Simon V. Bariol

A comparison of the pathology of transitional cell carcinoma of the bladder and upper urinary tract.

To clarify the histopathological patterns of upper and lower urinary tract transitional cell carcinomas (TCCs), as previous reports suggest that upper urinary tract TCCs have a greater tendency towards high‐grade disease than bladder TCCs, of which most are low‐grade and low‐stage tumours.

Evolution of stone management in Australia.

Whats known on the subject? and What does the study add?

Renal cell carcinoma: stage, grade and histology migration over the last 15 years in a large Australian surgical series

Study Type – Therapy (case series) 
Level of Evidence 4

Stopping Anticoagulation Before TURP Does Not Appear to Increase Perioperative Cardiovascular Complications

OBJECTIVE To evaluate the impact of stopping anticoagulant medications prior to transurethral resection of the prostate on peri-operative cardiovascular complications. METHODS Retrospective series (305 patients) undergoing TURP at a tertiary hospital between 2006 and 2010. All men were evaluated in preadmission clinics with defined protocols, with a low threshold for cardiovascular investigation. Incidence of postoperative bleeding and cardiovascular and cerebrovascular events was determined for 3 patient cohorts: group A--where anticoagulants were ceased preoperatively; group B--who were not receiving any anticoagulants; and group C--who underwent TURP while taking aspirin. RESULTS Of 305 patients, 194 (64%) did not receive anticoagulation therapy, 108 (35%) stopped receiving anticoagulation therapy pre-TURP, and 3 (0.98%) underwent TURP while taking aspirin. Anticoagulants used were aspirin (22.6%), warfarin (4.9%), antiplatelets (4.9%), and combination treatments (3.9%). Incidence of postoperative hemorrhage (early and delayed) was not significant (P = .69) between group A (10/108) and group B (7/194). Transfusion rate was 0.6% (2/305). Overall incidence of cardiovascular events was 0.98% (group A, n = 1 vs group B, n = 2), and incidence of deep vein thrombosis (0.32%; group A, n = 0 vs group B, n = 1) was not statistically significant (P = .30 and P = .37, respectively). Overall incidence of cerebrovascular events (0.65%; group A, n = 1 vs group B, n = 1) was not significant (P = 1.00). There were no deaths. CONCLUSION Men who have discontinue anticoagulation therapy before TURP do not appear to have a higher incidence of cardiovascular or cerebrovascular events, or bleeding-associated morbidity. It is possible that the morbidity attributed to discontinuing anticoagulation in this population may be overemphasized. Larger prospective studies are needed to better evaluate this clinical problem.

Changes in upper urinary tract stone composition in Australia over the past 30 years

To investigate upper urinary tract stone composition rates in Australia To investigate changes in stone composition in Australia over the past 30 years

Comparison of urinary stone and stent encrustation: Biochemical analysis

PURPOSE To compare biochemical analysis of stent encrustation with that of urinary stones from the same patient. PATIENTS AND METHODS Any patient presenting from February to December 2000 with a symptomatic ureteral or renal calculus that necessitated stenting and delayed calculus retrieval was enrolled in the study. The stent and stone were sent to the same laboratory for qualitative and semiquantitative chemical analysis. A total of 50 stents and matched calculi were available for comparison; four stents were excluded because they had insufficient encrustation for analysis. RESULTS Two patients had open ureterolithotomy; the remainder were treated by endoscopic or percutaneous means. Every stone containing calcium oxalate had a stent that was positive for calcium oxalate. Four uric acid stones were available for comparison, and three of the four matched stents tested positive for uric acid. CONCLUSION Biochemical analysis of urinary stent encrustation is a good predictor of urinary stone composition, especially for calcium oxalate-containing stones. Uric acid stent encrustation is likely to occur in patients with uric acid stones.

Intracorporeal ribbon gauze in laparoscopic surgery

Good haemostasis optimizes laparoscopic visibility and performance. The use of suction reduces pneumoperitoneum and collapses the operative space, and the resulting fall in intra‐abdominal pressure can increase the rate of bleeding. Therefore, other methods of improving laparoscopic visibility need to be investigated. In the present report we describe the effectiveness of a 20−40‐cm length of 3‐inch ribbon dressing gauze when introduced into the peritoneal cavity via a 10−12 mm laparoscopic port. Current results indicate that intracorporeal ribbon gauze can be used successfully during laparoscopic procedures as a suction filter, to assist haemostasis, to facilitate dissection and to provide atraumatic organ retraction.

Geographical variation in the management of urolithiasis in Australia.

To examine any geographical variation in the management of urolithiasis amongst the Australian states and territories.

Comparison of cost of care for tethered versus non‐tethered ureteric stents in the management of uncomplicated upper urinary tract stones

Many surgeons use a stent after ureteroscopic lithotripsy (URSL). For short‐term stenting purposes, a surgeon has the choice of either a tethered or a non‐tethered stent. Stents may be associated with complications that entail an additional cost to their use. There is a paucity of data on the direct healthcare cost of using stent type after either primary or secondary URSL.

Urethral calculus originating from ureterocele and causing urinary retention.

It is with great interest that we read the article ‘Use of fine-needle aspiration cytology in the diagnosis of parotid neoplasms’. Although fine-needle aspiration cytology (FNAC) is reliable in identifying neoplastic lesions, its inaccuracy in differentiating malignant from benign tumours, with high false-negative and ‘non-diagnostic’ rates, suggests it may not be the best modality for preoperative workup of parotid masses. Accurate preoperative diagnosis aids surgical planning, given superficial parotidectomy may be performed for benign tumours whereas malignant lesions require a more aggressive approach with higher risk of complications such as facial nerve sacrifice. Ultrasound-guided core biopsy (USCB) is an alternative to FNAC with recent meta-analyses demonstrating better sensitivity, specificity and accuracy in diagnosing malignant and benign parotid lesions, with a low ‘non-diagnostic’ rate of 1.6%. USCB is more invasive than FNAC, requiring local anaesthetic and skin incision. Despite this, it is generally well tolerated and we believe USCB’s superiority to FNAC makes it the preferred first-line diagnostic investigation. Frozen section (FS) is a useful intra-operative tool that accurately and rapidly differentiates malignant from benign tumours. A 2014 study found FS to have superior sensitivity, specificity, positive predictive value and negative predictive value than FNAC. FS should not replace FNAC as it obviously cannot aid in preoperative surgical planning. However, FS can be used in conjunction with preoperative investigations, with studies showing FS can correct false-negative results of FNAC with the surgical procedure consequently modified appropriately. Magnetic resonance imaging (MRI) has the ability to identify features of parotid lesions such as irregular margins, signal intensity heterogeneity and tissue infiltration. Whether these features are characteristic of malignant tumours is controversial; however, a 2013 study found MRI enables accurate differentiation of malignant and the two most common benign tumours. Further research is warranted to justify the use of MRI, allowing a triple preoperative investigation approach utilizing clinical assessment, imaging and biopsy.