Archive for category: Latest Articles

Towards a new paradigm in Bladder Pain Syndrome and Interstitial Cystitis

Abstract

Objectives

To define pre‐morbid, clinical, laboratory, and imaging features and identify prognostic factors associated with morbidity and mortality in patients with Emphysematous pyelonephritis (EPN) and develop a prognostic scoring system for improving management outcomes.

Patients and Methods

From Jan 2009 to Dec 2019, we performed a prospective study of all patients with a suspected diagnosis of EPN referred to a specialist tertiary centre in South India. All patients who underwent non‐contrast Computed tomography (CT) of the abdomen and those diagnosed with EPN were included in this study. Demographic parameters, imaging, haematological and microbiology results were recorded. Patients were divided into three groups: Group 1 ‐ patients who survived without any intervention; Group 2 ‐ those who survived with surgical intervention, and group 3 ‐ those who died with or without intervention. A prognostic scoring system was developed from 18 different parameters and risk stratification was developed. The scores were correlated with overall prognosis. Data analysis was performed using IBM SPSS version 20 and STATA 14, p‐value <0.05 was considered significant.

Results

Data from 131 patients with EPN enrolled in the study were analysed: Group 1 (n=22); Group 2 (n=102); Group 3 (n=7). By using univariate analysis, 10 factors were identified to be significantly associated with prognosis. Diabetes mellitus was the most common co‐morbidity. Shock at initial admission indicated a poor prognosis and warranted immediate attention (p <0.001).

Conclusions

A multi‐disciplinary approach, a high index of clinical suspicion, an early diagnosis and administration of culture‐specific antibiotics with identification of prognostic indicators and risk stratification allows prompt and appropriate medical and surgical treatments that could improve EPN management outcomes.

Oncological outcome according to attainment of pentafecta after robot assisted radical cystectomy among bladder cancer patients using KORARC database (730 multicenter robot radical cystectomy database) BJU Int 2020 Jul 8. doi: 10.1111/ bju.15178

Abstract

Objectives

To define pre‐morbid, clinical, laboratory, and imaging features and identify prognostic factors associated with morbidity and mortality in patients with Emphysematous pyelonephritis (EPN) and develop a prognostic scoring system for improving management outcomes.

Patients and Methods

From Jan 2009 to Dec 2019, we performed a prospective study of all patients with a suspected diagnosis of EPN referred to a specialist tertiary centre in South India. All patients who underwent non‐contrast Computed tomography (CT) of the abdomen and those diagnosed with EPN were included in this study. Demographic parameters, imaging, haematological and microbiology results were recorded. Patients were divided into three groups: Group 1 ‐ patients who survived without any intervention; Group 2 ‐ those who survived with surgical intervention, and group 3 ‐ those who died with or without intervention. A prognostic scoring system was developed from 18 different parameters and risk stratification was developed. The scores were correlated with overall prognosis. Data analysis was performed using IBM SPSS version 20 and STATA 14, p‐value <0.05 was considered significant.

Results

Data from 131 patients with EPN enrolled in the study were analysed: Group 1 (n=22); Group 2 (n=102); Group 3 (n=7). By using univariate analysis, 10 factors were identified to be significantly associated with prognosis. Diabetes mellitus was the most common co‐morbidity. Shock at initial admission indicated a poor prognosis and warranted immediate attention (p <0.001).

Conclusions

A multi‐disciplinary approach, a high index of clinical suspicion, an early diagnosis and administration of culture‐specific antibiotics with identification of prognostic indicators and risk stratification allows prompt and appropriate medical and surgical treatments that could improve EPN management outcomes.

Penile intraepithelial neoplasia, penile cancer precursors and HPV prevalence in symptomatic preputium: A cross‐sectional study of 351 circumcised men in Sweden

Abstract

Objectives

To define pre‐morbid, clinical, laboratory, and imaging features and identify prognostic factors associated with morbidity and mortality in patients with Emphysematous pyelonephritis (EPN) and develop a prognostic scoring system for improving management outcomes.

Patients and Methods

From Jan 2009 to Dec 2019, we performed a prospective study of all patients with a suspected diagnosis of EPN referred to a specialist tertiary centre in South India. All patients who underwent non‐contrast Computed tomography (CT) of the abdomen and those diagnosed with EPN were included in this study. Demographic parameters, imaging, haematological and microbiology results were recorded. Patients were divided into three groups: Group 1 ‐ patients who survived without any intervention; Group 2 ‐ those who survived with surgical intervention, and group 3 ‐ those who died with or without intervention. A prognostic scoring system was developed from 18 different parameters and risk stratification was developed. The scores were correlated with overall prognosis. Data analysis was performed using IBM SPSS version 20 and STATA 14, p‐value <0.05 was considered significant.

Results

Data from 131 patients with EPN enrolled in the study were analysed: Group 1 (n=22); Group 2 (n=102); Group 3 (n=7). By using univariate analysis, 10 factors were identified to be significantly associated with prognosis. Diabetes mellitus was the most common co‐morbidity. Shock at initial admission indicated a poor prognosis and warranted immediate attention (p <0.001).

Conclusions

A multi‐disciplinary approach, a high index of clinical suspicion, an early diagnosis and administration of culture‐specific antibiotics with identification of prognostic indicators and risk stratification allows prompt and appropriate medical and surgical treatments that could improve EPN management outcomes.

Corrigendum

Objective

To evaluate the long‐term bowel‐associated quality of life (QOL) in men after radiotherapy (RT) for prostate cancer with and without the use of rectal hydrogel spacer.

Patients and Methods

The patients’ QOL was examined using the Expanded Prostate Cancer Index Composite (EPIC) and mean changes from baseline in EPIC domains were evaluated. A total of 215 patients from a randomised multi‐institutional trial of RT, with or without hydrogel spacer, with a QOL endpoint were pooled with 165 non‐randomised patients from a single institution with prospective QOL collection in patients with or without hydrogel spacer. The proportions of men with minimally important differences (MIDs) relative to pre‐treatment baseline in the bowel domain were tested using repeated measure logistic models with a pre‐specified threshold for clinically significant declines (≥5 equivalent to MIDx1 and ≥10 equivalent to MIDx2).

Results

A total of 380 men were evaluated (64% with spacer and 36% without) with QOL data being available for 199 men with >24 months of follow‐up [median (range) 39.5 (31–71.4) months]. Treatment with spacer was associated with less decline in average long‐term bowel QOL (89.4 for control and 94.7 for spacer) with differences at >24 months meeting the threshold of a MID difference between cohorts (bowel score difference from baseline: control = −5.1, spacer = 0.3, difference = −5.4; P < 0.001). When evaluated over time men without spacer were more likely to have MIDx1 (5 points) declines in bowel QOL (P = 0.01). At long‐term follow‐up MIDx1 was 36% without spacer vs 14% with spacer (P <0.001; odds ratio [OR] 3.5, 95% CI 1.7–6.9) while MIDx2 was seen in 19% vs 6% (= 0.008; OR 3.6, 95% CI 1.4–9.1). The use of spacer was associated with less urgency with bowel movements (P = 0.002) and fewer loose stools (P = 0.009), as well as less bother with urgency (P = 0.007) and frequency of bowel movements (P = 0.009).

Conclusions

In this pooled analysis of QOL after prostate RT with up to 5 years of follow‐up, use of a rectal spacer was associated with preservation of bowel QOL. This QOL benefit was preserved with long‐term follow‐up.

Journal information

Objective

To evaluate the long‐term bowel‐associated quality of life (QOL) in men after radiotherapy (RT) for prostate cancer with and without the use of rectal hydrogel spacer.

Patients and Methods

The patients’ QOL was examined using the Expanded Prostate Cancer Index Composite (EPIC) and mean changes from baseline in EPIC domains were evaluated. A total of 215 patients from a randomised multi‐institutional trial of RT, with or without hydrogel spacer, with a QOL endpoint were pooled with 165 non‐randomised patients from a single institution with prospective QOL collection in patients with or without hydrogel spacer. The proportions of men with minimally important differences (MIDs) relative to pre‐treatment baseline in the bowel domain were tested using repeated measure logistic models with a pre‐specified threshold for clinically significant declines (≥5 equivalent to MIDx1 and ≥10 equivalent to MIDx2).

Results

A total of 380 men were evaluated (64% with spacer and 36% without) with QOL data being available for 199 men with >24 months of follow‐up [median (range) 39.5 (31–71.4) months]. Treatment with spacer was associated with less decline in average long‐term bowel QOL (89.4 for control and 94.7 for spacer) with differences at >24 months meeting the threshold of a MID difference between cohorts (bowel score difference from baseline: control = −5.1, spacer = 0.3, difference = −5.4; P < 0.001). When evaluated over time men without spacer were more likely to have MIDx1 (5 points) declines in bowel QOL (P = 0.01). At long‐term follow‐up MIDx1 was 36% without spacer vs 14% with spacer (P <0.001; odds ratio [OR] 3.5, 95% CI 1.7–6.9) while MIDx2 was seen in 19% vs 6% (= 0.008; OR 3.6, 95% CI 1.4–9.1). The use of spacer was associated with less urgency with bowel movements (P = 0.002) and fewer loose stools (P = 0.009), as well as less bother with urgency (P = 0.007) and frequency of bowel movements (P = 0.009).

Conclusions

In this pooled analysis of QOL after prostate RT with up to 5 years of follow‐up, use of a rectal spacer was associated with preservation of bowel QOL. This QOL benefit was preserved with long‐term follow‐up.

Table of Contents

Objective

To evaluate the long‐term bowel‐associated quality of life (QOL) in men after radiotherapy (RT) for prostate cancer with and without the use of rectal hydrogel spacer.

Patients and Methods

The patients’ QOL was examined using the Expanded Prostate Cancer Index Composite (EPIC) and mean changes from baseline in EPIC domains were evaluated. A total of 215 patients from a randomised multi‐institutional trial of RT, with or without hydrogel spacer, with a QOL endpoint were pooled with 165 non‐randomised patients from a single institution with prospective QOL collection in patients with or without hydrogel spacer. The proportions of men with minimally important differences (MIDs) relative to pre‐treatment baseline in the bowel domain were tested using repeated measure logistic models with a pre‐specified threshold for clinically significant declines (≥5 equivalent to MIDx1 and ≥10 equivalent to MIDx2).

Results

A total of 380 men were evaluated (64% with spacer and 36% without) with QOL data being available for 199 men with >24 months of follow‐up [median (range) 39.5 (31–71.4) months]. Treatment with spacer was associated with less decline in average long‐term bowel QOL (89.4 for control and 94.7 for spacer) with differences at >24 months meeting the threshold of a MID difference between cohorts (bowel score difference from baseline: control = −5.1, spacer = 0.3, difference = −5.4; P < 0.001). When evaluated over time men without spacer were more likely to have MIDx1 (5 points) declines in bowel QOL (P = 0.01). At long‐term follow‐up MIDx1 was 36% without spacer vs 14% with spacer (P <0.001; odds ratio [OR] 3.5, 95% CI 1.7–6.9) while MIDx2 was seen in 19% vs 6% (= 0.008; OR 3.6, 95% CI 1.4–9.1). The use of spacer was associated with less urgency with bowel movements (P = 0.002) and fewer loose stools (P = 0.009), as well as less bother with urgency (P = 0.007) and frequency of bowel movements (P = 0.009).

Conclusions

In this pooled analysis of QOL after prostate RT with up to 5 years of follow‐up, use of a rectal spacer was associated with preservation of bowel QOL. This QOL benefit was preserved with long‐term follow‐up.

For men’s problems, we need a women’s approach: equality in treatment care planning

Abstract

Objectives

To define pre‐morbid, clinical, laboratory, and imaging features and identify prognostic factors associated with morbidity and mortality in patients with Emphysematous pyelonephritis (EPN) and develop a prognostic scoring system for improving management outcomes.

Patients and Methods

From Jan 2009 to Dec 2019, we performed a prospective study of all patients with a suspected diagnosis of EPN referred to a specialist tertiary centre in South India. All patients who underwent non‐contrast Computed tomography (CT) of the abdomen and those diagnosed with EPN were included in this study. Demographic parameters, imaging, haematological and microbiology results were recorded. Patients were divided into three groups: Group 1 ‐ patients who survived without any intervention; Group 2 ‐ those who survived with surgical intervention, and group 3 ‐ those who died with or without intervention. A prognostic scoring system was developed from 18 different parameters and risk stratification was developed. The scores were correlated with overall prognosis. Data analysis was performed using IBM SPSS version 20 and STATA 14, p‐value <0.05 was considered significant.

Results

Data from 131 patients with EPN enrolled in the study were analysed: Group 1 (n=22); Group 2 (n=102); Group 3 (n=7). By using univariate analysis, 10 factors were identified to be significantly associated with prognosis. Diabetes mellitus was the most common co‐morbidity. Shock at initial admission indicated a poor prognosis and warranted immediate attention (p <0.001).

Conclusions

A multi‐disciplinary approach, a high index of clinical suspicion, an early diagnosis and administration of culture‐specific antibiotics with identification of prognostic indicators and risk stratification allows prompt and appropriate medical and surgical treatments that could improve EPN management outcomes.

Indications and complications of pelvic lymph node dissection for prostate cancer: are currently available nomograms accurate to predict lymph node invasion?

Abstract

Objectives

To define pre‐morbid, clinical, laboratory, and imaging features and identify prognostic factors associated with morbidity and mortality in patients with Emphysematous pyelonephritis (EPN) and develop a prognostic scoring system for improving management outcomes.

Patients and Methods

From Jan 2009 to Dec 2019, we performed a prospective study of all patients with a suspected diagnosis of EPN referred to a specialist tertiary centre in South India. All patients who underwent non‐contrast Computed tomography (CT) of the abdomen and those diagnosed with EPN were included in this study. Demographic parameters, imaging, haematological and microbiology results were recorded. Patients were divided into three groups: Group 1 ‐ patients who survived without any intervention; Group 2 ‐ those who survived with surgical intervention, and group 3 ‐ those who died with or without intervention. A prognostic scoring system was developed from 18 different parameters and risk stratification was developed. The scores were correlated with overall prognosis. Data analysis was performed using IBM SPSS version 20 and STATA 14, p‐value <0.05 was considered significant.

Results

Data from 131 patients with EPN enrolled in the study were analysed: Group 1 (n=22); Group 2 (n=102); Group 3 (n=7). By using univariate analysis, 10 factors were identified to be significantly associated with prognosis. Diabetes mellitus was the most common co‐morbidity. Shock at initial admission indicated a poor prognosis and warranted immediate attention (p <0.001).

Conclusions

A multi‐disciplinary approach, a high index of clinical suspicion, an early diagnosis and administration of culture‐specific antibiotics with identification of prognostic indicators and risk stratification allows prompt and appropriate medical and surgical treatments that could improve EPN management outcomes.

UK Practice for Penile Prosthesis Surgery – baseline analysis of the British Association of Urological Surgeons (BAUS) Penile Prosthesis Audit

Abstract

Objectives

To define pre‐morbid, clinical, laboratory, and imaging features and identify prognostic factors associated with morbidity and mortality in patients with Emphysematous pyelonephritis (EPN) and develop a prognostic scoring system for improving management outcomes.

Patients and Methods

From Jan 2009 to Dec 2019, we performed a prospective study of all patients with a suspected diagnosis of EPN referred to a specialist tertiary centre in South India. All patients who underwent non‐contrast Computed tomography (CT) of the abdomen and those diagnosed with EPN were included in this study. Demographic parameters, imaging, haematological and microbiology results were recorded. Patients were divided into three groups: Group 1 ‐ patients who survived without any intervention; Group 2 ‐ those who survived with surgical intervention, and group 3 ‐ those who died with or without intervention. A prognostic scoring system was developed from 18 different parameters and risk stratification was developed. The scores were correlated with overall prognosis. Data analysis was performed using IBM SPSS version 20 and STATA 14, p‐value <0.05 was considered significant.

Results

Data from 131 patients with EPN enrolled in the study were analysed: Group 1 (n=22); Group 2 (n=102); Group 3 (n=7). By using univariate analysis, 10 factors were identified to be significantly associated with prognosis. Diabetes mellitus was the most common co‐morbidity. Shock at initial admission indicated a poor prognosis and warranted immediate attention (p <0.001).

Conclusions

A multi‐disciplinary approach, a high index of clinical suspicion, an early diagnosis and administration of culture‐specific antibiotics with identification of prognostic indicators and risk stratification allows prompt and appropriate medical and surgical treatments that could improve EPN management outcomes.

Treatment and prognosis of patients with urinary bladder cancer with other primary cancers: a nationwide population‐based study in the Bladder Cancer Data Base Sweden (BladderBaSe)

Objective

To study how patients with urinary bladder cancer (UBC) with previous or concomitant other primary cancers (OPCs) were treated, and to investigate their prognosis.

Patients And Methods

Using nationwide population‐based data in the Bladder Cancer Data Base Sweden (BladderBaSe), we analysed the probability of treatment with curative intent, and UBC‐specific and overall survival (OS) in patients with UBC diagnosed in the period 1997–2014 with or without OPC. The analyses considered the patient’s characteristics, UBC tumour stage at diagnosis, and site of OPC.

Results

There were 38 689 patients, of which 9804 (25%) had OPCs. Those with synchronous OPCs more often had T2 and T3 tumours and clinically distant disease at diagnosis than those with UBC only. Patients with synchronous prostate cancer, female genital cancer and lower gastro‐intestinal cancer were more often treated with curative intent than patients with UBC only. When models of survival were adjusted for age at diagnosis, marital status, education, year of diagnosis, Charlson Comorbidity Index and T‐stage, UBC‐specific survival was similar to patients with UBC only, but OS was lower for patients with synchronous OPC, explained mainly by deaths in OPC primaries with a bad prognosis.

Conclusions

OPC is common in patients with UBC. Treatment for UBC, after or in conjunction with an OPC, should not be neglected and carries just as high a probability of success as treatment in patients with UBC only. The needs of patients with UBC and OPC, and optimisation of their treatment considering their complicated disease trajectory are important areas of research.

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