M. Laniado

Does intraprostatic inflammation have a role in the pathogenesis and progression of benign prostatic hyperplasia

To compare the incidence of acute and/or chronic intraprostatic inflammation (ACI) in men undergoing transurethral resection of the prostate (TURP) for urinary retention and lower urinary tract symptoms (LUTS), as recently a role was suggested for ACI in the pathogenesis and progression of BPH, and urinary retention is considered an endpoint in the natural history of this condition.

Publication rate of abstracts presented at the British Association of Urological Surgeons Annual Meeting

To determine the number of peer‐reviewed publications arising from the abstracts presented at the annual meetings of the British Association of Urological Surgeons (BAUS), and to assess urological trainees’ attitudes to research in relationship to the pursuit of Specialist Registrar (SpR) training numbers and their perception of academic urology in the UK.

Trans-rectal ultrasound guided biopsy of the prostate: nationwide diversity in practice and training in the United Kingdom.

Introduction: TRUS-guided needle biopsy of the prostate is the standard technique in the diagnosis of prostate cancer. However the practice is highly variable across the United Kingdom. We survey the standard approaches to TRUS biopsy of prostate, highlighting the nationwide diversity of practice and training. Methods: One hundred and eighty questionnaires were sent out to specialist registrars, investigating the number of prostate biopsy cores taken, the use of prophylactic antibiotics, rectal preparation and local analgesia in TRUS biopsy of the prostate. One hundred and fourteen trainees (63%) returned the questionnaires. Twenty-three percent reported sextant biopsy as standard, 36% taking eight-core and 26% taking 10 or more cores. There is no standard regime for antibiotic prophylaxis. Eighteen percent also reported rectal preparation as routine. Thirty-eight percent of the patients receive local anaesthesia prior to the biopsy. Overall, 42% of the TRUS biopsies are carried out by urologists, 29% by radiologists and 21% by both. Six percents have nurse practitioners’ involvement. Fifty-six percent of trainees are involve in the TRUS biopsy, 68% do not think they received enough training to carry out the procedure. Conclusions: TRUS-guided needle biopsy of the prostate is the standard technique in the diagnosis of prostate cancer. Our survey highlights nationwide diversity in practice in the UK with respect of the number of cores taken, antibiotic prophylaxis and local anaesthesia utilisation. This raised the issue of standardising the practice. More urologists are also actively taking part in this procedure, making the structured training increasingly important.

The role of endoscopy in the management of patients with upper urinary tract transitional cell carcinoma

Tumours of the renal pelvis make up 10% of all renal tumours and 5% of urothelial tumours, while 1±2% of all TCCs arise from the ureter. TCCs constitute < 90% of primary urothelial tumours of the upper urinary tract (UUT), with squamous cell carcinomas (1±7%) and adenocarcinomas (<1%) accounting for the remainder. Bilateral involvement by TCC may occur synchronously or metachronously in 2±4% of patients because of the propensity for polychronotropism, but in higher proportions in those with occupational bladder cancer. The distal ureter is the most common site (73%) of ureteric tumours [1]. The incidence of subsequent bladder cancer after previous UUT-TCC is 30±50%, but increases to 75% when there is multifocal disease in the renal pelvis and ureter. UUT-TCCs have aetiological and pathological characteristics similar to those of bladder TCCs [1]. Most UUTTCCs occur in men and are more common in Caucasians than in Blacks. The most important association is smoking [2]. Analgesic/phenacetin abuse, and its association with renal papillary necrosis, have been considered independent and synergistic risk factors [3], although apparently they may not be as important as was originally thought [4]. Occupational risk factors appear to be similar to those for bladder cancer. Acrolein, which is the metabolite of cyclophosphamide [5] and ifosphamide, appears to increase the risk of UUT-TCCs in a similar way to bladder TCC, giving aggressive and highgrade tumours. In the Balkan states of central Europe, where there are regions affected by endemic nephropathy [6], there is a 100-fold greater incidence of UUT-TCCs, but these tend to be of lower stage and grade than those encountered elsewhere. The categorization of UUT-TCCs follows the TNM system (.Table 1) [7].

Safety and detailed patterns of morbidity of transrectal ultrasound guided needle biopsy of prostate in a urologist-led unit

Objective: We prospectively evaluate the safety, morbidity and characteristics of complications for transrectal ultrasound guided needle biopsy of prostate carried out solely by urologists in a single unit. This will help to counsel patient prior to the biopsy. Patients and methods: One hundred consecutive patients were recruited to complete questionnaires prospectively, 2 weeks and 3 months after TRUS and prostate biopsy. Haematospermia, haematuria and rectal bleeding characteristics were evaluated. Pain, analgesia requirement, infection and urinary retention rates were also assessed. Results: Ninety-two patients (92%) returned questionnaires 2 weeks and 63 patients (63%) three months after the biopsy. At 2 weeks questionnaire, 58 patients (63%) experienced haematuria and 9 patients (10%) for more than 1 week. Eighty-five percent of the 58 patients who had haematuria described it as mild and intermittent. Twenty-three (25%) patients experienced a rectal bleed and none for more than four days. Only 1 patient experienced clots with the rectal bleeding. Twelve (13%) patients had difficulty passing urine but the symptoms resolved by day four. Acute urinary retention did not occur. Thirty-five (38%) patients had some degree of discomfort and only one patient had pain for more than three days. Twenty-five (27%) patients took analgesia between 1 and 8 days (Mean 3 days). Two patients had a urinary tract infection despite prophylactic antibiotics. At three months, 4 patients (6%) had experienced secondary haematuria 3 weeks after the biopsy. Two patients experienced more rectal bleeding 2 weeks after the biopsy and 1 patient had residual discomfort 2 weeks after the procedure. Thirteen patients (21%) had haematospermia between day 6 and 56 (Mean 21 days). Conclusions: Transrectal ultrasound guided biopsy of the prostate is generally well tolerated with minor pain and morbidity in our urologist-led service. Our data will assist counselling of patients prior to the procedure.

Occlusion Angiography Using Intraoperative Contrast-enhanced Ultrasound Scan (CEUS): A Novel Technique Demonstrating Segmental Renal Blood Supply to Assist Zero-ischaemia Robot-assisted Partial Nephrectomy

BACKGROUNDnRecent innovations in technology and operative techniques have enabled safe performance of robot-assisted zero-ischaemia partial nephrectomy (PN), thus preventing the deleterious effect of warm ischaemia time.nnnOBJECTIVEnTo describe a novel technique of occlusion angiography using intraoperative contrast-enhanced ultrasound scan (CEUS) for zero-ischaemia robot-assisted PN (RAPN).nnnDESIGN, SETTING, AND PARTICIPANTSnWe used a prospective cohort evaluation of five patients who had imaging suspicious of renal cell carcinoma (RCC) treated at a single centre.nnnSURGICAL PROCEDUREnWe used computed tomography with three-dimensional reconstruction to identify renal arterial anatomy and its relationship to the tumour. Then, RAPN was performed with selective clamping and demonstration of a nonperfused segment of kidney (occlusion angiography) using intraoperative CEUS.nnnOUTCOME MEASUREMENTS AND STATISTICAL ANALYSISnWe prospectively collected data on baseline, perioperative, and postoperative parameters.nnnRESULTS AND LIMITATIONSnWe describe the effects seen on ultrasound contrast administration. Contrast flare is seen in the segment of the kidney that is perfused. When selective clamping is performed, a watershed (line of demarcation) between the perfused and nonperfused segments of the kidney is clearly seen, allowing excision of the tumour in a relatively avascular plane and ensuring an adequate oncologic margin, when feasible. The mean age was 68.2 yr of age (range: 36-85), and the mean tumour size was 29.6mm (range: 20-42). The mean intraparenchymal extension of the tumour was 22.6mm (range: 12-30). Three tumours were located on the right kidney and two on the left. The mean blood loss was 420ml (range: 200-1000). The histology revealed clear cell RCC in two patients, oncocytoma in two patients, and type 1 papillary RCC in one patient. All the surgical specimens had negative surgical margins. The mean decrease in glomerular filtration rate was 8.4ml (range: 0-24). The mean follow-up was 6.4 mo (range: 5-8), with no evidence of recurrence in any patient. The only limitation in adopting this technique is the need for an intraoperative ultrasound probe with a CEUS mode. However, most specialists who perform minimally invasive surgery for small renal tumours believe that intraoperative ultrasound scan imaging is essential to achieving adequate resection margins.nnnCONCLUSIONSnIntraoperative CEUS can be a useful adjunct in determining whether zero-ischaemia RAPN is feasible by delineating the area of nonperfusion. This technique has several advantages over the currently available techniques, such as indigo carmine green and Doppler probes.

Quality-of-life outcomes from the Prostate Adenocarcinoma: TransCutaneous Hormones (PATCH) trial evaluating luteinising hormone-releasing hormone agonists versus transdermal oestradiol for androgen suppression in advanced prostate cancer

To compare quality‐of‐life (QoL) outcomes at 6 months between men with advanced prostate cancer receiving either transdermal oestradiol (tE2) or luteinising hormone‐releasing hormone agonists (LHRHa) for androgen‐deprivation therapy (ADT).

Incidental acute prostatic inflammation is associated with a lower percentage of free prostate-specific antigen than other benign conditions of the prostate : a prospective screening study

To evaluate the performance of percentage free/total prostate‐specific antigen (f/tPSA) as a screening tool for prostate cancer, and to assess the impact of prostatic inflammation on f/tPSA.

Role of i.v. urography in patients with haematuria.

Objective: Traditionally, patients presenting with haematuria undergo a series of investigations, including urine cytology, cystoscopy, i.v. urography (IVU) and renal tract ultrasound (US). Studies have suggested that the omission of IVU as a routine investigation for painless haematuria does not dramatically reduce the detection rate of malignant conditions. In this large retrospective study we evaluated the impact of the omission of IVU on the diagnosis of renal tract malignancies and other non‐malignant but significant conditions. Material and Methods: A retrospective analysis of all patients attending our haematuria clinic between January 2000 and August 2002 was carried out. The diagnostic yields of IVU and a US scan were compared and the significance of abnormalities missed by either modality was assessed with regard to the overall management of patients. Diagnoses were divided into those that were significant and potentially harmful [e.g. tumour, pelvi‐ureteric junction (PUJ) obstruction, hydronephrosis] and those that were insignificant and harmless (e.g. simple cyst, non‐obstructing calculus). Liddells exact test for matched pairs was used to test for statistical significance and to give the relative risk of a positive result. Results: A total of 1211 patients were included in the study. When cytology, cystoscopy and US were normal, IVU did not detect any additional malignant pathology. Performing IVU instead of a US scan would have resulted in 74 non‐malignant conditions remaining undiagnosed. Similarly, US alone would have missed 64 non‐malignant lesions. Six non‐malignant but significant conditions, including PUJ obstruction (nu2005=u20055) and benign ureteric stricture with hydronephrosis (nu2005=u20051), were missed by US but detected by IVU. Conclusion: In this cohort of retrospectively studied patients attending a haematuria clinic, IVU could safely have been omitted without decreasing the overall detection of malignant pathologies. Nevertheless, significant non‐malignant pathologies would have remained undiagnosed. The authors suggest that US combined with a MAG III renogram could be considered as a first‐line investigation instead of IVU. This is likely to result in maximum detection of malignant and non‐malignant conditions, while reducing the radiation exposure to the patient.

Use and rationale of a multicompartment microcassette for site-specific biopsies of the prostate in a consecutive cohort of men.

The collection of prostate biopsies into individual or site-specific specimen containers has not been performed routinely because of concerns of time, cost and lack of additional clinical value. This report evaluates the first ever use of a multicompartment microcassette for the collection and processing of site-specific prostate biopsies.Site-specific prostate biopsies were taken in sequential men suspected to have prostate cancer and collected in a multicompartment microcassette, which holds six biopsies and fits within a standard specimen container. Estimates were made of the cost and time savings compared with biopsies collected in individual specimen containers.In 88 men evaluated, use of the multicompartment microcassette saved time (72% reduction) and cost (83% reduction) with the added ability of easy identification of the site of each prostate biopsy.The multicompartment microcassette is a convenient, time- and cost-effective container for the collection of site-specific prostate biopsies.