BJU International

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Prognostic significance of the mode of detection in renal tumours
BJU International - Tập 90 Số 4 - Trang 358-363 - 2002
Jean Jacques Patard, Alejandro Rodríguez, Nathalie Rioux-Leclercq, F. Guillé, Bernard Lobel

Objective  To evaluate the mode of detection of 400 renal tumours as a prognostic factor compared with the usual clinical and pathological prognostic variables.

Patients and methods  The data were reviewed for 400 patients operated for a renal tumour at our institution between 1984 and 1999, analysing the prognostic value of age, sex, tumour size, stage, grade, vein invasion, adrenal gland invasion, lymph node invasion, metastasis, and mode of detection (incidental or not). The survival rates were assessed using the Kaplan‐Meier method and log‐rank test, and the data evaluated using multivariate analysis with the Cox proportional‐hazard model.

Results  In all, 151 (38%) renal tumours were discovered incidentally. There was no significant difference in the percentage of renal cell carcinoma found between the groups of patients discovered incidentally or not (94.4% vs 93.9%). Tumours were smaller in the incidental group (5.7 cm vs 8.7 cm, P  < 0.001). In the incidental group, 15.2% of the tumours were treated with partial nephrectomy, against 1.2% in the symptomatic group ( P  < 0.001). The specific survival was significantly better in patients with renal tumours discovered incidentally (log‐rank test, P  < 0.001). The multivariate analysis showed that the mode of detection, stage, grade, metastasis (all P  < 0.001), and lymphatic extension ( P   =  0.005) were independent prognostic factors.

Conclusion  The incidental discovery of renal tumours gives a supplementary benefit to patients in terms of survival, and should be considered as a prognostic factor in addition to stage and grade.

Kết hợp hệ thống ghi nhận và dữ liệu hình ảnh tuyến tiền liệt (PI-RADS) và mật độ kháng nguyên tuyến tiền liệt đặc hiệu (PSA) để dự đoán kết quả sinh thiết ở bệnh nhân chưa từng sinh thiết
BJU International - Tập 119 Số 2 - Trang 225-233 - 2017
Satoshi Washino, Tomohisa Okochi, Kimitoshi Saito, Tsuzumi Konishi, Masaru Hirai, Yutaka Kobayashi, Tomoaki Miyagawa
Mục tiêu

Đánh giá giá trị của hệ thống điểm Prostate Imaging Reporting and Data System (PI-RADS) cho khảo sát hình ảnh cộng hưởng từ đa thông số (mpMRI) tuyến tiền liệt nhằm phát hiện ung thư tuyến tiền liệt, và các thông số cổ điển như mức độ kháng nguyên tuyến tiền liệt đặc hiệu (PSA), thể tích tuyến tiền liệt và mật độ PSA, để dự đoán kết quả sinh thiết ở bệnh nhân nghi ngờ ung thư tuyến tiền liệt chưa từng sinh thiết.

Bệnh nhân và phương pháp

Phân tích hồi cứu các bệnh nhân thực hiện mpMRI tại bệnh viện chúng tôi và sinh thiết tuyến tiền liệt lần đầu từ tháng 7/2010 đến tháng 4/2014. Sinh thiết tuyến tiền liệt được thực hiện qua ngã tầng sinh môn dưới hướng dẫn siêu âm qua trực tràng. Tổng cộng, 14 mẫu sinh thiết được lấy một cách hệ thống ở tất cả các bệnh nhân. Thêm hai mẫu sinh thiết mục tiêu bằng cách hợp nhất nhận thức được thêm vào mỗi tổn thương ở bệnh nhân có tổn thương nghi ngờ hoặc không rõ ràng trên mpMRI. Sử dụng hệ thống điểm PI-RADS phiên bản 2.0 để mô tả các phát hiện trên MRI. Phân tích đơn biến và đa biến được thực hiện để xác định các yếu tố dự đoán có ý nghĩa của ung thư tuyến tiền liệt và ung thư tuyến tiền liệt lâm sàng có ý nghĩa.

Kết quả

Tổng cộng, 288 bệnh nhân được phân tích. Tuổi trung vị của bệnh nhân, mức độ PSA, thể tích tuyến tiền liệt và mật độ PSA lần lượt là 69 tuổi, 7,5 ng/mL, 28,7 mL, và 0,26 ng/mL/mL. Kết quả sinh thiết cho thấy các dạng lành tính, ung thư không quan trọng về mặt lâm sàng, và ung thư quan trọng về mặt lâm sàng tương ứng với 129 (45%), 18 (6%) và 141 (49%) bệnh nhân. Phân tích đa biến cho thấy điểm số PI-RADS v2 và mật độ PSA là những yếu tố dự đoán độc lập cho ung thư tuyến tiền liệt và ung thư tuyến tiền liệt có ý nghĩa lâm sàng. Khi kết hợp điểm số PI-RADS v2 và mật độ PSA, điểm số PI-RADS v2 từ 4 trở lên và mật độ PSA từ 0.15 ng/mL/mL hoặc điểm số PI-RADS v2 là 3 và mật độ PSA từ 0.30 ng/mL/mL liên quan đến tỷ lệ phát hiện ung thư tuyến tiền liệt có ý nghĩa lâm sàng cao nhất (76–97%) trong lần sinh thiết đầu tiên. Trong nhóm bệnh nhân này có kết quả sinh thiết âm tính, 22% sau đó được chẩn đoán là ung thư tuyến tiền liệt. Ngược lại, điểm số PI-RADS v2 từ 3 trở xuống và mật độ PSA dưới 0.15 ng/mL/mL cho kết quả không có ung thư tuyến tiền liệt có ý nghĩa lâm sàng và không có thêm phát hiện ung thư tuyến tiền liệt trong các sinh thiết tiếp theo.

Kết luận

Sự kết hợp của điểm số PI-RADS v2 và mật độ PSA có thể giúp trong quá trình ra quyết định trước sinh thiết tuyến tiền liệt và trong chiến lược theo dõi ở bệnh nhân chưa từng sinh thiết. Bệnh nhân có điểm số PI-RADS v2 từ 3 trở xuống và mật độ PSA dưới 0.15 ng/mL/mL có thể tránh các sinh thiết không cần thiết.

#PI-RADS #PSA density #prostate cancer #biopsy #MRI #predictive model
Role of emergency ureteroscopy in the management of ureteric stones: analysis of 394 cases
BJU International - Tập 115 Số 6 - Trang 946-950 - 2015
Kamran Zargar‐Shoshtari, William B. Anderson, Michael Rice
Objective

To analyse the outcomes of emergency ureteroscopy (URS) cases performed in Auckland City Hospital.

Methods

We conducted a retrospective review of all emergency URS procedures performed at Auckland City Hospital between 1 January 2010 and 31 December 2011. Data on patients, stones and procedures were collected and analysed. Emergency URS failure was defined as fragments >3 mm or the need for a repeat procedure.

Results

A total of 499 URS procedures were identified. Of these 394 (79%) were emergency procedures. The mean (sd; range) patient age was 48 (16; 13–88) years. In all, 83% of emergency URS cases had an American Society of Anesthesiologists (ASA) score of 1 or 2, 25% of stones were >9 mm, with a mean (sd) size of 8 (4) mm, and 285 procedures (72%) were successful. These patients were younger (47 vs 51 years), were more likely to have an ASA score of 1 (103 patients in the successful treatment group vs 26 in the failed treatment group), had smaller stones (7 vs 9 mm) and were more likely to have distal stones (P < 0.05). A total of 20 complications (5%) were recorded including six false passages and three mucosal injuries, one of which required radiological intervention, and 50 patients (13%) re‐presented, for pain (76%), bleeding (10%) or infection (14%).

Conclusion

We showed that emergency URS is a feasible approach for the routine management of acute ureteric colic with a low complications rate. A subgroup of younger, healthier patients may benefit the most from the procedure.

The medical management of metastatic renal cell carcinoma: integrating new guidelines and recommendations
BJU International - Tập 103 Số 5 - Trang 572-577 - 2009
Joaquim Bellmunt, Marta Guix

There are now five targeted agents, i.e. sorafenib, sunitinib, temsirolimus, bevacizumab (in combination with interferon) and everolimus, that have been shown to improve the outcome in patients with metastatic clear cell renal cell carcinoma (mRCC), in randomized controlled trials (RCTs). Compared with the period when cytokines were the only systemic intervention known to have any activity, decisions on medical management are now complex. Clinicians must seek to adjust therapy to the circumstances of the individual patient, and consider the sequencing of agents. In this context, several expert groups have sought to provide treatment guidelines. As in other diseases, guidelines for mRCC seek to establish evidence‐based recommendations for best clinical practice and to encourage their widespread use. Data from phase III trials (level 1 evidence) are an essential element in this process, and guidelines need continual updating in the light of new findings. However, there are inevitably questions that large RCTs have not directly addressed. This is the case for major subgroups of the mRCC population, e.g. the elderly and those with comorbidities. In these circumstances, less well‐controlled sources of data, and clinical experience, have a role to play. Certain guidelines (although not all) acknowledge the contribution that such sources of evidence can make.

KINETICS OF URINARY TRACT INFECTION
BJU International - Tập 38 Số 2 - Trang 156-162 - 1966
F. O’Grady, W. R. Cattell
The prevalence of varicocele and varicocele‐related testicular atrophy in Turkish children and adolescents
BJU International - Tập 86 Số 4 - Trang 490-493 - 2000
Erdem Akbay, S. Çayan, E. Doruk, Meltem Nass Duce, Murat Bozlu

Objective To determine the prevalence and site of varicocele and varicocele‐related testicular atrophy in children and adolescents.

Patients and methods The study included 4052 boys aged of 2–19 years, divided into four age groups; the findings of a physical examination, any testicular atrophy and testicular volume were recorded.

Results Varicocele was detected in 293 (7.2%) of the 4052 boys; the prevalence was 0.79% in those aged 2–6 years, 0.96% at 7–10 years, 7.8% at 11–14 years and 14.1% at 15–19 years. The prevalence was 0.92% in 1232 children aged 2–10 years and 11.0% in 2531 adolescents aged 11–19 years (P < 0.001). The prevalence increased significantly at age 13 years (P < 0.005). The varicocele was unilateral in 263 of the 293 (89.7%) boys with varicocele; of these, one (0.38%) was on the right and the others on the left side. Varicoceles were bilateral in 30 of 279 boys (10.8%) aged 11–19 years but none were detected in those aged < 11 years. Varicocele‐related testicular atrophy was not present in those aged < 11 years, but seven boys (7.3%) aged 11–14 years and 17 (9.3%) aged 15–19 years had testicular atrophy. The difference in prevalence between the last two age groups with atrophy was not significant.

Conclusion These findings support the view that varicocele is a progressive disease and that the prevalence of varicocele and testicular atrophy increases with the puberty.

Bipolar plasma enucleation of the prostate vs open prostatectomy in large benign prostatic hyperplasia cases - a medium term, prospective, randomized comparison
BJU International - Tập 111 Số 5
Correlation of intravesical prostatic protrusion with bladder outlet obstruction
BJU International - Tập 91 Số 4 - Trang 371-374 - 2003
S.J. Chia, Chin Tiong Heng, S P Chan, Keong Tatt Foo
OBJECTIVES

To determine the effect of intravesical protrusion of the prostate (IPP, graded I to III) on lower urinary tract function, by correlating it with the results of a pressure‐flow study.

PATIENTS AND METHODS

In a prospective study men (aged> 50 years) with lower urinary tract symptoms were initially evaluated as recommended by the International Consultation on Benign Prostatic Hyperplasia, together with the IPP and prostate volume, as measured by transabdominal ultrasonography. These variables were then correlated with the results from a pressure‐flow study.

RESULTS

The IPP was a statistically significant predictor (P < 0.001) of bladder outlet obstruction (BOO) compared with other variables in the initial evaluation. In all, 125 patients had significant BOO, defined as a BOO index of> 40. Of these men, 94 had grade III and 30 had grade I–II IPP. Seventy‐five patients had a BOO index of < 40; 69 had grade I–II and six grade III IPP. In patients with BOO confirmed on the pressure‐flow study, grade III IPP was associated with a higher BOO index than was grade I–II (P < 0.001).

CONCLUSION

The IPP assessed by transabdominal ultrasonography is a better and more reliable predictor of BOO than the other variables assessed.

THE NUTRITIONAL SIGNIFICANCE OF PRIMARY BLADDER STONES1
BJU International - Tập 34 Số 2 - Trang 160-177 - 1962
Daniel Andersen
MRI and its role in the evaluation and surgical decision making in patients with challenging IPP presentations: descriptions of MRI findings and algorithm for patient management
BJU International - Tập 109 Số 12 - Trang 1848-1852 - 2012
Eleanor McPhail, Ajay Nehra, Bryan Bruner, Akira Kawashima, Bernard F. King, Bohyun Kim

Study Type – Diagnostic (case series)

Level of Evidence 4

What's known on the subject? and What does the study add?

It is known that magnetic resonance imaging (MRI) is safe and effective for imaging patients with inflatable penile prostheses (IPPs). Previous series have reported results of MRI for imaging series of patients with IPPs. The impact on management in particular with regard to salvage procedures is not well defined.

This study represents the largest known experience with MRI evaluation of IPPs. This also provides an algorithm that assists with decisions regarding utilization of MRI and treatment planning based on results.

OBJECTIVE

In some patients who undergo placement of an inflatable penile prosthesis (IPP) the device may function inadequately. We describe the use of magnetic resonance imaging (MRI) for anatomical localization and detection of prosthesis malrotation, angulation, displacement and erosion in IPPs with equivocal clinical examination.

PATIENTS AND METHODS

We prospectively performed MRI by a defined protocol including T1‐weighted imaging, and transaxial, sagittal and coronal fat‐saturated fast spin‐echo T2‐weighted imaging in both deflated and inflated states to evaluate patients seen at our referral centre for IPP‐related complaints.

We retrospectively reviewed 32 such MRI studies performed as a supplement to clinical examination between 2000 and 2008.

RESULTS

Of 32 cases, 75% (24/32) underwent surgical intervention. Of these, 45% (11/24) underwent device salvage procedures including cylinder revision in 33% (8/24), cylinder replacement in 8% (2/24) and pump replacement in 4% (1/24).

MRI was most useful for determination of surgical approach in those with abnormal physical examination, and for justification of either surgical or expectant management in those with indeterminate physical examination.

CONCLUSIONS

MRI is safe and effective for imaging genitourinary prostheses.

We found MRI to be a valuable adjunct for evaluation of IPP‐related complaints when clinical examination is equivocal as it detected a variety of prosthetic and corporal abnormalities and impacted management decisions regarding observation, replacement or device salvage procedures.

We provide technique, results and an algorithm that can be beneficial in this complex subset of patients.

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