Arjun Pon Avudaiappan, Pushan Prabhakar, Rachel Siretskiy, Andrew Renshaw, Ahmed Eldefrawy, Murugesan Manoharan
Background
Detecting carcinoma prostate (CaP) after intravesical Bacillus Calmette Guerin (BCG) immunotherapy for non-muscle invasive bladder cancer (NMIBC) poses diagnostic challenges. Granulomatous prostatitis (GP) has an incidence of 0.8%–3.3% in post-intravesical BCG patients and 6% incidence in a PIRADS 5 lesion on multiparametric MRI (mpMRI). Patients with GP after intravesical BCG may have clinical, biochemical, and radiological features similar to CaP. In our study, we evaluate the reliability of mpMRI in diagnosing CaP after intravesical BCG therapy.
Materials and Methods
We reviewed the NMIBC patients treated with intravesical BCG therapy between 2017 and 2023 and investigated those who underwent mpMRI and MR fusion biopsy in suspicion of CaP. A total of 120 patients had intravesical BCG immunotherapy, and 10 patients met our selection criteria. We performed a descriptive analysis of these patients and assessed the sensitivity and specificity of mpMRI in diagnosing CaP.
Results
The sensitivity of mpMRI in detecting CaP was 100%, and the specificity was 28.6%. Similarly, the negative predictive value for detecting CaP was 100%, and the positive predictive value was 37.5%. Among patients evaluated with mpMRI, a PIRADS 4 or 5 lesion was seen in 8 (80%) patients, and there was no lesion in 2 (20%) patients. The mpMRI detected 1 lesion in 6 patients (60%) and 2 (20%) in 2 patients. The lesions had a PIRADS score of 4 and 5 in 6 (60%) and 2 (20%) patients, respectively. Among these lesions, 8 (80%) were in the peripheral zone and 2 (20%) in the transition zone. In the MR fusion biopsy of these 10 patients, 7 (70%) had granulomatous prostatitis, and 3 (30%) had CaP.
Conclusion
In our study on evaluating the reliability of mpMRI in diagnosing CaP among post-intravesical BCG patients, we noted that although PIRADS in mpMRI had high sensitivity in identifying prostate lesions, its specificity for detecting CaP is limited.
{"title":"Reliability of mpMRI in diagnosing cancer prostate following intravesical BCG for bladder cancer","authors":"Arjun Pon Avudaiappan, Pushan Prabhakar, Rachel Siretskiy, Andrew Renshaw, Ahmed Eldefrawy, Murugesan Manoharan","doi":"10.1002/bco2.446","DOIUrl":"10.1002/bco2.446","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Detecting carcinoma prostate (CaP) after intravesical Bacillus Calmette Guerin (BCG) immunotherapy for non-muscle invasive bladder cancer (NMIBC) poses diagnostic challenges. Granulomatous prostatitis (GP) has an incidence of 0.8%–3.3% in post-intravesical BCG patients and 6% incidence in a PIRADS 5 lesion on multiparametric MRI (mpMRI). Patients with GP after intravesical BCG may have clinical, biochemical, and radiological features similar to CaP. In our study, we evaluate the reliability of mpMRI in diagnosing CaP after intravesical BCG therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We reviewed the NMIBC patients treated with intravesical BCG therapy between 2017 and 2023 and investigated those who underwent mpMRI and MR fusion biopsy in suspicion of CaP. A total of 120 patients had intravesical BCG immunotherapy, and 10 patients met our selection criteria. We performed a descriptive analysis of these patients and assessed the sensitivity and specificity of mpMRI in diagnosing CaP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The sensitivity of mpMRI in detecting CaP was 100%, and the specificity was 28.6%. Similarly, the negative predictive value for detecting CaP was 100%, and the positive predictive value was 37.5%. Among patients evaluated with mpMRI, a PIRADS 4 or 5 lesion was seen in 8 (80%) patients, and there was no lesion in 2 (20%) patients. The mpMRI detected 1 lesion in 6 patients (60%) and 2 (20%) in 2 patients. The lesions had a PIRADS score of 4 and 5 in 6 (60%) and 2 (20%) patients, respectively. Among these lesions, 8 (80%) were in the peripheral zone and 2 (20%) in the transition zone. In the MR fusion biopsy of these 10 patients, 7 (70%) had granulomatous prostatitis, and 3 (30%) had CaP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In our study on evaluating the reliability of mpMRI in diagnosing CaP among post-intravesical BCG patients, we noted that although PIRADS in mpMRI had high sensitivity in identifying prostate lesions, its specificity for detecting CaP is limited.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 11","pages":"1090-1094"},"PeriodicalIF":1.6,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cameron E. Alexander, Arjun Nathan, Alexander Light, Chuanyu Gao, Vinson Chan, Sinan Khadhouri, Kevin Gallagher, Kevin G. Byrnes, Michael Walters, Terry Hughes, Rita Perry, Kelvin Okoth, Laura Magill, Thomas Pinkney, Joseph B. John, John S. McGrath, Alexandra Colquhoun, Yuhao Zhang, James Blackmur, Eric Etchill, Stanley Tang, Damián García Escudero, Grant Stewart, Veeru Kasivisvanathan, COVIDSurg Collaborative
Objective
The objective of this study was to report the 12-month oncological outcomes for patients with non-muscle-invasive bladder cancer (NMIBC) within the prospective, international COVIDSurg Cancer study.
Patients and methods
Eligible patients were aged ≥18 years and scheduled for elective surgical management of NMIBC with curative intent (transurethral resection of bladder tumour [TURBT] or bladder biopsy) from 21 January to 14 April 2020. The primary outcome was disease recurrence within 12 months of previous elective TURBT/bladder biopsy. Secondary outcomes included disease progression within 12 months of previous elective TURBT/bladder biopsy, site-declared delay to surgery from diagnosis as a consequence of COVID-19 and deviation in standard care due to COVID-19. Comparisons were made to cohorts from the pre-pandemic era.
Results
Bladder cancer accounted for 2.2% (n = 446) of patients in the COVIDSurg Cancer study, with data contributed by 27 centres across 12 countries internationally. Within this included cohort, 229 patients had NMIBC and 12-month follow-up data available. On application of National Institute for Health and Care Excellence (NICE) criteria, 47.2% were classified as having high-risk disease. Overall disease recurrence and progression rates were 29.3% and 9.7% at 12 months, respectively. In purely high-risk pre-pandemic cohorts, the International Bladder Cancer Group (IBCG) estimates a recurrence rate of 25% at 12 months, and the European Association of Urology (EAU) NMIBC 2021 scoring model estimates a 12-month progression rate of 3.5%. As a consequence of the COVID-19 pandemic, 10.9% of patients had site-declared delay to TURBT/bladder biopsy; 7.4% did not undergo intravesical therapy or had early discontinuation of this; 9.2% did not undergo early repeat resection for high-risk disease; and 18.3% had a delay to cystoscopic follow-up surveillance.
Conclusions
This prospective study indicates that there were widespread deviations in usual care for NMIBC during the pandemic and that 12-month oncological outcomes appear to be impaired compared to published pre-pandemic outcomes.
{"title":"Understanding the long-term impact of the COVID-19 pandemic on non-muscle-invasive bladder cancer outcomes: 12-Month follow-up data from the international, prospective COVIDSurg Cancer study","authors":"Cameron E. Alexander, Arjun Nathan, Alexander Light, Chuanyu Gao, Vinson Chan, Sinan Khadhouri, Kevin Gallagher, Kevin G. Byrnes, Michael Walters, Terry Hughes, Rita Perry, Kelvin Okoth, Laura Magill, Thomas Pinkney, Joseph B. John, John S. McGrath, Alexandra Colquhoun, Yuhao Zhang, James Blackmur, Eric Etchill, Stanley Tang, Damián García Escudero, Grant Stewart, Veeru Kasivisvanathan, COVIDSurg Collaborative","doi":"10.1002/bco2.432","DOIUrl":"10.1002/bco2.432","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study was to report the 12-month oncological outcomes for patients with non-muscle-invasive bladder cancer (NMIBC) within the prospective, international COVIDSurg Cancer study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>Eligible patients were aged ≥18 years and scheduled for elective surgical management of NMIBC with curative intent (transurethral resection of bladder tumour [TURBT] or bladder biopsy) from 21 January to 14 April 2020. The primary outcome was disease recurrence within 12 months of previous elective TURBT/bladder biopsy. Secondary outcomes included disease progression within 12 months of previous elective TURBT/bladder biopsy, site-declared delay to surgery from diagnosis as a consequence of COVID-19 and deviation in standard care due to COVID-19. Comparisons were made to cohorts from the pre-pandemic era.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Bladder cancer accounted for 2.2% (<i>n</i> = 446) of patients in the COVIDSurg Cancer study, with data contributed by 27 centres across 12 countries internationally. Within this included cohort, 229 patients had NMIBC and 12-month follow-up data available. On application of National Institute for Health and Care Excellence (NICE) criteria, 47.2% were classified as having high-risk disease. Overall disease recurrence and progression rates were 29.3% and 9.7% at 12 months, respectively. In purely high-risk pre-pandemic cohorts, the International Bladder Cancer Group (IBCG) estimates a recurrence rate of 25% at 12 months, and the European Association of Urology (EAU) NMIBC 2021 scoring model estimates a 12-month progression rate of 3.5%. As a consequence of the COVID-19 pandemic, 10.9% of patients had site-declared delay to TURBT/bladder biopsy; 7.4% did not undergo intravesical therapy or had early discontinuation of this; 9.2% did not undergo early repeat resection for high-risk disease; and 18.3% had a delay to cystoscopic follow-up surveillance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This prospective study indicates that there were widespread deviations in usual care for NMIBC during the pandemic and that 12-month oncological outcomes appear to be impaired compared to published pre-pandemic outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 11","pages":"1044-1051"},"PeriodicalIF":1.6,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Liam Mannion, Verity Watson, Vinod Mullassery, Rajesh Nair, Thomas Charlton, Margaret Northover, Deborah Enting, Mieke Van Hemelrijck, Muhammad Shamim Khan, Ramesh Thurairaja, Suzanne Amery, Kathryn Chatterton, Kate Smith, Simon Hughes
Background
When faced with treatment options, patients are asked to participate in decision-making. We sought to determine which treatment aspects matter most for individuals treated for muscle invasive bladder cancer (MIBC), with an aim to improve understanding of patient preferences and what trade-offs patients are willing to accept. Our study consisted of a discrete choice experiment (DCE): a type of questionnaire used to elicit preferences in the absence of real-world choice.
Methods
The DCE had five attributives, each with three levels. Participants were asked to complete a questionnaire in which they were asked to choose between two hypothetical MIBC treatments. The data were analysed using a conditional logit model, and preferences for, and trade-offs between, attributes were estimated.
Results
We recruited patients with MIBC who had either already completed, were undergoing or had yet to commence radical treatment for MIBC (n = 60). Participants indicated a strong preference for treatments that increased their life expectancy (p = <0.001), had a lower risk of long-term complications (p = <0.001) and less changes to their body image (p = <0.001). Changes to sexual wellbeing (p = 0.09) or an increase in acute side effects (p = 0.99) did not influence preferences. Patients were willing to accept treatments with higher risk of long-term complications to improve their life expectancy or body image.
Conclusion
When deciding on the type of treatment, increased life expectancy is the most important consideration for people with MIBC. The risk of long-term complications and changes to overall body image as a result of treatment are also important. Our study also highlighted that patients are willing to accept a higher risk of long-term complications to improve other treatment outcomes. Understanding patient preferences is important for shared decision-making, which has an impact on quality of care for people living with MIBC.
背景：面对治疗方案时，患者需要参与决策。我们试图确定肌肉浸润性膀胱癌（MIBC）患者最关心哪些治疗方面，以加深对患者偏好以及患者愿意接受哪些权衡的理解。我们的研究包括离散选择实验（DCE）：这是一种用于在没有实际选择的情况下征求偏好的问卷：离散选择实验有五个属性，每个属性有三个等级。受试者被要求填写一份问卷，其中要求他们在两种假定的 MIBC 治疗方法中做出选择。我们使用条件对数模型对数据进行了分析，并对属性的偏好和属性之间的权衡进行了估算：我们招募了已经完成、正在进行或尚未开始根治性治疗的 MIBC 患者（n = 60）。参与者对延长预期寿命（p = p = p = p = 0.09）或增加急性副作用（p = 0.99）的治疗方法有强烈偏好，但这并不影响偏好。患者愿意接受长期并发症风险较高的治疗方法，以改善其预期寿命或身体形象：结论：在决定治疗类型时，延长预期寿命是MIBC患者最重要的考虑因素。结论：在决定治疗方式时，延长预期寿命是宫颈癌患者最重要的考虑因素，长期并发症的风险和治疗对整体身体形象的改变也很重要。我们的研究还强调，患者愿意接受较高的长期并发症风险，以改善其他治疗效果。了解患者的偏好对于共同决策非常重要，而共同决策对 MIBC 患者的护理质量也有影响。
{"title":"Treatment preferences of patients with muscle invasive bladder cancer: A discrete choice experiment","authors":"Liam Mannion, Verity Watson, Vinod Mullassery, Rajesh Nair, Thomas Charlton, Margaret Northover, Deborah Enting, Mieke Van Hemelrijck, Muhammad Shamim Khan, Ramesh Thurairaja, Suzanne Amery, Kathryn Chatterton, Kate Smith, Simon Hughes","doi":"10.1002/bco2.443","DOIUrl":"10.1002/bco2.443","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>When faced with treatment options, patients are asked to participate in decision-making. We sought to determine which treatment aspects matter most for individuals treated for muscle invasive bladder cancer (MIBC), with an aim to improve understanding of patient preferences and what trade-offs patients are willing to accept. Our study consisted of a discrete choice experiment (DCE): a type of questionnaire used to elicit preferences in the absence of real-world choice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The DCE had five attributives, each with three levels. Participants were asked to complete a questionnaire in which they were asked to choose between two hypothetical MIBC treatments. The data were analysed using a conditional logit model, and preferences for, and trade-offs between, attributes were estimated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We recruited patients with MIBC who had either already completed, were undergoing or had yet to commence radical treatment for MIBC (<i>n</i> = 60). Participants indicated a strong preference for treatments that increased their life expectancy (<i>p</i> = <0.001), had a lower risk of long-term complications (<i>p</i> = <0.001) and less changes to their body image (<i>p</i> = <0.001). Changes to sexual wellbeing (<i>p</i> = 0.09) or an increase in acute side effects (<i>p</i> = 0.99) did not influence preferences. Patients were willing to accept treatments with higher risk of long-term complications to improve their life expectancy or body image.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>When deciding on the type of treatment, increased life expectancy is the most important consideration for people with MIBC. The risk of long-term complications and changes to overall body image as a result of treatment are also important. Our study also highlighted that patients are willing to accept a higher risk of long-term complications to improve other treatment outcomes. Understanding patient preferences is important for shared decision-making, which has an impact on quality of care for people living with MIBC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 11","pages":"1059-1068"},"PeriodicalIF":1.6,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ali H. Zahalka, Ethan Fram, Evan Garden, Lauren Howard, Emily Wiggins, Mustufa Babar, Jay Annam, Allison Reagan, Benjamin Eilender, Amanda de Hoedt, Stephen J. Freedland, Ash Tewari, Kara L. Watts
Objectives
The objective of this study is to investigate the association between the use of beta-adrenergic antagonist atenolol and risk of pathologic upgrade in patients on active surveillance, considering growing literature implicating adrenergic innervation with disease progression mediated through beta-adrenergic signalling.
Patients and Methods
Men with low-risk or favourable intermediate-risk prostate cancer who were placed on an active surveillance protocol between 2006 and 2020 across three diverse urban hospitals were included. Exposure was duration of atenolol use, and outcome was pathologic grade group upgrading (to GG ≥ 3) on final prostate biopsy. Cox proportional hazard regression models were used to determine the associations between atenolol use and risk of upgrading with time, on a per-examination basis.
Results
A total of 467 men with initial GG ≤ 2 were included. Postdiagnosis atenolol use was associated with a decreased risk of pathologic upgrade to GG ≥ 3 on final repeat biopsy (HR 0.81, 95% CI 0.39–0.98). Longer duration of postdiagnosis atenolol use (>2 years) and greater cumulative atenolol dose (>730 defined daily doses) were associated with a more pronounced decreased risk of upgrade to GG ≥ 3 (HR 0.41, 95% CI 0.05–0.88, and HR 0.32, 95% CI 0.15–0.99, respectively). Initiation of atenolol use prior to prostate cancer diagnosis had a slightly greater protective effect than drug initiation postdiagnosis (HR 0.79, 95% CI 0.43–0.98, and HR 0.83, 95% CI 0.30–0.99, respectively).
Conclusions
Beta-adrenergic blockade with atenolol use in men on active surveillance is associated with a reduced risk for clinically significant grade group pathologic upgrade.
研究目的考虑到越来越多的文献表明肾上腺素能神经支配通过β-肾上腺素能信号介导疾病进展，本研究旨在调查主动监测患者使用β-肾上腺素能拮抗剂阿替洛尔与病理升级风险之间的关系：纳入了三家不同城市医院在 2006 年至 2020 年期间接受主动监测方案的低危或良好中危前列腺癌男性患者。暴露是指阿替洛尔的使用时间，结果是指最终前列腺活检的病理分级组别升级（GG≥3）。采用Cox比例危险回归模型确定阿替洛尔的使用与每次检查的升级风险之间的关系：结果：共纳入467名初始GG≤2的男性。诊断后使用阿替洛尔与最终重复活检时病理结果升级为GG≥3的风险降低有关（HR 0.81，95% CI 0.39-0.98）。诊断后使用阿替洛尔的时间越长（>2 年），阿替洛尔的累积剂量越大（>730 定义日剂量），升级为 GG ≥ 3 的风险就越低（HR 分别为 0.41，95% CI 0.05-0.88 和 HR 0.32，95% CI 0.15-0.99）。前列腺癌确诊前开始使用阿替洛尔的保护作用略大于确诊后开始用药（分别为HR 0.79，95% CI 0.43-0.98和HR 0.83，95% CI 0.30-0.99）：结论：在接受主动监测的男性中使用阿替洛尔进行β-肾上腺素能阻断与降低临床上显著的病理分级升级风险有关。
{"title":"Association between beta-blocker atenolol use and prostate cancer upgrading in active surveillance†","authors":"Ali H. Zahalka, Ethan Fram, Evan Garden, Lauren Howard, Emily Wiggins, Mustufa Babar, Jay Annam, Allison Reagan, Benjamin Eilender, Amanda de Hoedt, Stephen J. Freedland, Ash Tewari, Kara L. Watts","doi":"10.1002/bco2.441","DOIUrl":"10.1002/bco2.441","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The objective of this study is to investigate the association between the use of beta-adrenergic antagonist atenolol and risk of pathologic upgrade in patients on active surveillance, considering growing literature implicating adrenergic innervation with disease progression mediated through beta-adrenergic signalling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>Men with low-risk or favourable intermediate-risk prostate cancer who were placed on an active surveillance protocol between 2006 and 2020 across three diverse urban hospitals were included. Exposure was duration of atenolol use, and outcome was pathologic grade group upgrading (to GG ≥ 3) on final prostate biopsy. Cox proportional hazard regression models were used to determine the associations between atenolol use and risk of upgrading with time, on a per-examination basis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 467 men with initial GG ≤ 2 were included. Postdiagnosis atenolol use was associated with a decreased risk of pathologic upgrade to GG ≥ 3 on final repeat biopsy (HR 0.81, 95% CI 0.39–0.98). Longer duration of postdiagnosis atenolol use (>2 years) and greater cumulative atenolol dose (>730 defined daily doses) were associated with a more pronounced decreased risk of upgrade to GG ≥ 3 (HR 0.41, 95% CI 0.05–0.88, and HR 0.32, 95% CI 0.15–0.99, respectively). Initiation of atenolol use prior to prostate cancer diagnosis had a slightly greater protective effect than drug initiation postdiagnosis (HR 0.79, 95% CI 0.43–0.98, and HR 0.83, 95% CI 0.30–0.99, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Beta-adrenergic blockade with atenolol use in men on active surveillance is associated with a reduced risk for clinically significant grade group pathologic upgrade.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 11","pages":"1095-1100"},"PeriodicalIF":1.6,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Waseem Ashraf, Arif Hamid, Sajad Ahmad Malik, Rouf Khawaja, Sajad Ahmad Para, Mohammad Saleem Wani, Saqib Mehdi
Introduction
Enhanced recovery after surgery (ERAS) is a patient-centerd, evidence-based approach to improve postoperative outcomes. The protocol involves multidisciplinary collaboration and standardisation of perioperative interventions. ERAS has shown positive results in reducing hospitalisation and complications.
Methods
The study conducted in the Department of Urology was a retro-prospective study. It included an ERAS cohort group of 47 patients, studied prospectively from May 2021 to May 2023. These patients were compared to a historical cohort of 47 consecutive patients who underwent radical cystectomy with traditional care before the ERAS pathway was implemented. The primary outcome was hospital length of stay (LOS). Secondary outcomes included perioperative management, time to recovery milestones and complications.
Results
Implementation of ERAS pathway for radical cystectomy was associated with reduced hospital LOS (mean LOS 16.19 ± 2.53 days vs. 10.26 ± 3.33 days 7 days; p < 0.0001), reduced time to key recovery milestones, including days to first flatus (3.17 vs. 2.68; p = 0.013) and days to first solid food (5.19 vs. 3.45 p value < 0.0001), first stool (5.53 vs. 4.23; p < 0.0001), reductions in some complications like postoperative ileus (p value = 0.021) and need for total parental nutrition (p value = 0.023).
Conclusion
In conclusion, the implementation of the integrated approach facilitates a more efficient recovery process, potentially reducing healthcare costs and enhancing patient comfort.
导言：加强术后恢复（ERAS）是一种以患者为中心、以证据为基础的改善术后效果的方法。该方案涉及多学科协作和围手术期干预标准化。ERAS 在减少住院和并发症方面取得了积极成果：在泌尿科进行的研究是一项回顾性研究。该研究包括一个由 47 名患者组成的 ERAS 队列组，研究时间为 2021 年 5 月至 2023 年 5 月。这些患者与ERAS路径实施前接受根治性膀胱切除术的47名连续患者进行了比较。主要结果是住院时间（LOS）。次要结果包括围手术期管理、康复里程碑时间和并发症：结果：在根治性膀胱切除术中实施ERAS路径可缩短住院时间（平均住院时间为16.19±2.53天 vs. 10.26±3.33 天 7天；p p = 0.013）、首次进食固体食物的天数（5.19 vs. 3.45 p value p value = 0.021）和对全父母营养的需求（p value = 0.023）：总之，综合方法的实施有助于提高康复过程的效率，有可能降低医疗成本并提高患者的舒适度。
{"title":"Integrated enhanced recovery after surgery protocol in radical cystectomy for bladder tumour—A retroprospective study","authors":"Waseem Ashraf, Arif Hamid, Sajad Ahmad Malik, Rouf Khawaja, Sajad Ahmad Para, Mohammad Saleem Wani, Saqib Mehdi","doi":"10.1002/bco2.438","DOIUrl":"10.1002/bco2.438","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Enhanced recovery after surgery (ERAS) is a patient-centerd, evidence-based approach to improve postoperative outcomes. The protocol involves multidisciplinary collaboration and standardisation of perioperative interventions. ERAS has shown positive results in reducing hospitalisation and complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study conducted in the Department of Urology was a retro-prospective study. It included an ERAS cohort group of 47 patients, studied prospectively from May 2021 to May 2023. These patients were compared to a historical cohort of 47 consecutive patients who underwent radical cystectomy with traditional care before the ERAS pathway was implemented. The primary outcome was hospital length of stay (LOS). Secondary outcomes included perioperative management, time to recovery milestones and complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Implementation of ERAS pathway for radical cystectomy was associated with reduced hospital LOS (mean LOS 16.19 ± 2.53 days vs. 10.26 ± 3.33 days 7 days; <i>p</i> < 0.0001), reduced time to key recovery milestones, including days to first flatus (3.17 vs. 2.68; <i>p</i> = 0.013) and days to first solid food (5.19 vs. 3.45 <i>p</i> value < 0.0001), first stool (5.53 vs. 4.23; <i>p</i> < 0.0001), reductions in some complications like postoperative ileus (<i>p</i> value = 0.021) and need for total parental nutrition (<i>p</i> value = 0.023).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In conclusion, the implementation of the integrated approach facilitates a more efficient recovery process, potentially reducing healthcare costs and enhancing patient comfort.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 11","pages":"1069-1080"},"PeriodicalIF":1.6,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nikita R. Bhatt, Simona Ippoliti, Arjun Nambiar, Cristian Ilie, Ruth Doherty, Lee Smith
Background
Urodynamic evidence of storage dysfunction such as detrusor overactivity (DO) and/or poor compliance are present in up to 30–40% of patients after Radical Prostatectomy (RP). However, the current optimal management of men with DO on preoperative urodynamics prior to male stress urinary incontinence (SUI) surgery is not known.
Methods
We performed a systematic search of the literature including articles on patients undergoing SUI surgery after prostatectomy with preoperative DO between January 2003 and May 2023 to ensure contemporaneous data was obtained.
Results
We identified 11 eligible publications with a total of 792 patients. On Urodynamics, 29% (n = 229) patients had DO prior to SUI surgery. Overall 69% patients had a successful outcome after SUI surgery while 26% (132/499) failed while 34% (32/95) patients who had proven DO preoperatively failed SUI surgery. The difference was not statistically significant. Considering the sub-group analysis, the failure rate with preoperative DO was significantly higher in the sling group (43%) than in the AUS group (18%). The review was limited by the outcome heterogeneity, variability in study inclusion criteria, reporting and analysis and the quality of the available studies.
Conclusions
Within the limitations of the data, this review did not show a statistically significant higher failure rate of male incontinence surgery in patients with DO. Hence, patients with DO on preoperative urodynamics who are eligible for male SUI surgery should not be denied surgery but should be counselled appropriately of the risks and potential need for subsequent treatment, to manage expectations.
背景：多达 30-40% 的根治性前列腺切除术（RP）患者会出现尿动力学证据显示的储尿功能障碍，如逼尿肌过度活动（DO）和/或顺应性差。然而，目前对男性压力性尿失禁（SUI）手术前尿动力学检查显示有DO的男性的最佳治疗方法尚不清楚：我们对 2003 年 1 月至 2023 年 5 月期间有关前列腺切除术后接受 SUI 手术且术前有 DO 的患者的文献进行了系统检索，以确保获得同期数据：结果：我们发现了11篇符合条件的文献，共涉及792名患者。在尿动力学方面，29%（n = 229）的患者在 SUI 手术前进行了 DO。总体而言，69% 的患者在 SUI 手术后取得了成功，而 26% 的患者（132/499）手术失败，34% 的患者（32/95）术前证实有 DO，但 SUI 手术失败。差异在统计学上并不显著。考虑到分组分析，术前有 DO 的吊带组失败率（43%）明显高于 AUS 组（18%）。研究结果的异质性、研究纳入标准、报告和分析的差异性以及现有研究的质量限制了该综述：在数据有限的情况下，本综述并未显示 DO 患者的男性尿失禁手术失败率在统计学上有显著提高。因此，对于术前尿动力学检查符合男性尿失禁手术条件的尿失禁患者，不应拒绝其接受手术，而应就其风险和后续治疗的潜在需求提供适当的建议，以控制期望值。
{"title":"Outcome of post-prostatectomy stress urinary incontinence surgery in men with preoperative idiopathic detrusor overactivity","authors":"Nikita R. Bhatt, Simona Ippoliti, Arjun Nambiar, Cristian Ilie, Ruth Doherty, Lee Smith","doi":"10.1002/bco2.442","DOIUrl":"10.1002/bco2.442","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Urodynamic evidence of storage dysfunction such as detrusor overactivity (DO) and/or poor compliance are present in up to 30–40% of patients after Radical Prostatectomy (RP). However, the current optimal management of men with DO on preoperative urodynamics prior to male stress urinary incontinence (SUI) surgery is not known.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a systematic search of the literature including articles on patients undergoing SUI surgery after prostatectomy with preoperative DO between January 2003 and May 2023 to ensure contemporaneous data was obtained.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 11 eligible publications with a total of 792 patients. On Urodynamics, 29% (n = 229) patients had DO prior to SUI surgery. Overall 69% patients had a successful outcome after SUI surgery while 26% (132/499) failed while 34% (32/95) patients who had proven DO preoperatively failed SUI surgery. The difference was not statistically significant. Considering the sub-group analysis, the failure rate with preoperative DO was significantly higher in the sling group (43%) than in the AUS group (18%). The review was limited by the outcome heterogeneity, variability in study inclusion criteria, reporting and analysis and the quality of the available studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Within the limitations of the data, this review did not show a statistically significant higher failure rate of male incontinence surgery in patients with DO. Hence, patients with DO on preoperative urodynamics who are eligible for male SUI surgery should not be denied surgery but should be counselled appropriately of the risks and potential need for subsequent treatment, to manage expectations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 11","pages":"1001-1010"},"PeriodicalIF":1.6,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Simon Hughes, Rajesh Nair, Bhav Radia, Ravimohan S. mavuduru, Prokar Dasgupta, Amit Ghose
No pan-India-specific guidelines exist for the management of urological cancers. Although western guidelines are useful for informing management strategies, they do not account for the nuances of management in the Indian context. A modified Delphi method was used to provide a framework for the systematic development of India-centric guidelines for the management of three uro-oncology disease states: small renal masses, non-muscle invasive bladder cancer and high-risk/locally advanced prostate cancer.
{"title":"Indian consensus statements on the management of small renal masses, non-muscle invasive bladder cancer and high-risk/locally advanced prostate cancer","authors":"Simon Hughes, Rajesh Nair, Bhav Radia, Ravimohan S. mavuduru, Prokar Dasgupta, Amit Ghose","doi":"10.1002/bco2.440","DOIUrl":"10.1002/bco2.440","url":null,"abstract":"<p>No pan-India-specific guidelines exist for the management of urological cancers. Although western guidelines are useful for informing management strategies, they do not account for the nuances of management in the Indian context. A modified Delphi method was used to provide a framework for the systematic development of India-centric guidelines for the management of three uro-oncology disease states: small renal masses, non-muscle invasive bladder cancer and high-risk/locally advanced prostate cancer.</p>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 11","pages":"1034-1043"},"PeriodicalIF":1.6,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paul K. Hegarty, Mona Kalantar, Penelope A. Hegarty, Helen Zafirakis, Jack E. Monahan
Objectives
To assess the effect of bilateral orchidopexy in preventing future torsion and testicular loss in patients with intermittent testicular torsion. Secondarily, this study aims to assess the rate of pain improvement following orchidopexy.
Methods
This is a prospective cohort of patients. Participants were men who underwent elective bilateral orchidopexy for intermittent testicular torsion. All consecutive cases were treated by a single surgeon in a single centre between 2015 and 2023. The primary outcomes were prevention of torsion and testicular loss. The secondary outcome was the resolution or improvement in pain.
Results
The success rate of bilateral orchidopexy in preventing testicular loss due to torsion was 100%, at a follow-up of mean 33.5 months. Of the 50 patients, 88% were pain-free following orchidopexy, and 12% had an improvement in their pain. There were no cases of hydrocoele or haematoma in this series. To our knowledge, this is the largest series reported in the literature.
Conclusions
Elective bilateral orchidopexy prevents torsion and preserves testicular viability. Pain is resolved in most but not all cases. This is important in counselling men who are considering surgical management of intermittent torsion of the testicle.
{"title":"Bilateral orchidopexy for intermittent testicular torsion","authors":"Paul K. Hegarty, Mona Kalantar, Penelope A. Hegarty, Helen Zafirakis, Jack E. Monahan","doi":"10.1002/bco2.439","DOIUrl":"10.1002/bco2.439","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the effect of bilateral orchidopexy in preventing future torsion and testicular loss in patients with intermittent testicular torsion. Secondarily, this study aims to assess the rate of pain improvement following orchidopexy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a prospective cohort of patients. Participants were men who underwent elective bilateral orchidopexy for intermittent testicular torsion. All consecutive cases were treated by a single surgeon in a single centre between 2015 and 2023. The primary outcomes were prevention of torsion and testicular loss. The secondary outcome was the resolution or improvement in pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The success rate of bilateral orchidopexy in preventing testicular loss due to torsion was 100%, at a follow-up of mean 33.5 months. Of the 50 patients, 88% were pain-free following orchidopexy, and 12% had an improvement in their pain. There were no cases of hydrocoele or haematoma in this series. To our knowledge, this is the largest series reported in the literature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Elective bilateral orchidopexy prevents torsion and preserves testicular viability. Pain is resolved in most but not all cases. This is important in counselling men who are considering surgical management of intermittent torsion of the testicle.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 11","pages":"1017-1022"},"PeriodicalIF":1.6,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zhong-Hua Yang, Yong-Zhi Wang, Tao Liu, Hang Zheng, Xing-Huan Wang
Objectives
This study aims to describe a novel dorsal venous complex (DVC) ligation-free and parietal endopelvic fascia preserving technique for laparoscopic radical prostatectomy and to evaluate its post-operative outcomes.
Methods
From April 2020 to May 2021, a total of 125 patients with localized prostate cancer received laparoscopic radical prostatectomy by a single surgeon. In the procedure, a novel technique of DVC ligation-free and parietal endopelvic fascia preserving was used. Preoperative characteristics of patients and perioperative results were recorded. In this study, continence was defined as zero to one pad per day. Oncological outcomes were evaluated based on positive surgical margin.
Results
Five patients required a blood transfusion. Mean post-operative hospital stay was 3.9 days (2–5), and the catheter could be removed on post-operative day 7 to 9. Final pathologic evaluations were 87 stage pT2, 22 stage pT3a, and 7 pT3b, 9 stage pT4, respectively. The positive surgical margin rate was 10.4% in total. Ninety-three patients (74.4%) returned to urinary continence 2 months post-operatively, and 11 patients (11/125) developed biochemical recurrence 6 months post-operatively.
Conclusions
The DVC ligation-free and parietal endopelvic fascia preserving technique provides early recovery from incontinence without adversely affecting the oncological outcome.
{"title":"Dorsal venous complex ligation-free and parietal endopelvic fascia preserving in laparoscopic radical prostatectomy: A prospective study of single centre","authors":"Zhong-Hua Yang, Yong-Zhi Wang, Tao Liu, Hang Zheng, Xing-Huan Wang","doi":"10.1002/bco2.437","DOIUrl":"10.1002/bco2.437","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aims to describe a novel dorsal venous complex (DVC) ligation-free and parietal endopelvic fascia preserving technique for laparoscopic radical prostatectomy and to evaluate its post-operative outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From April 2020 to May 2021, a total of 125 patients with localized prostate cancer received laparoscopic radical prostatectomy by a single surgeon. In the procedure, a novel technique of DVC ligation-free and parietal endopelvic fascia preserving was used. Preoperative characteristics of patients and perioperative results were recorded. In this study, continence was defined as zero to one pad per day. Oncological outcomes were evaluated based on positive surgical margin.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five patients required a blood transfusion. Mean post-operative hospital stay was 3.9 days (2–5), and the catheter could be removed on post-operative day 7 to 9. Final pathologic evaluations were 87 stage pT2, 22 stage pT3a, and 7 pT3b, 9 stage pT4, respectively. The positive surgical margin rate was 10.4% in total. Ninety-three patients (74.4%) returned to urinary continence 2 months post-operatively, and 11 patients (11/125) developed biochemical recurrence 6 months post-operatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The DVC ligation-free and parietal endopelvic fascia preserving technique provides early recovery from incontinence without adversely affecting the oncological outcome.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 11","pages":"1101-1105"},"PeriodicalIF":1.6,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gavin Wei, James Antony Sidney Sewell, Caroline Bartolo, Amelia Pearce, Owen Harris, Richard Grills
Objectives
The objectives of this study are as follows: to assess the uropathogen antibiogram at two tertiary hospitals in Victoria to look at the difference in susceptibility patterns, to assess whether national guideline recommendations were applicable and to assess the feasibility of local antibiogram analysis to guide development of hospital-specific guidelines for empirical treatment of urosepsis and for pre-operative prophylaxis for urological procedures.
Patients and methods
All positive urine cultures analysed at Barwon Health and Monash Health, two tertiary hospitals in regional and metropolitan Victoria, Australia, respectively, between January 2019 and December 2020 were retrospectively identified. Data obtained included the organism cultured and their susceptibility profiles.
Results
Three thousand seven hundred and seventy-seven positive urine cultures from Barwon Health and 6821 from Monash Health were identified. The most common uropathogen was Escherichia coli, which was cultured in 53.4% and 59.1% of urine cultures at Barwon Health and Monash Health, respectively. The main differences observed were in Enterococcus spp., which were cultured in 8.8% and 4.9% of cultures at Barwon Health and Monash Health, respectively, and Candida spp. in 4.2% and 1.5% of cultures at Barwon Health and Monash Health, respectively. The largest differences were found in fluoroquinolone resistance with 12.1% of organisms resistant to ciprofloxacin at Barwon Health compared to 6.4% at Monash Health and 7.1% of organisms resistant to vancomycin compared to 20.1% at Barwon Health and Monash Health, respectively.
Conclusion
This study demonstrates that there is considerable variability in the uropathogens and their antimicrobial susceptibility profile in two large health services in the same state. We recommend that each centre performs regular analysis of their uropathogen antibiogram to develop local guidelines for treatment and pre-operative prophylaxis for uropathogens.
{"title":"Uropathogen antibiogram regional variations—Are Australian antimicrobial guidelines appropriate?","authors":"Gavin Wei, James Antony Sidney Sewell, Caroline Bartolo, Amelia Pearce, Owen Harris, Richard Grills","doi":"10.1002/bco2.429","DOIUrl":"10.1002/bco2.429","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The objectives of this study are as follows: to assess the uropathogen antibiogram at two tertiary hospitals in Victoria to look at the difference in susceptibility patterns, to assess whether national guideline recommendations were applicable and to assess the feasibility of local antibiogram analysis to guide development of hospital-specific guidelines for empirical treatment of urosepsis and for pre-operative prophylaxis for urological procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>All positive urine cultures analysed at Barwon Health and Monash Health, two tertiary hospitals in regional and metropolitan Victoria, Australia, respectively, between January 2019 and December 2020 were retrospectively identified. Data obtained included the organism cultured and their susceptibility profiles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three thousand seven hundred and seventy-seven positive urine cultures from Barwon Health and 6821 from Monash Health were identified. The most common uropathogen was <i>Escherichia coli</i>, which was cultured in 53.4% and 59.1% of urine cultures at Barwon Health and Monash Health, respectively. The main differences observed were in <i>Enterococcus</i> spp., which were cultured in 8.8% and 4.9% of cultures at Barwon Health and Monash Health, respectively, and <i>Candida</i> spp. in 4.2% and 1.5% of cultures at Barwon Health and Monash Health, respectively. The largest differences were found in fluoroquinolone resistance with 12.1% of organisms resistant to ciprofloxacin at Barwon Health compared to 6.4% at Monash Health and 7.1% of organisms resistant to vancomycin compared to 20.1% at Barwon Health and Monash Health, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrates that there is considerable variability in the uropathogens and their antimicrobial susceptibility profile in two large health services in the same state. We recommend that each centre performs regular analysis of their uropathogen antibiogram to develop local guidelines for treatment and pre-operative prophylaxis for uropathogens.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 11","pages":"1011-1016"},"PeriodicalIF":1.6,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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