPS) reduces the need for opioids and other pain treatments. This is a retrospective analysis of 28 patients receiving endoscopic injections of 0.5–1.0 cc of triamcinolone acetate into Hunner’s lesions between 2010 and 2018. Wilcoxon signed-rank test was used to compare pain regimens before and after injections. Median age at first triamcinolone injection was 63 (IQR 54–73). Median number of injections/patient was 3 (IQR 2–5.5), at a mean of 8-month intervals (2–80). The median number of pain treatments prior to triamcinolone was 4 (0–13), and 25% of patients were using opioids. With one or more injections, 92.9% had improvement in pain symptoms. There was a significant decrease in number of pain treatments following triamcinolone injections (4.1 vs 0.8, p = 0.006). Fifty-seven percent managed with triamcinolone injections alone, with no other pain treatments. Of the seven patients using opioids, four discontinued opioids altogether. Repeat triamcinolone injections into Hunner’s lesions are associated with a significant reduction in the number of pain treatments used for BPS, with an associated decrease in opioid use. 4","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48834956","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 : 2022-09-14DOI: 10.1177/20514158211070141
Hiranya Deka, Appu Thomas
Zinner’s syndrome is a very rare congenital condition characterised by seminal vesicle cyst, obstruction of the ejaculatory duct and ipsilateral renal agenesis. Here, we present a 25-year- old young short-statured male presented with left lower abdominal colicky pain. MRI abdomen showed the absence of the left kidney with a seminal vesicle cyst on the left side. The cyst in question was laparoscopically de-roofed. A second case is a 16-years-old young male who presented with intermittent lower abdominal pain. MRI abdomen showed seminal vesicle cyst with ipsilateral absent kidney which is managed conservatively with medication. Level of evidence: Not applicable
{"title":"Zinner’s syndrome: Triad of seminal vesicle cyst, ejaculatory duct obstruction and ipsilateral renal agenesis: A rare case series","authors":"Hiranya Deka, Appu Thomas","doi":"10.1177/20514158211070141","DOIUrl":"https://doi.org/10.1177/20514158211070141","url":null,"abstract":"Zinner’s syndrome is a very rare congenital condition characterised by seminal vesicle cyst, obstruction of the ejaculatory duct and ipsilateral renal agenesis. Here, we present a 25-year- old young short-statured male presented with left lower abdominal colicky pain. MRI abdomen showed the absence of the left kidney with a seminal vesicle cyst on the left side. The cyst in question was laparoscopically de-roofed. A second case is a 16-years-old young male who presented with intermittent lower abdominal pain. MRI abdomen showed seminal vesicle cyst with ipsilateral absent kidney which is managed conservatively with medication. Level of evidence: Not applicable","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48989237","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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