Background & Objectives:
Percutaneous nephrostomy (PN) for malignant ureteric obstruction (MUO) is increasingly accessible with high success rates. However, it is not without associated risks and ...morbidity, impacting quality of life, while not improving overall survival. In two UK hospitals, we investigated the outcomes of undergoing PN for MUO, to inform future patient counselling and selection for this intervention.
Methods:
A retrospective audit of electronic records identified patients that received PN for bladder, and prostate cancer (PCa) between January 2015 and December 2018. Hospital 1 had a 24-h nephrostomy service, while Hospital 2 had a limited service; Group A: recurrent or treatment-resistant PCa, Group B: primary PCa, Group C: Bladder cancer.
Results:
A total of 261 patients (Hospital 1 = 186, Hospital 2 = 75), had PN insertion. Seventy-eight had prostate or bladder cancer. Group A n = 30, Group B n = 12, Group C n = 36. Median age = 79 interquartile range (IQR) = 72–86. Following PN insertion, 12-month mortality was significantly greater in Hospital 1 at 82%, versus 52% in Hospital 2 (p = 0.015). Median survival: Group A: 177 days (IQR = 80–266), Group B: 209 days (IQR = 77–352), Group C: 145 days (IQR = 97–362). There was no significant difference in same-admission mortality, although group A had the greatest same-admission mortality at 17%. A total of 69% of all patients received bilateral nephrostomies. Patients with bilateral versus unilateral PN had no difference in mortality or nadir creatinine.
Conclusion:
Most patients with malignant obstruction secondary to prostate or bladder cancer lived less than 12 months after PN insertion. When offering PN, careful consideration of disease prognosis should be made, and frank discussion of the implications of a life-long nephrostomy with patients and relatives.
Objectives
To evaluate the activity of intravesical mitomycin‐C (MMC) to ablate recurrent low‐risk non‐muscle‐invasive bladder cancer (NMIBC) and assess whether it may enable patients to avoid ...surgical intervention for treatment of recurrence.
Patients and Methods
CALIBER is a phase II feasibility study. Participants were randomized (2:1) to treatment with four once‐weekly MMC 40‐mg intravesical instillations (chemoablation arm) or to surgical management. The surgical group was included to assess the feasibility of randomization. The primary endpoint was complete response to intravesical MMC in the chemoablation arm at 3 months, reported with exact 95% confidence intervals (CIs). Secondary endpoints included time to subsequent recurrence, summarized by Kaplan–Meier methods.
Results
Between February 2015 and August 2017, 82 patients with visual diagnosis of recurrent low‐risk NMIBC were enrolled from 24 UK hospitals (chemoablation, n = 54; surgical management, n =28). The median follow‐up was 24 months. Complete response at 3 months was 37.0% (20/54; 95% CI 24.3–51.3) with chemoablation and 80.8% (21/26; 95% CI 60.6–93.4) with surgical management. Amongst patients with complete response at 3 months, a similar proportion was recurrence‐free by 12 months in both groups (84%). Amongst those with residual disease at 3 months, the 12‐month recurrence‐free proportion was lower in the surgical management group (40.0%) than in the chemoablation group (84%). Recruitment stopped early as chemoablation did not meet the prespecified threshold of 45% complete responses at 3 months.
Conclusion
Intravesical chemoablation in low‐risk NMIBC is feasible and safe, but did not demonstrate sufficient response in the present trial. After chemoablation there may be a reduction in recurrence rate, even in non‐responders, that is greater than with surgery alone. Further research is required to investigate the role and optimal schedule of neoadjuvant intravesical chemotherapy prior to surgery for NMIBC.
Interstitial cystitis or bladder pain syndrome (BPS) is often a chronic debilitating condition characterised by predominantly storage symptoms and associated frequently with pelvic pain that varies ...with bladder filling. The aetiology is uncertain as the condition occurs in the absence of a urinary tract infection or other obvious pathology. Resulting discomfort may vary and ranges from abdominal tenderness to intense bladder spasms. Diagnosis and management of this syndrome may be difficult and is often made by its typical cystoscopic features. This review discusses the diagnosis and management of interstitial cystitis according to the current available best evidence and advises a multimodal approach in its management.
OBJECTIVE
To evaluate the long‐term results of using the UrolumeTM endourethral prosthesis (American Medical Systems, Minnetonka, MN, USA) for managing benign prostatic hyperplasia (BPH), an ...alternative minimally invasive option.
PATIENTS AND METHODS
Sixty‐two patients with moderate/severe lower urinary tract symptoms secondary to BPH were treated with the Urolume stent by one surgeon (J.H.P.). They were followed up at 12 weeks, 6 months and then yearly. Data recorded before and after treatment included symptom scoring, peak urinary flow rate (PFR) and postvoid residual volume (PVR). A one‐way anova was used to compare baseline and the 5‐ and 12‐year follow‐up data.
RESULT
Twenty‐two and 11 patients completed the 5‐ and 12‐year follow‐up, respectively. Twenty‐one (34%) patients died with the stent in situ from causes unrelated to BPH and Urolume insertion. Twenty‐nine (47%) stents were removed; 18 in the first 2 years, seven at 3–5 years and four at 9–10 years. Early stent explantation was primarily a result of poor case selection, or stent malposition/migration. Four stents were removed because the patient was dissatisfied. Late stent explantation was for symptom progression. At 5 years, the symptom score and PFR were 6.82 an 11.7 mL/s, respectively, compared with 20.4 and 9 mL/s at basleine (P < 0.05); at 12 years, the symptom score, PFR and PVR were 10.82, 11.5 mL/s and 80 mL, respectively. The mean quality of life score was 2 and no patient opted for any further treatment.
CONCLUSION
The Urolume wallstent is a safe treatment for BPH, in selected patients. Careful case selection and experience is mandatory. This stent can provide the urologist with an alternative along with other minimally invasive treatments for men with BPH at high risk of requiring transurethral resection.
The aim of this article was to investigate quality and cost benefits of managing urolithiasis by primary ureteroscopic procedures (P-URS) during index admission to hospital. With the rise in ...prevalence of urolithiasis, the focus has shifted to manage these patients during their first admission rather than using temporary measures like emergency stenting (ES) or nephrostomies which are followed by deferred ureteroscopic procedures (D-URS). We compared results of P-URS, D-URS and ES procedures in terms of quality and cost benefits.
Data was collected retrospectively for all P-URS, D-URS and ES procedures performed during year 2019. A total of 85 patients underwent ES while as 138 patients underwent elective URS (26 had P-URS and 112 had D-URS). The quality assessment was based in relation to patient factors including- number of procedures per patient, number of days spent at hospital, number of days off work. Cost analysis included theatre and hospital stay expenses, loss of working days.
This study revealed that the average hospital stay of patients on index admission who had a ES was 1.35 days (Total 3.85) and who had P-URS was 1.78 days (Total 2.78). Overall, additional expenditure in patients who did not undergo primary URS was in the range of 1800-2000€ (excluding loss of work for patients, who needed to return for multiple procedures).
We conclude approach of P-URS and management of stones in index admission is very effective in both improving quality of patients as well as bringing down cost expenditure effectively.
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