Nicholas Cohen

TURP and sex: patient and partner prospective 12 years follow-up study.

Study Type – Symptom prevalence (prospective cohort)

Fate of Indeterminate Lesions Detected on Noncontrast Computed Tomography Scan for Suspected Urolithiasis: A Retrospective Cohort Study With a Minimum Follow-up of 15 Months

OBJECTIVE To investigate the fate of indeterminate lesions incidentally found on noncontrast computed tomography (NCCT) for suspected urolithiasis. METHODS A retrospective review of 404 consecutive cases of suspected urolithiasis was undertaken between May 2010 and April 2011. Data were collected for patient demographics, presence of calculus disease, and additional urologic or nonurologic pathologies and their clinical relevance. The indeterminate or suspicious lesions were followed up and the data were reviewed in September 2012. RESULTS In total, 404 patients underwent NCCT for renal colic (mean age, 50 years [range, 13-91 years]; 165 females). Minimum follow-up period was 15 months. Fifty-eight patients (14%) had ureteric, 85 (21%) had renal, and 39 patients (10%) had combined ureteric and renal stones. Noncalculus pathologies were found in 107 patients (26%). Sixty patients (15%) had indeterminate lesions. Of these patients, 6 required operative intervention, 35 had a benign diagnosis after further imaging and multidisciplinary team meeting, and 13 remained under surveillance after 1 year. Indeterminate pulmonary lesions (8 of 16) were the commonest lesions to remain under surveillance. CONCLUSION NCCT is vital for the diagnosis of urolithiasis with a pick up rate of 45% and remains the standard of care. However, with incidental detection of potential malignant lesions, a significant minority will need close monitoring, intervention, or both. In our study, approximately one-third of these lesions either remained under surveillance or had intervention.

2016 FATE OF INDERMINATE/SUSPICIOUS LESIONS FOUND INCIDENTALLY ON CTKUB FOR SUSPECTED RENAL COLIC ? OUTCOMES AFTER A MINIMUM FOLLOW-UP OF 15 MONTHS

INTRODUCTION AND OBJECTIVES: CT-KUB is the gold standard for the investigation of suspected renal colic. In addition to stone diagnosis additional pathology can be found in 5-20% of CTKUBs. Although most additional findings are minor, sometimes suspicious/indeterminate lesions are found. With increasing incidence of renal colic and stones these incidental but potentially serious lesions will pose a dilemma to surgeons and patients alike.The aim of this study was assess the fate of these indeterminate lesion found CT-KUB. METHODS: A retrospective review of 404 patients having CTKUB’s for suspected acute renal colic was undertaken between May 2010 and April 2011. Data was collected for patient demographics, presence or calculus disease and additional urological or non-urological pathologies and its clinical relevance. The indeterminate/suspicious lesions were followed up and the data was reviewed in September 2012. RESULTS: The mean age was 50 years (Range: 13-91 years), with 165 females (41%). Ureteric stone was found in 58 (14%), with renal stones in 85 (21%), combined ureteric and renal stones in 39 (10%) patients.The minimum follow up for each patient was 15 months. Clinically relevant non-calculus pathologies were found in 107 patients (26%). A total of 54 patients (13.4%) had indeterminate/suspicious lesion, which required either a follow-up or intervention or further imaging. Of these 6 (11%) patients required operative intervention for malignant or serious condition. A further 13 (24%) patients are still under follow-up imaging after one year. This was specially the case in incidental lung nodules where half of them (8/16) were still under follow-up after 15 months. In 35 (65%) patients a benign diagnosis was made after further imaging and or specialist multidisciplinary team meeting. CONCLUSIONS: CTKUBs are vital for stone diagnosis with a pick up rate of 45%.However, it does pick up other important potential malignant lesions which may need monitoring or intervention. In our study, a third of these lesions were either still under follow-up or had intervention after 15 months of being diagnosed.

There are calls for a national screening programme for prostate cancer: what is the evidence to justify such a national screening programme?

Introduction Prostate cancer is the commonest cancer in men and a major health issue worldwide. Screening for early disease has been available for many years, but there is still no national screening programme established in the United Kingdom. Objective To assess the latest evidence regarding prostate cancer screening and whether it meets the necessary requirements to be established as a national programme for all men. Methods Electronic databases and library catalogues were searched electronically and manual retrieval was performed. Only primary research results were used for the analysis. Results In recent years, several important randomised controlled trials have produced varied outcomes. In Europe the largest study thus far concluded that screening reduced prostate cancer mortality by 20%. On the contrary, a large American trial found no reduction in mortality after 7–10 years follow-up. Most studies comment on the adverse effects of screening – principally those of overdiagnosis and subsequent overtreatment. Discussion Further information about the natural history of prostate cancer and accuracy of screening is needed before a screening programme can be truly justified. In the interim, doctors and patients should discuss the risks, benefits and sequelae of taking part in voluntary screening for prostate cancer.

Surgical management for upper tract transitional cell carcinoma

This is the protocol for a review and there is no abstract. The objectives are as follows: To determine the best surgical management of upper tract transitional cell carcinoma. The following comparisons are pre-stated: 1.Whether open radical nephroureterectomy is better than laparoscopic nephroureterectomy 2.Whether nephroureterectomy is better than conservative localised resection of ureter, where indicated 3. Whether open surgical resection (local or nephroureterectomy) is better than endoscopic resection and surveillance, where indicated 4.Whether open surgical method of handling lower end of ureter is better than endoscopic or laproscopic assisted methods 1 Surgical management for upper tract transitional cell carcinoma (Protocol) Copyright