James Armitage

Identifying co-morbidity in surgical patients using administrative data with the Royal College of Surgeons Charlson Score

Surgical outcomes are influenced by co‐morbidity. The Royal College of Surgeons (RCS) Co‐morbidity Consensus Group was convened to improve existing instruments that identify co‐morbidity in International Classification of Diseases tenth revision administrative data.

Mortality in men admitted to hospital with acute urinary retention: database analysis

Objectives To investigate mortality in men admitted to hospital with acute urinary retention and to report on the effects of comorbidity on mortality. Design Analysis of the hospital episode statistics database linked to the mortality database of the Office for National Statistics. Setting NHS hospital trusts in England, 1998-2005. Participants All men aged over 45 who were admitted to NHS hospitals in England with a first episode of acute urinary retention. Main outcome measures Mortality in the first year after acute urinary retention and standardised mortality ratio against the general population. Results During the study period, 176 046 men aged over 45 were admitted to hospital with a first episode of acute urinary retention. In 100 067 men with spontaneous acute urinary retention, the one year mortality was 4.1% in men aged 45-54 and 32.8% in those aged 85 and over. In 75 979 men with precipitated acute urinary retention, mortality was 9.5% and 45.4%, respectively. In men with spontaneous acute urinary retention aged 75-84, the most prevalent age group, the one year mortality was 12.5% in men without comorbidity and 28.8% in men with comorbidity. The corresponding figures for men with precipitated acute urinary retention were 18.1% and 40.5%. Compared with the general population, the highest relative increase in mortality was in men aged 45-54 (standardised mortality ratio 10.0 for spontaneous and 23.6 for precipitated acute urinary retention) and the lowest for men 85 and over (1.7 and 2.4, respectively). Conclusions Mortality in men admitted to hospital with acute urinary retention is high and increases strongly with age and comorbidity. Patients might benefit from multi-disciplinary care to identify and treat comorbid conditions.

The thermo-expandable metallic stent for managing benign prostatic hyperplasia: a systematic review

To systematically review published reports of the safety, effectiveness and durability of a self‐expanding metallic prostatic stent (Memokath®, Engineers & Doctors A/S Ltd., Denmark) in patients with benign prostatic hyperplasia (BPH) who are unfit for surgery.

Incidence of Primary and Recurrent Acute Urinary Retention Between 1998 and 2003 in England

PURPOSE We report how the incidence of primary and recurrent acute urinary retention changed in England between 1998 and 2003. In addition, we present data on changes with time in the use of prostatectomy after acute urinary retention and recurrent acute urinary retention. MATERIALS AND METHODS Data were extracted from the Hospital Episode Statistics database of the Department of Health in England. Patients were included in the study if an International Classification of Diseases, Tenth Revision code for acute urinary retention or an operative procedure code for transurethral prostate resection was present in any diagnosis or procedure fields of the Hospital Episode Statistics database. A total of 165,527 men were identified to have been hospitalized with acute urinary retention in the study period. RESULTS The incidence of primary acute urinary retention was 3.06/1,000 men yearly. Acute urinary retention was spontaneous in 65.3% of cases. The incidence of acute urinary retention decreased from 3.17/1,000 men yearly in 1998 to 2.96/1,000 yearly in 2003. Surgical treatment following spontaneous acute urinary retention decreased 20% from 32% in 1998 to 26% in 2003. This trend coincided with a 20% increase in the rate of recurrent acute urinary retention. CONCLUSIONS The slight decrease in the incidence of primary acute urinary retention suggests that the shift away from surgical treatment for benign prostatic hyperplasia has not resulted in an increase in acute urinary retention. The increase in recurrent acute urinary retention suggests that the observed decrease in surgery after acute urinary retention may have put more men at risk for acute urinary retention recurrence.

Percutaneous nephrolithotomy in England: practice and outcomes described in the Hospital Episode Statistics database.

To investigate the postoperative outcomes of percutaneous nephrolithotomy (PCNL) in English National Health Service (NHS) hospitals.

Assessment of Stone Complexity for PCNL: A Systematic Review of the Literature, How Best Can We Record Stone Complexity in PCNL?

INTRODUCTION This study aims to systematically review the literature reporting tools for scoring stone complexity and the stratification of outcomes by stone complexity. In doing so, we aim to determine whether the evidence favors uniform adoption of any one scoring system. METHODS PubMed and Embase databases were systematically searched for relevant studies from 2004 to 2014. Reports selected according to predetermined inclusion and exclusion criteria were appraised in terms of methodologic quality and their findings summarized in structured tables. RESULTS After review, 15 studies were considered suitable for inclusion. Four distinct scoring systems were identified and a further five studies that aimed to validate aspects of those scoring systems. Six studies reported the stratification of outcomes by stone complexity, without specifically defining a scoring system. All studies reported some correlation between stone complexity and stone clearance. Correlation with complications was less clearly established, where investigated. CONCLUSIONS This review does not allow us to firmly recommend one scoring system over the other. However, the quality of evidence supporting validation of the Guys Stone Score is marginally superior, according to the criteria applied in this study. Further evaluation of the interobserver reliability of this scoring system is required.

The role of anticholinergic drugs in men with lower urinary tract symptoms.

Purpose of review Male lower urinary tract symptoms are often attributed to benign prostatic hyperplasia. However, coexisting overactive bladder may be responsible for storage symptoms in a substantial proportion. Treatment of these symptoms with anticholinergic drugs has been considered hazardous in benign prostatic hyperplasia because of concerns that they may predispose to acute urinary retention. We present recent research evidence on the effectiveness and safety of anticholinergics for male lower urinary tract symptoms. Recent findings Two systematic reviews and a large randomized controlled trial recently evaluated anticholinergic drugs in men with lower urinary tract symptoms. These studies provided good evidence that anticholinergics are effective at improving both urodynamic and patient-reported outcomes. Postvoid residual urine volumes and urine flow rates were not significantly affected, and acute urinary retention was rare. Summary In men with lower urinary tract symptoms treatment may need to be directed at both the prostate and the bladder, and a pragmatic approach therefore seems appropriate. Men presenting with lower urinary tract symptoms should undergo comprehensive clinical evaluation before benign prostatic hyperplasia is treated, if indicated. Should symptoms fail to resolve, addition of anticholinergic drugs may be considered in the absence of significant postvoid residual urine volumes.

PCNL Access by Urologist or Interventional Radiologist: Practice and Outcomes in the United Kingdom

To compare outcomes of urologist vs interventional radiologist (IR) access during percutaneous nephrolithotomy (PCNL) in the contemporary UK setting.

Hospital Volume Does Not Influence the Safety of Percutaneous Nephrolithotomy in England: A Population-Based Cohort Study.

PURPOSE This study aims to investigate the relationship between hospital case volume and safety-related outcomes after percutaneous nephrolithotomy (PCNL) within the English National Health Service (NHS). PATIENTS AND METHODS The study used the Hospital Episode Statistics (HES) database, a routine administrative database, recording information on operations, comorbidity, and outcomes for all NHS hospital admissions in England. Records for all patients undergoing an initial PCNL between April 1, 2006 and March 31, 2012 were extracted. NHS trusts were divided into low-, medium-, and high-volume groups, according to the average annual number of PCNLs performed. We used multiple regression analyses to examine the associations between hospital volume and outcomes incorporating risk adjustment for sex, age, comorbidity, and hospital teaching status. Postoperative outcomes included: Emergency readmission, infection, and hemorrhage. Mean length of stay was also measured. RESULTS There were 7661 index elective PCNL procedures performed in 163 hospital trusts, between April 2006 and March 2012. There were 2459 patients who underwent PCNL in the 116 units performing fewer than 10 PCNL procedures per year; 2643 patients in the 37 units performing 10 to 19 procedures per year; and 2459 patients in the 9 hospitals performing more than 20 procedures per year. For low-, medium-, and high-volume trusts, there was little variation in the rates of emergency readmission (L 9.7%, M 9.3%, H 8.4%), infection (3.0%, 4.2%, 3.8%), or hemorrhage (1.3%, 1.5%, 1.5%), and there was no statistical evidence that volume was associated with adjusted outcomes. Mean length of stay was slightly shorter in the medium- (5.0 days) and high-volume (5.0) groups compared with the low-volume group (5.3). The effect remained statistically significant after adjusted for confounding. CONCLUSION Hospital volume was not associated with emergency readmission, infection, or hemorrhage. Length of stay appears to be shorter in higher volume units.

Dynamic variables: novel and perhaps better predictors of progression in benign prostatic hyperplasia.

The previous issue of the BJU International presented a 7.4-year update of the ongoing bicalutamide Early Prostate Cancer (EPC) trial programme [1]. The authors conclude that bicalutamide is not useful in patients with localized disease, but recommend its use in patients with locally advanced disease, as it significantly improves progression-free survival (PFS) irrespective of standard care. The optimum use of hormonal therapy in prostate cancer is a fervently debated topic.