Archive for category: Latest Articles

The experience of UK bladder cancer patients during the COVID‐19 pandemic: A survey‐based snapshot

Abstract

The COVID‐19 pandemic has placed unprecedented strain on healthcare systems worldwide with the requirement to treat large influxes of infected patients, many of whom require respiratory support. Healthcare systems have had to redirect resources and redeploy staff away from routine diagnostic, treatment and follow‐up services. The UK’s National Health Service (NHS) is no different and cancer services have undergone significant disruption to create the emergency capacity to tackle the pandemic. As a charity that endeavours to support bladder cancer (BC) patients and improve outcomes, Action Bladder Cancer UK (ABCUK, Tetbury, UK) designed and administered an online survey to investigate the prevalence of such disruption.

The Rising Worldwide Impact of Benign Prostatic Hyperplasia

Abstract

The COVID‐19 pandemic has placed unprecedented strain on healthcare systems worldwide with the requirement to treat large influxes of infected patients, many of whom require respiratory support. Healthcare systems have had to redirect resources and redeploy staff away from routine diagnostic, treatment and follow‐up services. The UK’s National Health Service (NHS) is no different and cancer services have undergone significant disruption to create the emergency capacity to tackle the pandemic. As a charity that endeavours to support bladder cancer (BC) patients and improve outcomes, Action Bladder Cancer UK (ABCUK, Tetbury, UK) designed and administered an online survey to investigate the prevalence of such disruption.

Impact of Circulating miRNA‐371a‐3p Test on Appropriateness of Treatment and Cost Outcomes in Patients with Stage I Nonseminomatous Germ Cell Tumors

Abstract

The COVID‐19 pandemic has placed unprecedented strain on healthcare systems worldwide with the requirement to treat large influxes of infected patients, many of whom require respiratory support. Healthcare systems have had to redirect resources and redeploy staff away from routine diagnostic, treatment and follow‐up services. The UK’s National Health Service (NHS) is no different and cancer services have undergone significant disruption to create the emergency capacity to tackle the pandemic. As a charity that endeavours to support bladder cancer (BC) patients and improve outcomes, Action Bladder Cancer UK (ABCUK, Tetbury, UK) designed and administered an online survey to investigate the prevalence of such disruption.

Research Highlights

Objectives

To analyse all mortalities related to surgery for urinary tract calculi in Australia from 1 January 2009 to 31 December 2018, and identify common causes, clinical management issues (CMIs), and areas for improvement.

Patients and Methods

All urological‐related deaths reported to the Australian and New Zealand Audit of Surgical Mortality (ANZASM) from 2009 to 2017 were analysed. The Bi‐National Audit of Surgical Mortality (BAS) database was interrogated for any involvement with renal, ureteric or bladder stones and all relevant associated data analysed. Any CMIs documented by the peer reviewers were recorded and compared to those in urology and all of surgery ANZASM data.

Results

Of 1034 total urological deaths, 100 (9.7%) were related to stones. The mean (range) age of patients was 74.4 (21–97) years; 95% of the patients underwent at least one procedure, with 45 (47.4%) of these being elective. Urinary sepsis was responsible for 49.5% of the deaths, with 20% dying of cardiac events. In all, 39% (37/95) of deaths were associated with CMIs, the most common considerations being delays in diagnosis or treatment, perioperative management and inadequate preoperative evaluation. This is a considerably higher percentage than the 26% recorded for the general urology and all surgery national data. Ureterorenoscopy at 54% (12/22) had the highest rate of CMIs.

Conclusion

Death related to stone surgery represents only a small proportion of all urological surgical deaths, but generates more CMIs amongst ANZASM peer assessors. Results could be improved with more rapid diagnosis and treatment. Careful case selection and access to all treatment options are recommended.

Corrigendum

Objectives

To analyse all mortalities related to surgery for urinary tract calculi in Australia from 1 January 2009 to 31 December 2018, and identify common causes, clinical management issues (CMIs), and areas for improvement.

Patients and Methods

All urological‐related deaths reported to the Australian and New Zealand Audit of Surgical Mortality (ANZASM) from 2009 to 2017 were analysed. The Bi‐National Audit of Surgical Mortality (BAS) database was interrogated for any involvement with renal, ureteric or bladder stones and all relevant associated data analysed. Any CMIs documented by the peer reviewers were recorded and compared to those in urology and all of surgery ANZASM data.

Results

Of 1034 total urological deaths, 100 (9.7%) were related to stones. The mean (range) age of patients was 74.4 (21–97) years; 95% of the patients underwent at least one procedure, with 45 (47.4%) of these being elective. Urinary sepsis was responsible for 49.5% of the deaths, with 20% dying of cardiac events. In all, 39% (37/95) of deaths were associated with CMIs, the most common considerations being delays in diagnosis or treatment, perioperative management and inadequate preoperative evaluation. This is a considerably higher percentage than the 26% recorded for the general urology and all surgery national data. Ureterorenoscopy at 54% (12/22) had the highest rate of CMIs.

Conclusion

Death related to stone surgery represents only a small proportion of all urological surgical deaths, but generates more CMIs amongst ANZASM peer assessors. Results could be improved with more rapid diagnosis and treatment. Careful case selection and access to all treatment options are recommended.

Certification in reporting multiparametric MRI of the prostate ‐ recommendations of a UK consensus meeting

Abstract

Multiparametric (mp) MRI of the prostate is now recommended as the initial investigation method for men with suspected prostate cancer within both UK and international guidelines. Potential benefits of this pathway include: (a) reductions in the number of men requiring biopsy; (b) reductions in the diagnoses of indolent cancers unlikely to cause harm, minimizing treatment‐related complications; (c) improved detection of clinically significant prostate cancers, particularly for patients with prior negative systematic biopsy; and (d) improved risk‐stratification of diagnosed cancers owing to greater precision in tumour grade and volume determinations.

Stereotactic radiotherapy combined with immune‐ or targeted therapy for metastatic renal cell carcinoma

Abstract

Multiparametric (mp) MRI of the prostate is now recommended as the initial investigation method for men with suspected prostate cancer within both UK and international guidelines. Potential benefits of this pathway include: (a) reductions in the number of men requiring biopsy; (b) reductions in the diagnoses of indolent cancers unlikely to cause harm, minimizing treatment‐related complications; (c) improved detection of clinically significant prostate cancers, particularly for patients with prior negative systematic biopsy; and (d) improved risk‐stratification of diagnosed cancers owing to greater precision in tumour grade and volume determinations.

Negative first follow‐up prostate biopsy on active surveillance is associated with decreased risk of upgrading, suspicion of progression and converting to active treatment

Abstract

Objective

To determine the risk of disease progression and conversion to active treatment following a negative biopsy while on AS for PCa.

Patients and methods

Men on the AS programme at a single tertiary hospital (London, UK) between 2003‐2018 with confirmed low‐intermediate risk PCa, Grade Group<3, clinical stage <T3, diagnostic PSA <20ng/mL. This cohort included men diagnosed by TRUS (12‐14 cores) or transperineal (median 32 cores) biopsy. Multivariate Cox hazards regression analysis was undertaken to determine 1) risk of upgrading, 2) clinical or radiological suspicion of disease progression and 3) transitioning to active treatment. Suspicion of disease progression was defined as any biopsy upgrading, >30% positive cores, MRI Likert>3/T3 or PSA>20. Conversion to treatment included radical or hormonal treatment.

Results

Among the 460 eligible patients, 23% had negative follow‐up biopsy findings. Median follow‐up was 62 months, with 1‐2 repeat biopsies and 2 magnetic resonance imaging scans per patient during that period. Negative biopsy findings at first repeat biopsy were associated with decreased risk of converting to active treatment (HR: 0.18; 95%CI: 0.09‐0.37, p<0.001), suspicion of disease progression (HR 0.56: 95%CI: 0.34‐0.94, p=0.029) and upgrading (HR: 0.48; 95%CI: 0.23‐0.99, p=0.047). Data are limited by fewer men with multiple follow‐up biopsies.

Conclusion

Negative biopsy findings at the first scheduled follow‐up biopsy among men on AS for PCa was strongly associated decreased risk of subsequent upgrading, clinical or radiological suspicion of disease progression and conversion to active treatment. A less intense surveillance protocol should be considered for this cohort of patients.

Risk‐adapted biopsy decision based on prostate MRI and PSA‐density for enhanced biopsy avoidance in first prostate cancer diagnostic work‐up

Abstract

Prostate MRI has been integrated into the diagnostic work‐up for men at risk of having clinically significant cancer in multiple clinical care guidelines. Owing to the low false‐negative rate of prostate MRI accompanying a sensitivity averaging 91%, we can reduce biopsies (by 30%) and indolent cancer detection, while maintaining (or even improving) detection of significant cancers, compared to systematic biopsy.

The dramatic COVID 19 outbreak in Italy is responsible of a huge drop of urological surgical activity: a multicenter observational study

Objective

To describe the trend in surgical volume in urology in Italy during the coronavirus disease 2019 (COVID‐19) outbreak, as a result of the abrupt reorganisation of the Italian national health system to augment care provision to symptomatic patients with COVID‐19.

Methods

A total of 33 urological units with physicians affiliated to the AGILE consortium (Italian Group for Advanced Laparo‐Endoscopic Surgery; www.agilegroup.it) were surveyed. Urologists were asked to report the amount of surgical elective procedures week‐by‐week, from the beginning of the emergency to the following month.

Results

The 33 hospitals involved in the study account overall for 22 945 beds and are distributed in 13/20 Italian regions. Before the outbreak, the involved urology units performed overall 1213 procedures/week, half of which were oncological. A month later, the number of surgeries had declined by 78%. Lombardy, the first region with positive COVID‐19 cases, experienced a 94% reduction. The decrease in oncological and non‐oncological surgical activity was 35.9% and 89%, respectively. The trend of the decline showed a delay of roughly 2 weeks for the other regions.

Conclusion

Italy, a country with a high fatality rate from COVID‐19, experienced a sudden decline in surgical activity. This decline was inversely related to the increase in COVID‐19 care, with potential harm particularly in the oncological field. The Italian experience may be helpful for future surgical pre‐planning in other countries not so drastically affected by the disease to date.

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