Damian C. Hanbury

GuidelinesEAU Guidelines on Renal Cell Carcinoma: The 2010 Update

CONTEXT AND OBJECTIVES The European Association of Urology Guideline Group for renal cell carcinoma (RCC) has prepared these guidelines to help clinicians assess the current evidence-based management of RCC and to incorporate the present recommendations into daily clinical practice. EVIDENCE ACQUISITION The recommendations provided in the current updated guidelines are based on a thorough review of available RCC guidelines and review articles combined with a systematic literature search using Medline and the Cochrane Central Register of Controlled Trials. EVIDENCE SYNTHESIS A number of recent prospective randomised studies concerning RCC are now available with a high level of evidence, whereas earlier publications were based on retrospective analyses, including some larger multicentre validation studies, meta-analyses, and well-designed controlled studies. CONCLUSIONS These guidelines contain information for the treatment of an individual patient according to a current standardised general approach. Updated recommendations concerning diagnosis, treatment, and follow-up can improve the clinical handling of patients with RCC.

Sildenafil influences lower urinary tract symptoms

Objective  To assess the possible relationship between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) in men, and whether treatment of their ED with sildenafil influences their LUTS.

A study comparing various noninvasive methods of detecting bladder cancer in urine

Objectives To compare the nuclear matrix protein (NMP)‐22 assay, bladder tumour specific antigen (BTAstat) test, telomerase activity (using the telomeric repeat amplification protocol assay, TRAP) and a haemoglobin dipstick test for their ability to replace voided urine cytology (VUC) for detecting bladder cancer.

Prevalence of undiagnosed diabetes mellitus in male erectile dysfunction

Objective To determine the prevalence of previously undiagnosed diabetes mellitus (DM) in men presenting with erectile dysfunction (ED), using fasting blood glucose (FBG) compared with urinary dipstick testing for glycosuria.

Complications of vasectomy.

INTRODUCTION Vasectomy is a common method of sterilisation. However, it is less popular than tubal ligation world-wide. It is also a frequent cause of litigation relating to its complications. This article reviews the early and late risks associated with the procedure. PATIENTS AND METHODS Data collection was done using the internet to search Medline for obtaining evidence-based medicine reviews. Cross-references were obtained from key articles. Websites of government bodies and medical associations were searched for guidelines relating to vasectomy. DISCUSSION Early complications include haematoma, wound and genito-urinary infections, and traumatic fistulae. Vasectomy failure occurs in 0-2% of patients. Late recanalisation causes failure in 0.2% of vasectomies. Significant chronic orchalgia may occur in up to 15% of men after vasectomy, and may require epididyectomy or vasectomy reversal. Antisperm antibodies develop in a significant proportion of men post-vasectomy, but do not increase the risk of immune-complex or atherosclerotic heart disease. Similarly, vasectomy does not enhance risk of testicular or prostate cancer. Vasectomy has a lower mortality as compared to tubal occlusion, but is still significantly high in non-industrialised countries because of infections. CONCLUSIONS Vasectomy, though safe and relatively simple, requires a high level of expertise to minimise complications. Adequate pre-operative counselling is essential to increase patient acceptability of this method of permanent contraception.

Increased patient satisfaction from transrectal ultrasonography and biopsy under sedation.

Objective To determine the acceptability and patient satisfaction of transrectal biopsy undertaken with the patient under sedation.

Successful Use of Steroids and Ureteric Stents in 24 Patients with Idiopathic Retroperitoneal Fibrosis: A Retrospective Study

Background/Aims: Retroperitoneal fibrosis (RPF) is a chronic inflammatory disorder causing obstructive nephropathy and renal failure. We reviewed our management of this condition. Method: All patients with RPF treated at a single center over a 15-year period were identified. A full review of notes and computer records was undertaken. Results: Data was available on 27 patients, 3 of which were excluded from later analysis. Diagnosis was based on clinical history and cross-sectional imaging. Retroperitoneal biopsy was undertaken in 3 patients. 96% had significant renal impairment at presentation with a mean serum creatinine of 688 µmol/l. 46% required emergency hemodialysis. All patients were treated with a combination of ureteric stents and/or steroids with an excellent clinical response. The mean best creatinine reached by the cohort was 136 µmol/l, and renal function remained stable in the long term. No patients required chronic dialysis. Ureteric stents were removed within 12 months and low-dose steroids were continued for a mean of 34 months. Recurrent disease was observed in 25% of patients, who all responded well to further steroid therapy. Mean duration of follow-up was 76 months. Conclusions: RPF is very effectively treated by a combination of ureteric stents and steroids, with excellent long-term results using this approach. Continued follow-up is advised because of the possibility of recurrent disease.

Robotic pyeloplasty: Initial experience of a single UK centre

Objective: We present our experience and outcomes at a single UK robotic centre of robotic-assisted laparoscopic dismembered pyeloplasty for the treatment of pelvo-ureteric junction obstruction (PUJO). Materials and methods: Between July 2009 and July 2013, 20 robotic-assisted transperitoneal laparoscopic pyeloplasties were performed by four surgeons. Data were obtained from patient case notes, patient charts, and radiographic reports. Results: A total of 20 robot-assisted laparoscopic dismembered pyeloplasties were performed in 11 men and nine women. Mean age at treatment was 37 years (range 16–75) with an average follow-up of 14 months (five to 24). The average console time was two hours: 8 minutes (1:30–3:30), mean drop in haemoglobin 0.67 g/dl (−3.5 to +1.3), mean change in serum creatinine −0.5 (−22 to +18). The average time to post-operative catheter removal was 1.64 days (one to two), to post-operative drain removal 2.43 days (two to three), and to discharge 2.8 days (two to four). The average time to stent removal was 6.1 weeks (six to eight). At the mean follow-up of 14 months no major perioperative complications had occurred and no patients were re-admitted within 30 days of operation. The success rate was 95%; one patient required a second procedure in the form of an open redo-pyeloplasty because of continued pain and radiographic evidence of continued obstruction. Conclusions: These results suggest that robotic-assisted laparoscopic pyeloplasty is a feasible treatment for PUJO in a UK centre. Low rates of morbidity, short post-operative stay and high success rates at our centre are comparable with other series. Longer follow-up of this cohort is needed to demonstrate durable and effective outcomes.

Painless pulsatile mass as first presentation of renal cell carcinoma

Renal cell carcinoma rarely presents with typical features of abdominal pain, flank mass and haematuria, and up to 30% of patients present with metastases. We present the case of an 81 year old man who presented with a painless, pulsatile sternal metastasis as an initial presentation of renal cell carcinoma. This case highlights the importance of recognizing even unusual presentations of renal cell carcinoma, and that although sternal metastases are rare, when they do occur there should be a low threshold for ruling out renal cell carcinoma. ------------------------------- Cite this article as : Hoyland K, Vasdev N, Nathan P, Hanbury D. Painless pulsatile mass as first presentation of renal cell carcinoma. Int J Cancer Ther Oncol 2014; 2 (3):02036. DOI : 10.14319/ijcto.0203.6

The Lister Technique: a new technique for the management of the distal ureter during radical robotic nephroureterectomy.

Abstract We describe “The Lister Technique”—a new 3 step procedure developed in our department for robotic assisted laparoscopic nephroureterectomy (RANU). Our new technique facilitates the complete excision of the whole ureter including ureteric orifice and reduces this risk of tumour spillage from the distal ureter without the need for bivalving the bladder. Our initial data indicates that the technique is associated with reduction in bladder recurrence post-operatively in comparison to current published series. Longer follow up and larger patient numbers are required to validate these results further.