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Flying high as a kite




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Some of my happiest memories are from my childhood. Part of it was spent in Lucknow where my mother had her ancestral home. An important city in Northern India, Lucknow was the seat of the Nawabs who built many beautiful palaces. One of these has a labyrinth, which many have entered only to get lost within its many chambers. Another, the Chhota Imambara is pictured on the cover. Lucknow is also famous for its cuisine with street vendors selling tasty kebabs. Above all, I remember many hours perched on the roof top of our home in the old town, flying kites, with my family. The sky above became a riot of colours. Today there is even a touring company offering nostalgic kite flying holidays in this ancient city.

In May, our Article of the Month comes from the King George Medical University, Lucknow. In a prospective, longitudinal comparison over six years, of a large number of patients undergoing urinary diversion after radical cystectomy, the authors demonstrate better quality of life after orthotopic neobladder rather than ileal conduit formation [1]. The mean age of the patients was in the mid 50s, which is perhaps why a significant number underwent neobladder formation. This article and the accompanying editorial from Urs Studer [2] are must reads for anyone involved in the management of bladder cancer. In the UK many of our patients are generally older with multiple co-morbidities and end up having ileal conduits. For the younger patients it is perhaps time for a rethink?

We also feature an excellent multi-institutional collaboration reporting on PCNL outcomes in England from the Hospital Episode Statistics (HES) database over a five year period. Mortality is rare after this procedure but 9% of patients have a readmission within 30 days [3]. While the HES like most other databases has its inherent limitations, the authors should be congratulated for analysing complex outcomes on nearly 6000 patients; in particular John Withington who is writing his thesis on the subject.

And finally – an invitation. If you are attending the AUA, we are again having a BAUS–BJUI–USANZ session on the afternoon of the 18 May. The faculty is international and the program even more exciting than it was last year. This is a further testament to the strong friendship that exists between our organisations and the AUA. The Coffey–Krane prize for the best paper published in the BJUI by a trainee, will be presented at the end of this session followed by the BJUI reception.

Many of you have loved our new design, layout and quality although this has led to a precipitous drop in our acceptance rate in favour of only the very best papers. Thank you for your support, which has given us the strength and resolve to fly high. The sky is the limit.

Prof. Prokar Dasgupta
Editor-in-Chief, BJUI

King’s College London, Guy’s Hospital#

References

  1. Singh V, Yadav R, Sinha RJ, Gupta DK. Prospective comparison of quality-of-life outcomes between ileal conduit urinary diversion and orthotopic neobladder reconstruction after radical cystectomy: a statistical model. BJU Int 2014; 113: 726–732
  2. Studer UE. Life is good with orthotopic bladder substitutes! BJU Int 2014; 113: 686–687
  3. Armitage JN, Withington J, van der Meulen J, et al. Percutaneous nephrolithotomy in England: practice and outcomes described in the Hospital Episode Statistics database. BJU Int 2014; 113: 777–782

 

  1. ravimohan
    I agree completely with the editor about the multicultural, music using beauty of the Lucknow city and can understand the nostalgia associated with it. Bladder cancer is very common in northern India (Lucknow is in the northern part of India) and undeniably we see a lot of young patients as opposed to rest of the world, but QOL being better in orthotopic is a bit surprising and encouraging too!. Surprising because the problems of orthotopic essentially guided by the type of urethro-vesical anastomosis and would usually remain successfull if performed by an experienced surgeon which implies that, the results should have been different in the initial half vs the later half whereas the illeal conduit is a simple and straight forward procedure and QOL remains good. Encouraging because earlier published studies did not show any difference in the QOL between these two procedures.

    The article on PCNL is definitely a honest effort to report the complications of a most commonly performed procedure the PCNL, YET widely under-reported. Various centers in the world should try to collaborate and find a means of standardised HES so as to find the true incidence of complications, because PNL still remains a blind procedure (largely image guided unlike laparoscopy where things are more direct) till one enters the pelvicaleceal system. Proper reporting of complication is essential for this common yet under reported part of the procedure.
    All the best for the AUA.

    Dr Ravimohan.
    Assistant Professor, Urology.
    PGIMER, Chandigarh, India.

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