Derek Hennessey

A Systematic Review of Ileal Conduit and Neobladder Outcomes in Primary Bladder Cancer

Treatment for muscle invasive bladder cancer with curative intent includes radical cystectomy and urinary diversion. Using PRISMA guidelines, we conducted a systematic review assessing differences in patient selection, operative parameters, complications, and quality of life between ileal conduit and neobladder cohorts. Ileal conduit cohorts have more advanced age and disease, more comorbidities and complications, and poorer quality of life. Ileal conduit surgery is associated with adverse patient selection that inhibits reasonable comparison of outcomes with neobladder cohorts. Despite this, we observe longer operative times and hospital stays in neobladder cohorts, perhaps reflecting greater technical difficulty and the need for postoperative bladder training.

Infective complications after retrograde intrarenal surgery: a new standardized classification system

PurposeRetrograde intrarenal surgery (RIRS) is considered a safe procedure; however, infective complications are potentially serious postoperative complications. The aim of this multicentre study was to evaluate prospectively the prevalence of infective complications after RIRS and identify risk factors.MethodsBaseline data were collected, and patients were questioned regarding postoperative infective complications following RIRS. The Fisher exact test, Student t test, Mann–Whitney U test, and multivariate regression analysis were used for data analysis.ResultsA total of 403 patients from five European centers were included. Antibiotic prophylaxis was administered prior to RIRS in 100xa0%. Infection complications were recorded in 31 patients (7.7xa0%), consisting of fever in 18 (4.4xa0%), SIRS in 7 (1.7), and sepsis in 3 (0.7xa0%). Three required hospitalization for non-obstructive pyelonephritis (0.7xa0%). Univariate analysis revealed that coronary heart disease, chronic kidney disease, alteration of lipid metabolism, anticoagulant therapy, past surgery for renal stone, presence of residual fragments were predictors of infective complications. Multivariate analysis did not identify any patient subgroups at a significantly higher risk of infection. The low rate of complications may have limited the conclusions from our study.ConclusionUsing a standardized method for the definition and classification of infective complication from a multicentre prospective large database, we find a prevalence of 7.7xa0% of infective complication among patients undergoing RIRS for renal stone. However, to predict which patients will develop infective complications still remains a clinical challenge.

Sacral neuromodulation for detrusor hyperactivity with impaired contractility

Detrusor hyperactivity with impaired contractility (DHIC) is a challenging condition to manage. Sacral neuromodulation (SNM) is a proven treatment modality for both the individual aspects of DHIC. To date, data reporting the outcome of SNM for DHIC are lacking.

Implementation rates of uro-oncology multi-disciplinary meeting decisions

To assess implementation rates of the consensus plans made at the uro‐oncology multidisciplinary meeting (MDM) of an Australian tertiary centre, and analyse obstacles to implementation.

The surgical experience influences the safety of retrograde intrarenal surgery for kidney stones: a propensity score analysis

The aim of this study is to evaluate if surgical experience could influence the outcomes of retrograde intrarenal surgery (RIRS) in terms of stone clearance and complication rate. Patients from five institutions were included in this study. Patients were divided into two groups. Group 1: patients treated by three surgeons in the early phase of learning curve (surgical experience <100 procedures); Group 2: cases operated by two surgeons with great endourological experience (>400 procedures). Patients and stone characteristics, outcome and complications were analyzed. Multivariable regression model was used. Differences between groups were estimated using propensity scores to adjust for the bias inherent to the different characteristics. 381 RIRS were analyzed (Group 1: 150 RIRS; Group 2: 231 RIRS). Clinical data and stone parameters were comparable. The SFR was 70xa0% in Group 1 and 77.9xa0% in Group 2 (pxa0=xa00.082). Operative time was significantly shorter in the Group 2 (76.3 vs. 53.1xa0min, pxa0=xa00.001). The overall complication rate was significantly lower in Group 2 (20.7 vs. 8.7, pxa0=xa00.001). At unadjusted analysis, a non-significant difference was found between centers on SFR (OR 1.51 95xa0% CI 0.95–2.41). Conversely, a significant difference was found on overall complications (OR 0.36 95xa0%CI 0.20–0.67) with lower overall complication in Group 2. This study shows that surgeon experience influences the outcomes of RIRS mainly in terms of safety. Further studies will be needed to assess the exact number of procedures necessary to obtain a plateau in the rate of complications and success.

The underactive bladder: diagnosis and surgical treatment options

The underactive bladder (UAB)/detrusor underactivity (DU) is a relatively common condition. It is difficult to diagnose and can be difficult to manage. The aim of this review is to provide a review of the diagnosis and different surgical treatment options for UAB/DU. A comprehensive literature review using medical search engines was performed. The search included a combination of the following terms, UAB, DU, TURP, reduction cystoplasty, bladder diverticulectomy and sacral neuromodulation (SNM). Search results were assessed for their overall relevance to this review. Definitions, general overview and management options were extracted from the relevant medical literature. DU affects up to 45% of men and women >70 years of age. The symptoms of DU overlap significantly with overactive bladder (OAB) and bladder outlet obstruction (BOO). Urodynamic findings include low voiding pressure combined with slow intermittent flow and incomplete bladder emptying. Non-operative management for DU is acceptable; only 1 in 6 male patients may need a TURP and acute urinary retention (AUR) is rare. TURP for DU is feasible and is associated with good short and medium term outcomes, but over time, there is a return to baseline symptoms. Bladder diverticulectomy can also improve DU, but there is a paucity of guidelines on patient selection. SNM provides excellent outcomes for DU, but patient selection is important.

Impact of bladder dysfunction in the management of post radical prostatectomy stress urinary incontinence—a review

Bladder dysfunction is a relatively common urodynamic finding post radical prostatectomy (RP). It can be the sole cause of post prostatectomy incontinence (PPI) or may be found in association with stress urinary incontinence (SUI). The aim of this review is to provide a comprehensive review of the diagnosis and different treatments of post RP bladder dysfunction. A comprehensive literature review using medical search engines was performed. The search included a combination of the following terms, PPI, detrusor overactivity (DO), detrusor underactivity (DU), impaired compliance, anticholinergic, onabotulinumtoxinA (Botox®) and sacral neuromodulation (SNM). Definitions, general overview and management options were extracted from the relevant medical literature. DO, DU and impaired compliance are common and may occur alone or in combination with SUI. In some patients the conditions exist pre RP, in others they arise due to denervation and surgical changes. DO can be treated with anticholinergics, Botox® and SNM. DO may need to be treated before SUI surgery. DU may be a contraindication to male sling surgery as some patients may go into urinary retention. Severely impaired bladder compliance may be a contraindication to SUI surgery as the upper tracts may be at risk. Each individual dysfunction may affect the outcome of PPI treatments and clinicians should be alert to managing bladder dysfunction in PPI patients.

Mini PCNL for renal calculi: does size matter?

To evaluate the minimally invasive percutaneous nephrolithotomy (MIP) system for renal calculi.

RIRS in the elderly: Is it feasible and safe?

BACKGROUNDnThe aim of this study was to compare the safety and efficacy of RIRS in men ≥65 years to those <65 years.nnnMATERIALS AND METHODSnPatients who underwent RIRS were prospectively collected from March 2013 to March 2014 in 5 European centers. Perioperative outcomes and complications in elderly men were compared with men <65 years. Univariable and multivariable analyses were performed for factors predicting overall complications. The groups were compared using Mann-Whitney U test. Categorical variables were compared using chi-squared test and the Yates correction or the Fishers exact test.nnnRESULTSnA total of 399 patients with renal stones were included, 308 (77.19%) were aged <65 years, 91 (22.8%) were aged ≥65 years. Elderly patients were more likely to have higher ASA scores (35.7% vs 92.3%; pxa0<xa0001), Charlson Comorbidity Index (1.8 vs. 5.2, pxa0<xa00.001), hyperlipidemia (10.06% vs. 30.76%; pxa0=xa00,0005) and coronary heart disease (5.51% vs. 17.58; pxa0=xa00.005) compared to younger cohort. Perioperative outcomes (stone free rate, operative time and re-intervention rate) did not show differences between the two groups (pxa0>xa00.05). Surgical and medical complication rates were similar between the cohorts (14.28% vs 9.89%; pxa0=xa00.38). Multivariate analysis did not identify any predictive factors of complications among the two groups (pxa0>xa00.05).nnnCONCLUSIONSnIn this study, elderly RIRS patients had comparable short term efficacy and perioperative complications to younger patients, despite a higher prevalence of comorbidity. Age itself should not be considered as a risk factor for the development of complications in patients undergoing RIRS for renal stone.

Impact of an acute surgical unit on patient outcomes in South Australia

Compared with traditional (Trad) systems of managing emergency surgical presentations, the acute surgical unit (ASU) model provides an on‐site registrar, on‐call surgeon and dedicated emergency theatre, 24 h/day. To date, there have been no Australasian ASU studies of >3000 patients, nor from South Australia.