David C Shackley

Photodynamic therapy for superficial bladder cancer under local anaesthetic.

Objectives To evaluate the use of local anaesthesia (LA) in 5‐aminolaevulinic acid (ALA) photodynamic therapy (PDT) for superficial transitional cell carcinoma (TCC) of the bladder, and to provide further toxicity and tolerability data on this new method within the context of a phase 1 trial.

Light penetration in bladder tissue: implications for the intravesical photodynamic therapy of bladder tumours

Objectives To assess (i) the optical properties and depth of penetration of varying wavelengths of light in ex‐vivo human bladder tissue, using specimens of normal bladder wall, transitional cell carcinoma (TCC) and bladder tissue after exposure to ionizing radiation; and (ii) to estimate the depth of bladder wall containing cancer that could potentially be treated with intravesical photodynamic therapy (PDT), assuming satisfactory tissue levels of photosensitizer.

The increased rate of prostate specific antigen testing has not affected prostate cancer presentation in an inner city population in the UK

To assess whether the increased use of prostate‐specific antigen (PSA) testing over the last 15 years has changed the way prostate cancer presents in an inner city UK population, where PSA screening rates might be expected to be lower than in epidemiological studies based in North America, where there is a significant tendency to a localized stage and earlier age at diagnosis.

Impact of socioeconomic status on bladder cancer outcome.

Purpose of review To give an update on the possible influence of socioeconomic status on bladder cancer outcome. Recent findings Research to investigate the impact of socioeconomic status on bladder cancer outcome has increased during the past 2 years. The findings of these studies show that socioeconomic status is a significant predictor of survival in male and female patients presenting with bladder cancer, when death from all causes is considered. Very limited data on the effect of affluence on bladder cancer-specific survival, however, are available. Bladder cancer is the only common malignancy for which women have a worse prognosis than men. Recent evidence suggests that the finding of worse survival in women may be confined to those from more deprived areas. Summary Bladder cancer outcomes are directly influenced by social deprivation.

The staged management of complex entero-urinary fistulae.

Objective To present the results of the staged management of complex entero‐urinary fistulae.

Photodynamic therapy for superficial bladder cancer

In photodynamic therapy, a photosensitizing drug is activated by visible light and in the presence of oxygen, results in local cell death. This evolving modality is now being used to treat and palliate a very wide variety of human solid tumors and carcinoma-in-situ lesions. With regard to bladder cancer, advances in drug development and modern light delivery techniques mean that photodynamic therapy shows promise in the treatment of superficial bladder cancer resistant to conventional treatments.

Comparison of the cellular molecular stress responses after treatments used in bladder cancer

Objective  To investigate the molecular stress responses related to the quality of recovery of normal tissue after various treatments for bladder cancer, i.e. hyperthermia, ionizing radiation, mitomycin‐C and 5‐aminolaevulinic acid photodynamic therapy (ALA‐PDT).

A century of prostatic surgery.

haemorrhage and were largely abandoned. In 1876, Introduction Bottini used electric current to destroy prostate tissue transurethrally with ‘galvanocautery’, but excess hyperThe syndrome of bladder neck obstruction has been described for many centuries. The ancient Ebers Egyptian thermia caused serious complications [7]. papyrus from the 15th century bc alludes to diBculty with passing urine and Hippocrates suggested that acute Orchidectomy and other operative techniques retention should be treated by purging [1,2]. The development of the urinary metal catheter is credited to the John Hunter in the 18th century discussed the sequelae of prostatic obstruction, including bladder hypertrophy Romans Celsus and Galen in the first century ad [3], and the flexible catheter by Avicenna of Arabia in 1036 and upper tract dilation. His specimens supporting these observations are displayed in the Museum of the Royal [4]. Since then, the catheter in all its forms, from the hollow leaves of Allium fistulosum used by the ancient Chinese [5] to the metal, rubber and gum elastic compounds of today, has been the mainstay of treatment for prostatic obstruction for 2000 years (Fig. 1). Despite this, there was great anatomical confusion about the male genitourinary tract and only in 1538 was the prostate first represented diagrammatically, although unlabelled, in Table 1 of Vesalius’ Tabula Anatomicae Sex. In 1611 Casper Bartholin named the gland ‘prostate’ and in the ensuing two centuries a succession of practitioners proved the association between prostate hypertrophy and obstructive uropathy [6]. However, successful prostatic surgery has evolved only in the last hundred years and this article celebrates its first century (Table 1).

Variation in the prevalence of urinary catheters: a profile of National Health Service patients in England.

Introduction Harm from catheter-associated urinary tract infections is a common, potentially avoidable, healthcare complication. Variation in catheter prevalence may exist and provide opportunity for reducing harm, yet to date is poorly understood. This study aimed to determine variation in the prevalence of urinary catheters between patient groups, settings, specialities and over time. Methods A prospective study (July 2012 to April 2016) of National Health Service (NHS) patients surveyed by healthcare professionals, following a standardised protocol to determine the presence of a urinary catheter and duration of use, on 1 day per month using the NHS Safety Thermometer. Results 1314 organisations (253 NHS trusts) and 9 266 284 patients were included. Overall, 12.9% of patients were catheterised, but utilisation varied. There was higher utilisation of catheters in males (15.7% vs 10.7% p<0.001) and younger people (18–70 year 14.0% vs >70 year 12.8% p<0.001), utilisation was highest in hospital settings (18.6% p<0.001), particularly in critical care (76.6% p<0.001). Most catheters had been in situ <28 days (72.9% p<0.001). No clinically significant changes were seen over time in any setting or specialty. Conclusion Catheter prevalence in patients receiving NHS-funded care varies according to gender, age, setting and specialty, being most prevalent in males, younger people, hospitals and critical care. Utilisation has changed only marginally over 46 months, and further guidance is indicated to provide clarity for clinicians on the insertion and removal of catheters to supplement the existing guidance on care.

Ranking of urology registrar placements within a region. An SAC pilot

Background: There is a continual desire to improve educational standards, demonstrate quality assurance of training and to respond to the growing pressure to reduce SpR numbers. Any reduction would need to be based on an assessment which looks at educational value and trainee experience. We describe our experience using a tool to rank urology registrar posts in a single region. Methods and materials: An assessment scoring tool was created with equal trainee and trainer components. The trainee and trainer elements were developed from the proposed JCST trainee assessment and the GMC standards for trainers, with a maximum score of 200 achievable. Higher scores could be obtained by the unit being pro-active with educational activities. This tool was completed by all the training units and trainees within a single region. Results: Results were obtained from all units within the region, with scores ranging from 130 to 168 (mean 149). Units scoring highly in trainee components also scored highly in the trainer component. Conclusion: This tool allows objective assessment of training posts using evidence from the training unit, trainee and TPD. Incorporating this data into the annual ARCP would potentially improve the process. There was widespread support for repeating the exercise and the tool provided a powerful means of engagement in improving training.