Until then we have some old reports here:
1. Andrology
2. Endourology
3. Reconstruction
4. Calculus Disease
5. Incontinance
6. Oncology
7. Oncology Prostate
8. Prostate BPH
9. Equipment
10. Special Interest
Equipment |
| MONTH PUBLISHED | June - 2001 |
Journal: Journal of Urology Authors: Ono Y, Kinukawa T, Hattori R, Gotoh M, Kamihira O and Ohshima S. Issue: 2001, 165: 1867-1870
Title: The long-term outcome of laparoscopic radical nephrectomy for small renal cell carcinoma..
Abstract: The usual caveat applies to this study - it is not a prospective randomised study, but a comparison of the results of 103 patients undergoing laparoscopic radical nephrectomy with those of 46 patients undergoing open surgery for tumours of the same size in the same period. All patients had tumours less than 5cms in diameter and there were no significant differences in patient characteristics. In 99 of the 103 laparoscopic procedures the kidney was successfully removed, with emergency laparotomy required in the remaining 4 cases for uncontrollable bleeding. Mean operating time was 4.7 hours (3.3 hours for open cases), and mean blood loss was 254mls (465mls open). There were 10 (10%) intra-operative complications in the laparoscopic group, including 1 duodenal and 1 colonic injury. This compared to 2 (4%) intra-operative complications in the open surgery patients. The mean time to resumption of normal activity was 23 days (laparoscopic) versus 57 (open). 102 of the laparoscopic patients were followed up (median follow up 29 months). 100 survived without recurrence, with 2 having died without recurrence at months 45 and 34. 3 patients had developed metastases, and local recurrence had occurred in 1. 41 of the 44 open surgery patients survived without recurrence, whilst 3 patients had developed metastatic disease (2 deaths). 5 year disease-free survival rates showed no statistically significant difference (95.1% laparoscopic, 89.7% open) and overall patient survival rates were almost identical (95% and 95.6% respectively). Importantly, seeding of the port sites did not occur in any of the patients undergoing laparoscopic surgery. Within the limitations of this study, these results support the continuing interest in laparoscopic surgery for these small renal tumours.
Reviewer: Jonathan Rees
| MONTH PUBLISHED | April - 2001 |
Journal: Journal of Urology Authors: Guilloneau B, Cappele O, Martinez J, Navarra and Vallancien G Issue: 2001, 165:1078-81
Title: Robotic assisted, laparoscopic pelvic lymph node dissection in humans.
Abstract: Robotics is an exciting possibility in surgery. Although it conjures scepticism and apprehension in many, it is inevitable that it will be introduced in some form into surgical practice. This paper explores the use of a remote surgeon (3m from patient) operating via robotic movement transduction in human laparoscopic pelvic lymph node dissection. The procedure was performed on 10 consecutive patients and compared to the previous 10 performed laparoscopically. The unscrubbed surgeon operated via two joysticks corresponding to the movement of the left and right operating instruments and a microphone to control displacement of the scope. There was a scrubbed assistant available to maintain the integrity and sterility of the operating field and instruments. The results showed an increased operating time in the robotic group and also an increased complication rate in the robotic group. Two patients in the robotic group developed post-operative lymphocoeles, one of these patients having developed a post-operative deep vein thrombosis. The only reported complication in the laparoscopic group was 1 case of post-operative urinary retention. This paper, if nothing else, does report the feasibility of robotic use in laparoscopy. Unfortunately robotics, as yet, cannot translate tactile feedback, an obvious drawback. The use of a robotic scope holder with voice activated pan and zoom, however, are an eminent possibility. Robotics in the future may improve operative dexterity and could allow surgeons to operate remotely.
Reviewer: Paul William Foster
Journal: Journal of Urology Authors: Riedl CR, Daniltchenko D, Koenig F, Simak R, Loening SA, Pflueger H. Issue: 2001, 165:1121-3
Title: Fluorescence endoscopy with 5-aminolevulinic acid reduces early recurrence rate in superficial bladder cancer
Abstract: Previous anecdotal evidence has demonstrated an approximate 20% higher detection rate in superficial transitional cell carcinoma (TCC) using 5-aminolevulinic acid (ALA) fluorescence endoscopy compared to standard white light cystoscopy. This was the first published prospective randomized study, with 102 patients from several centres undergoing transurethral resection of bladder tumour either with white light or ALA fluorescence endoscopy. A second look trans urethral resection with ALA fluorescence endoscopy was performed 6 weeks after the initial operation, with all patients having the former tumour site, as well as newly-diagnosed lesions, resected and sent for histological diagnoses. The controlled study found ALA fluorescence endoscopy to reduce residual tumour recurrence rate by 59%, and the group concluded "ALA fluorescence endoscopy is an innocuous and inexpensive diagnostic procedure that significantly improves bladder tumour detection rates compared to white light endoscopy".
Reviewer: Justin Collins
Journal: Journal of Urology Authors: Riedl CR, Daniltchenko D, Koenig F, Simak R, Loening SA and Pflueger H. Issue: 2001l, 165: 1121-1123.
Title: Fluorescence endoscopy with 5-aminolevulinic acid reduces early recurrence rates in superficial bladder cancer.
Abstract: Aminolevulinic acid (ALA) assisted fluorescence endoscopy is reported to increase tumour detection rates by up to 25% when compared to conventional cystoscopy. This 2 centre randomised control study compared early recurrence rates when these two methods were employed. Patients were randomized to undergo transurethral resection with either conventional white light or ALA fluorescence assisted cystoscopy. ALA instillation was performed 1-4 hrs prior to resection. All abnormal or suspicious areas of urothelium were resected. Patients with >T1 disease on initial histology were excluded from further participation in the study and underwent cystectomy. All other patients had ALA assisted cystoscopy at 6 weeks. Previous sites of resection were re-biopsied and new lesions removed. 102 patients completed the trial with equal numbers in each group. No significant differences in tumour characteristics were noted between the two arms of the study. Total percentage recurrence rates of 27.4% were reported. The rate of recurrence was significantly lower in the ALA group (16%) compared to the conventional cystoscopy group (39%). There were no reported adverse events. Costs were quoted at $20,000 for equipment and $60 per instillation. It was concluded that ALA assisted endoscopy significantly improved tumour detection and subsequently reduced early recurrence rates.
Reviewer: David Scholfield
| MONTH PUBLISHED | March - 2001 |
Journal: BJU International Authors: J. Binder and W. Kramer Issue: 2001, 87:408-10
Title: Robotically-assisted laparoscopic radical prostatectomy
Abstract: Schuessler et al. first described laparoscopic radical prostatectomy in 1992 and the technique has since been adopted and refined by various other European centres. It remains one of the most technically demanding laparoscopic procedures in view of the difficulty of surgical access and the need for precise intracorporeal suturing. The authors evaluated a telerobotic surgical system (the da Vinci Surgical System) to assess its ability to facilitate the specific laparoscopic procedures required for radical prostatectomy. The system was initially developed in 1999 and rapidly taken up by cardiac surgeons where it was reported to improve both endoscopic vision and anastamotic techniques. For radical prostatectomy, patients are placed supine with their legs on spreader bars to accommodate placement of the robotic cart. The robot has three working arms – a median arm supporting a 30o 3-D endocamera and two lateral arms with Endo-wrist™ articulations allowing for wrist-like movements of instruments. The camera is inserted sub-umbilically whilst the instrument ports are inserted para-rectally. The authors placed two further working ports medial to the iliac crests for the placement of conventional laparoscopic instruments. During the procedure, the operating urologist sat at a remote console and controlled the three robotic arms. A scrub nurse and assistant remained at the operating table and assisted using the two conventional ports for access. The procedure was performed in 9 out of 10 patients and lasted a median of 9 (8.75 – 11) hours. Conversion occurred because of bleeding and this patient was the only individual requiring blood transfusion. Resection margins were positive in 3 patients (one with pT3b tumour and two with pT3a tumour). At discharge, all but one patient complained of mild to moderate stress incontinence. The authors concluded that the benefits of the robotic system included improved endoscopic visualization, facilitated use of laparoscopic tools by the Endo-wrist™ articulation and relaxed working position at the console. Limitations included the expense of the system and the limited availability of instruments. The authors do not comment on other parameters such as depth of field assessment, sensory feedback, system failures or patient outcomes following prolonged general anaesthesia. However, technological advances continue to facilitate and increase the range of procedures that can be usefully performed laparoscopically and the further development of telerobotic systems is awaited with great interest.
Reviewer: John McGrath
Journal: Urology Authors: Fraundorfer MR, Gilling PJ, Kennett KM and Dunton NG. Issue: 2001, 57: 454-8
Title: Holmium laser resection of the prostate is more cost effective than transurethral resection of the prostate: results of a randomized prospective study.
Abstract: 120 patients with BPH and bladder outflow obstruction proven by urodynamics were randomised to either holmium laser prostatectomy (61) or transurethral resection (TURP) (59). Outcomes relating to their in-patient care were compared. Resection time was 41 minutes for laser prostatectomy, and 25 minutes for TURP. Catheter duratrion was 20 hours for laser prostatectomy and 37 hours for TURP. Average hospital stay was 26 hours for laser prostatectomy, and 47 hours for TURP. No blood transfusions were required following laser prostatectomy, but 4 blood transfusions were given following TURP. After 1 year follow-up, TURPs were complicated by 1 episode of clot retention, 1 DVT, 3 patients who required bladder-neck incision, and 2 patients requiring re-operation. Holmium laser prostatectomies were complicated by 2 episodes of retention, and 1 patient required bladder-neck incision. The TURPs appeared to be attended by a greater number of complications than the laser prostatectomies, although the overall numbers were small, and the follow-up time relatively short. The authors calculated the total cost of the two procedures, and concluded that the cost of laser prostatectomy, in the first year, was 25% less than TURP, and may therefore prove more cost-effective, although operating time was significantly prolonged.
Reviewer: Richard Parkinson
| MONTH PUBLISHED | February - 2001 |
Journal: Journal of Urology Authors: Moody J, Lingeman J Issue: 2001, 165:459-62
Title: Holmium laser enucleation for prostate adenoma greater than 100gm.: comparison to open prostatectomy
Abstract: This paper attempts to compare holmium laser prostate enucleation with open prostatectomy in a small number of patiebts in a single institution with very large prostates. It is a retrospective unrandomised analysis of ten patients in each group with comparison of a number of patient, operative and post-operative parameters. To a large extent the paper confirms the safety of holmium laser enucleation in these patients although a significant number of short-term complications were seen. Unfortunately the work is entirely retrospective and does not address the main question about such novel BPH treatment technologies. It seems unlikely that any institution could justify the expense of such a system for the small number of patients with very large prostates, therefore the real issue is how holmium laser enucleation compares with standard TURP for the bulk of BPH patients. Hopefully the authors of this paper are in the process of conducting a prospective randomised controlled trial to confirm the potential of the holmium laser.
Reviewer: Kieran Jefferson
Journal: Journal of Urology Authors: Moody JA and Lingeman JE. Issue: 2001, 165: 459-62
Title: Holmium laser enucleation for prostate adenoma greater than 100g: comparison to open prostatectomy.
Abstract: The use of the holmium laser for prostatectomy was compared to open prostatectomy for adenomas of over 100g in this study of 20 patients. 10 patients undergoing each procedure were analysed retrospectively. The operation time was similar for each technique: 173 minutes for the open procedure vs 197 minutes for laser prostatectomy. The haemoglobin level dropped by 2.9g/dl in patients undergoing the open procedure and 4 patients required blood transfusion. The haemoglobin level did not fall in the laser group. Open prostatectomy was also associated with a longer hospital stay (6 days vs 2 days), and prolonged catheterisation (exact times not given). Laser prostatectomy was complicated by stress incontinence in 4 patients, although this was reported to be self-limiting, and settled within 3 months in all cases. There was also 1 case of prostate perforation, and 1 patient required intermittent self-catheterisation for neurogenic bladder dysfunction. Open prostatectomy was complicated by 1 case of stress incontinence lasting for 18 months and requiring 3 pads per day. There was also 1 case of urge incontinence at 20 months follow-up, and two patients had bladder-neck contractures. The authors suggest that holmium laser prostatectomy is a safe and feasible procedure, and may be associated with favourable post-operative outcomes. Although stress incontinence following laser prostatectomy was self-limiting and relatively short-lived, more information about its severity would help to define the importance of what is a common (40%) post-operative problem.
Reviewer: Richard Parkinson
| MONTH PUBLISHED | September - 2000 |
Journal: Journal of Urology Authors: Venn SN, Greenwell TJ and Mundy AR Issue: 2000, 164: 702-707
Title: The long-term outcome of artificial urinary sphincters.
Abstract: This is one of few large reviews of the long-term durability of artificial urinary sphincters, and comes from a well-known centre of excellence. The records of 100 patients (70 males and 30 females of all ages) were analysed in whom a sphincter had originally been inserted longer than ten years ago. After a median follow-up period of 11 years (range 2-15) 84 patients were found to be continent, however only 26 were completely dry and also had the original device in-situ; 6 others had the original device and needed one pad a day. At 10 years, the original device survival rate overall was 66% if cases erosion and infection were excluded (compared to 90% at 5 years) and was significantly better in males than females. Twenty-seven individuals required replacement due to mechanical failure after a median of 7 years (range 3-12). Twenty-three cases required removal due to infection all within 2 years, whilst 14 suffered terminal erosion anytime up to 10 years post-op. Females who had received pelvic radiotherapy did worst. Overall risk of revision surgery was 54% excluding late cuff replacement. Thus the quoted 10 year continence rate of 84% needs to be qualified as it includes individuals in whom the sphincter has been revised or replaced, individuals who have not been followed up at a minimum of 10 years and others who are continent but in whom the sphincter has been shown to be inactive or, indeed, has been totally explanted. However, this is a key paper on the subject and includes important discussions of the development, both past, present and future, of the authors' experiences.
Reviewer: Danny Painter
Journal: Journal of Urology Authors: Borboroglu PG and Kane CJ Issue: 2000, 164: 648-649
Title: Current management of severely encrusted ureteral stents with a large associated stone burden.
Abstract: Whilst it only considers a small series of patients, this paper highlights a problem that could potentially become more common as ureteric stents find a place in the management of a wider variety of conditions. Four patients, including three pregnant women, experienced a total of six episodes of extreme stent encrustation (stone burden ranging from 402 to 2300mm2) following a mean indwelling time of seven months. In two cases, struvite was a component of the encrustate. All patients were eventually rendered stent-free and stone-free following a combination of ESWL, cytolitholopaxy, retrograde ureteroscopy, percutaneous nephrolithotomy and antegrade ureteroscopy using the full range of intracorporeal lithotripsy modalities. Apart from a prior single session of ESWL all cases were completed during a single general anaesthetic although operation times are not stated, which may be relevant in the pregnant population. The editorial comment also mentions the potential place for laparoscopy or open surgery in such difficult cases.
Reviewer: Danny Painter
| MONTH PUBLISHED | July - 2000 |
Journal: Journal of Urology Authors: Delvecchio FC, Kuo RL and Preminger GM Issue: 2000, 164: 40-42
Title: Clinical Efficacy of combined Lithoclast and Lithovac stone removal during ureteroscopy.
Abstract: Lithoclast pneumatic lithotripsy is attractive in view of its safety (to patients and instruments), efficacy and cost effectiveness. However, it does suffer from some drawbacks, notably proximal migration of fragments and lack of efficient fragment retrieval. This paper assesses the ability of a new suction device, Lithovac, to overcome these problems. The combined Lithoclast/Lithovac procedure was utilised in 21 patients with mainly single, distal ureteric calculi. In order to accommodate both instruments it was necessary to use an 8.5Fr semi-rigid ureteroscope with a resultant 33% ureteral orifice balloon dilatation rate. There were no intra-operative complications. All patients were stented post-operatively. At 3 months, 20 of 21 patients (95.2%) had complete stone clearance as assessed by IVU - in one patient a 2 x 2mm fragment was seen in a lower pole calyx presumably as a result of proximal migration during the procedure. The Lithovac device reduces proximal stone fragment migration and improves fragment retrieval and field of vision during the procedure. It therefore may well significantly increase the relative merits of pneumatic lithotripsy when compared to other modalities.
Reviewer: Danny Painter
| MONTH PUBLISHED | June - 2000 |
Journal: BJU International Authors: Thompson A, Pearce I, Robinson E, Ladds TJ and Payne SR Issue: 2000, 85: 1019-1022
Title: Bacterial safety and cost-effectiveness of a non-refluxing valve in the irrigation system during outpatient flexible cystoscopy.
Abstract: It has recently been conclusively shown that there is a risk of retrograde reflux of irrigant up the giving set during outpatient flexible cystoscopy (Molina-Navarro et al. BJU Int. 2000 83: 948-56). This has led to the regimented use of one irrigation ‘set-up’ (saline bag plus giving set) per patient with a resultant increase in costs per procedure. The present study assesses the efficacy of a non-refluxing valve, Setguard - Mediplus Ltd., inserted between giving set and cystoscope, in maintaining minimal infection rates whilst allowing a single irrigation kit to be used for a whole list. Patients were prospectively allocated to either use a communal 3L saline bag and giving set with an individual Setguard, or to use an individual 1L saline bag and giving set (control). Procedural methodology and exclusion criteria are well described. Infection was defined as pure growth of >105 organisms with >10 pus cells per hpf. Notably 5 patients were included in the study in whom there was significant growth of organisms but no pyuria - this area would benefit from greater detail. Patients produced an MSU immediately prior and 3-4 days following the procedure. One patient out of 60 in the Setguard group developed a UTI following the procedure (1.7%) compared with 3 patients out of 64 in the control group (4.7%). Obviously with only a single UTI there was no evidence of failure of the reflux control valve. In a simple cost analysis, mean cost per procedure was £3.76 in the control group compared to £1.39 in the Setguard group. This study shows that use of Setguard with communal irrigation facilities does not increase bacterial infection rates in this unit. There are, however, a number of points to make. Firstly, Molina-Navarro et al. (2000) showed that reflux only occurs in men and is only of significant volume in about 10% of those. The current study fails to state a sex distribution. Also, the cost analysis assesses the cost of 1L of saline per patient, which may be felt to be excessive in some centres. Finally, the main idea behind Setguard is to prevent reflux into the giving set to prevent cross infection, both bacterial and perhaps more importantly viral. A description of simple UTI rates from an outpatient clinic does not completely address this question. Can the authors tell their patients that there is no chance of viral cross-infection with this product? It is likely that a significant amount of in-vitro work has been done with this device to satisfy the MDA and it would have been of benefit to include this work in this clinical paper.
Reviewer: Danny Painter
Journal: BJU International Authors: Thompson A, Pearce I, Robinson E, Ladds TJ and Payne SR Issue: 2001, 85: 1019-1022
Title: Bacteriological safety and cost-effectiveness of a non-refluxing calve in the irrigation system during outpatient flexible cystoscopy.
Abstract: The standard practice during a flexible cystoscopy list, to avoid the theoretical risk of contamination caused by reflux during the procedure, is to change the bag of irrigation fluid and ‘giving set’ between patients. A prospective randomised clinical trial was performed to determine the safety and cost-effectiveness of a non-refluxing valve in the irrigation system during flexible cystoscopy, allowing the use of a single bag of fluid per list. 124 patients (60 in study group, 64 controls) of 220 attending for flexible cystoscopy in a four-month period fitted the study criteria. Half of the lists were randomised to use the anti-reflux valve so that consecutive patients would use the same method of irrigation, and an MSU sample was taken before the procedure and 3-4 days afterwards. There was no difference in the infection rate between the study and control groups (1.7 v 4.7% p=0.62). The one patient in the study group who developed a UTI had not followed an infected patient, and there were no infections in subsequent patients on that list. The cost analysis revealed a saving of 37% (£1.39) per procedure on cost of disposable equipment when using the valve. This saving depends on how many patients there are on a flexible cystoscopy list: the number of patients per list in the study varied between 5 and 13, but calculations revealed that the minimum number to produce a cost saving was four. This study suggests that use of a non-refluxing valve between the cystoscope and ‘giving set’ during flexible cystoscopy is safe and can lead to significant cost savings on disposable items as the bag of irrigation fluid and ‘giving set’ do not need to be changed between patients.
Reviewer: John Parkin
| MONTH PUBLISHED | April - 2000 |
Journal: BJU International Authors: Greenwell TJ, Woodhams S, Denton ER, MacKenzie A, Rankin SC and Popert R Issue: 2000, 85: 632-636
Title: One year’s clinical experience with unenhanced spiral CT for assessment of acute loin pain suggestive of renal colic.
Abstract: Whilst IVU is the best method of investigating acute renal colic at present, it does have some drawbacks in terms of sensitivity reaction and renal dysfunction secondary to contrast media, occasional imprecision of diagnosis and inability to provide information about areas outside the renal tract. Unenhanced spiral CT has been shown to have better specificity and sensitivity for diagnosing renal tract calculi. There is no contrast media involved and information can also be gained about other organs or areas of interest. 3D reconstruction is possible with no increase in radiation dose compared to standard CT images. This study comprises a review of a single year’s experience where all patients presenting with renal colic (except those thought to have obstructed infected systems) underwent spiral CT as first line investigation, either immediately or the following day if they presented out of hours. Overall, out of 116 studies, there were two false positives (confirmed by retrograde or IVU) and one false negative (confirmed by passage of stone). In 36 patients, spiral CT identified more stones within the urinary tract than plain KUB. In 3 patients, an alternative diagnosis was made which would not have been seen on IVU (although none of these were malignancies). The radiation dose of CT was 3 times that of a 3 film IVU. The cost is claimed to be the same as for IVU. This paper shows that spiral CT can be a useful method of investigating renal colic. The authors admit that its use as a first line investigation is probably not warranted in view of difficulty in diagnosing obstruction, delays in investigation and reporting and probably initial capital expenditure on hardware and software.
Reviewer: Danny Painter
| MONTH PUBLISHED | March - 2000 |
Journal: Journal of Urology Authors: Gajewski JB et al. Issue: 2000, 163: 773-776
Title: Removal of urolume endoprosthesis: experience of the North American study group for detrusor-sphincter dyssynergia application.
Abstract: This study is based on 160 patients who have undergone Urolume stent insertion for DSD in order to convert their bladder management regime from indwelling Foley catheter to condom drainage. This is the largest study of its type. Specifically this paper looks at the reasons that lead to stent removal and also the technique with which removal was accomplished. Previous reports of explantation of such prostheses have been limited in detail and have also noted the difficulty of the procedure due to epithelialisation. The methodology of device removal is well documented. Retrieval of devices was split into those removed during the insertion process (21 of 160 patients – 13%) and those removed at a later date (31 of 158 patients – 19.6%). The main reason for removal in both categories was migration, with infection the next most common. A mean of 22 months (range 4 days to 66 months) elapsed between insertion and removal. The stent was removed en bloc in 20 cases and piecemeal in 19. Serious temporary complications were experienced by only two patients following device removal (bleeding and urethral injury) neither of which lead to long-term problems. Urolume explantation can be accomplished safely with minimal complications if the technique described in this paper is followed. Overall rates of replacement correlate well with rates of sphincterotomy recurrence in previous series. Concerns about difficulty with device removal should not affect the decision to use Urolume stents.
Reviewer: Danny Painter
Journal: Urology Authors: MacDiarmid SA, Harrigan CT, Cottone JL, McIntyre WJ and Johnson DE Issue: 2000, 55: 408-413
Title: Assessment of a new transurethral balloon dilatation catheter in the treatment of urethral stricture disease.
Abstract: Urethral stricture disease is still a difficult problem to manage. While urethroplasty offers the best chance for cure it requires surgical expertise and a general anaesthetic. Internal urethrotomy and dilatation are less invasive but have significant recurrence rates. This paper is the first large study of a new balloon dilatation catheter (similar to the rationale in PUJ management) which is used in an office setting under local anaesthesia. A successful treatment was defined as dilatation to 20Ch gauge. Outcome was based on ASA symptom scores and flow rates. Follow up continued up to 12 months. Overall, 43 of 51 patients had a successful procedure. Mean length of follow-up was only 9 months but as most recurrences occur within 6 months this was felt to be acceptable. At 6 months, overall there remained a significant improvement in symptom score and flow rate although the actual pre-treatment data is not provided. Also, it is not specifically stated whether patients were allowed more than one treatment. Twenty-three (46%) of patients required re-treatment for stricture recurrence including all 6 individuals with strictures longer than 2cm. Traditional teaching tells us that internal urethrotomy is better than serial dilatation in terms of recurrence rates. However, the authors quote an interesting paper from South Africa showing this is not the case. Recurrence rates are high with this simple balloon dilatation technique but it is well tolerated, safe, perhaps cheaper and hypothetically less traumatic than filiform dilatation in view of the fact that the pressure is applied radially. The study suffers from lack of a comparative group. The major flaw is lack of any reference to CISC following treatment, which has been shown conclusively to reduce the incidence of symptomatic stricture recurrence.
Reviewer: Danny Painter
Journal: Urology Authors: Yamanishi T, Yasuda K, Sakakibara R, Hattori T and Suda S Issue: 2000, 55: 353-357
Title: Randomised, double blind study of electrical stimulation for urinary incontinence due to detrusor overactivity.
Abstract: ‘The mechanism of electrical stimulation for detrusor inhibition is the reflex inhibition of pelvic efferents or activation of hypogastric efferents through stimulation of the afferent input in the pudendal or sacral root.’ Electrical stimulation has previously been shown to improve urinary urge incontinence by 50-90%. This well designed study investigated the results of 4 weeks of twice daily 10Hz electrical stimulation or sham in men (anal or surface electrode) and women (vaginal electrode). Overall, 7 (21.9%) patients in the active group and 1 (3.6%) patient in the sham group were cured; 26 (81.3%) patients in the active group and 9 (32.1%) patients in the sham group were improved. There were statistically significant improvements in frequency, nocturia, QOL score, symptom scores and incontinence following treatment in the active group. There was a statistically significant difference between sham and active treatments for incontinence episodes and QOL score and trends of improvement in all other variables. Follow up for a mean of 8.9 months revealed that 7 of 17 (41%) patients in the active group remained continent while 10 had relapsed (although this was managed successfully in 6 of 10 (35%) patients by periodic retreatment). These results suggest that electrical stimulation can help in the treatment of detrusor overactivity and also that these effects may be prolonged.
Reviewer: Danny Painter
| MONTH PUBLISHED | February - 2000 |
Journal: Urology Authors: D'a Honey RJ, Luymes J, Weir MJ, Kodama R and Tariq N Issue: 2000, 55: 204-206
Title: Mechanical percussion inversion can result in relocation of lower pole stone fragments after ESWL.
Abstract: Lower pole renal calculi present a problem for the urologist no matter what modality of lithotripsy is being utilised. Residual stone load in the lower pole can be due to both failure of stone fragmentation and failure of clearance of any fragments produced. Infundibulo-pelvic angle, calyceal length and width and the dependent position of the calyx relative to gravity are all probably partially responsible. Although small residual fragments between 2 mm and 5mm (depending on the author) are often labelled ‘clinically insignificant’ their remaining presence can act as a nidus for further stone growth. This paper studies a novel method of mobilisation of residual lower pole stone fragments post-ESWL. Twelve patients with residual fragments 2 mm or less in diameter at least two weeks following ESWL were entered. All patients underwent mechanical percussion inversion (MPI) to the loin area for 10 minutes, preceded by 20 mg of frusemide. Plain X-rays were obtained immediately prior and following treatment. Eleven of 12 patients demonstrated movement of stone fragments out of the lower pole immediately after MPI and in 8 of these the lower pole was entirely cleared. Four patients had passage of stone fragments in the first voided urine following treatment, and 10 passed fragments during the following two weeks. Three patients developed ureteric colic, one of whom developed steinstrasse. Neither of the two individuals with documented infundibular stenosis passed fragments, although there was movement of fragments out of the lower pole in one. Overall, 5 of 12 patients were stone free following one treatment. This paper comprises a novel and seemingly successful method of management of a common problem facing the urologist. Further studies with a control arm are required to optimise the procedure.
Reviewer: Danny Painter
Journal: BJU International Authors: Subramonian K, McNaught J, Spencer N and Harrison SC Issue: 2000, 85: 224-226
Title: Is bowel preparation useful before radiography of the renal tract in patients with spinal cord injury?
Abstract: Overlying bowel contents can often obscure the areas of most interest on radiographs of the urinary tract. Bowel preparation may clear the intestines of residue but leave significant pockets of gas and so not produce dramatic improvements in visualisation. In view of their altered bowel functionality patients with spinal cord injury are prone to constipation and so may be more applicable for bowel preparation prior to KUB or IVU. Fifty six spinal cord injury patients underwent plain abdominal radiography with or without prior bowel preparation. One urologist and one radiologist assessed the X-rays under blinded conditions. Each film was divided into five regions of interest and scored 1-4 according to ease of visibility. Causes of low total score were documented. Overall, there was no significant difference between film visibility of prepared or unprepared patients. In poorly visible films in the prepared group gas shadows predominated over residue as the cause. In both groups the bladder was better visualised than other areas. In view of these results and taking into account the problems of laxative inefficiency or resultant diarrhoea in this group of patients, pre-radiographic bowel preparation cannot be recommended.
Reviewer: Danny Painter
| MONTH PUBLISHED | November - 1999 |
Journal: Journal of Urology Authors: Schwartz BF and Stoller ML Issue: 1999, 162: 1594-1598
Title: Complications of retrograde balloon cautery endopyelotomy
Abstract: Complications secondary to retrograde balloon cautery endopyelotomy have been reported to occur at rates of 13 to 34% and commonly include stent obstruction or migration, fever, ileus, infection, ureteral avulsion and haemorrhage requiring transfusion or embolization. This paper describes five uncommon complications seen in a retrospective series of 52 cases and describes techniques to avoid or overcome such problems. Accessory lower pole artery injury occurred in 3 patients, in 1 presenting 12 days post-op. One case of right ovarian vein laceration is reported (eventually leading to nephrectomy) as is one case of breakage of the cautery wire within the ureter. The authors suggest that, in view of such complications, retrograde balloon cautery endopyelotomy should not be performed in centres without immediate access to interventional radiological techniques. Further, they comment on the causes of device failure both manufacture related and operative and also the avoidance of repeated incisions and being too forceful during the procedure. The use of intraoperative endoluminal ultrasound to try to avoid vascular complications is mentioned.
Reviewer: Danny Painter
| MONTH PUBLISHED | September - 1999 |
Journal: Journal of Urology Authors: Jarrett TW, Pound CR and Kavoussi LR Issue: 1999, 162: 775-776
Title: Stone entrapment during percutaneous removal of infection stones from a continent diversion
Abstract: Infection associated calculi consisting of struvite and apatite are a relatively common complication of both the long-term catheterised bladder and the reconstructed bladder. In view of the fact that such stones are within such a cavernous environment, their manipulation, disintegration and complete removal can often be more difficult than with ureteric calculi. Coupled to this is the fact that failure to remove the entire stone load (which comprises vast numbers of urease positive organisms) will lead to an inevitable recurrence of the problem. This paper describes a technique combining flexible and rigid endoscopy of an Indiana pouch. Following identification of neo-vesical calculi by flexible cystoscopy down the stoma, a 10 mm laparoscopic trocar was passed into the pouch under ultrasound guidance. A specimen retrieval laparoscopic bag was deployed through the trocar and the stones captured. Standard fragmentation devices were then deployed via a nephroscope and finally the stone fragments were removed completely contained within the bag. The patient was stone free and continent at 8-month follow up.
Reviewer: Danny Painter
Journal: Journal of Urology Authors: Fahlenkamp D, Rassweiler J, Fornara P, Frede T and Loening SA. Issue: 1999, 162: 765-771
Title: Complications of laparoscopic procedures in urology: experience with 2407 procedures in 4 German centres
Abstract: This retrospective survey of the four German centres with greatest experience of laparoscopic urological procedures comprises the most comprehensive record so far of this rapidly advancing technique. 2407 cases are described consisting of an array of both minor and major operations. Overall, an early complication rate of 4.4% is reported which compares favourably with similar large gynaecological and upper GI series. Complications were more frequent as the procedure increased in difficulty (0.8% for cryptorchidism vs. 13.6% for adrenelectomy). Also, as greater experience with the technique was gained, complication rates were seen to fall four-fold (13.3% for the first 100 procedures vs. 3.6% subsequently). Vascular injury was seen most often (1.7% all of cases) followed by visceral and neural injuries (1.1%) some of which presented late, wound infection (0.8%) and associated trauma (0.6%). Most of the complications arose during dissection, with monopolar diathermy often the culprit. There was no major problem reported which could be directly attributed to use of the Veress needle. The authors should be congratulated for providing such a comprehensive review of the risks associated with laparoscopic urology. Further, they describe methods, including specific operative techniques and protocols together with in-depth well tried training programs which, if instituted, would reduce complication rates significantly. Their thoughts concerning where laparoscopy will fit into the armamentarium of urological surgeons of the next millenium, together with those of the commentator, are of benefit to both trainers and trainees.
Reviewer: Danny Painter
| MONTH PUBLISHED | August - 1999 |
Journal: BJU International Authors: Menezes P, Dickinson A and Timoney AG Issue: 1999, 84: 257-260
Title: Flexible ureterorenoscopy for the treatment of refractory upper tract urinary stones
Abstract: The authors review the use of a 9.3F instrument in the treatment of 55 upper tract stones in 37 patients which were not cleared by a variety of conventional techniques (ESWL, PCNL, rigid ureteroscopy). The only fragmentation device used was EHL. In three individuals, primary endoscopic cannulation of the ureteric orifice was found to be impossible and so a JJ stent was left in situ for 4 weeks with subsequent attempts at access being successful in all cases. Of 37 patients, 23 were stone free and 5 asymptomatic but with residual fragments of <5mm after one treatment (75% success rate). Unsurprisingly, success rates varied with the site of the stone – 14 of 15 patients with ureteric stones cleared compared with only 14 of 22 with renal stones. Interestingly, in this series lower calyceal stones were better treated than those in other areas of the kidney. Fourteen patients received JJ stents following the procedure and no late complications were noted. This study confirms the findings of larger series’ from America and suggests residual stones are often well treated by FURS. It does suffer from the rapid advances in technology within this field with 7.5F endoscopes, super flexible baskets and more effective fragmentation devices (e.g. Holmium laser) now being commonly available. The question of which modality of therapy should be employed in difficult lower calyceal stones has yet to be answered adequately.
Reviewer: Danny Painter
| MONTH PUBLISHED | July - 1999 |
Journal: Urology Authors: Djavan B, Seitz C, Ghawidel K, Basharkhah A, Bursa B, Hruby S and Marberger M Issue: 1999, 54: 18-22
Title: High energy transurethral microwave thermotherapy in patients with acute urinary retention due to benign prostatic hyperplasia
Abstract: The gold standard treatment for intractable urinary retention due to prostatic enlargement is TURP. While results are good with 90% of patients voiding spontaneously at 12 weeks, the procedure carries a moderate risk and is sometimes felt to be unsuitable for certain groups of patients. These individuals are often then faced with the prospect of long-term catheterisation and all its associated complications. HE-TUMT has previously been shown to be significantly more effective in the treatment of symptomatic BPE (in terms of IPSS, QOL score and Qmax) than either sham treatment or terazosin and the results endure for at least 3 years. This paper comprises the early results of a prospective non-comparative trial of HE-TUMT for acute retention secondary to BPE. Pre-procedure investigations included urodynamic evaluation 48 hours following initial catheterisation. Of 31 patients treated, 29 (94%) had regained the ability to void spontaneously at 4 weeks post procedure. At 12 weeks follow up, mean IPSS had improved from 18.9 to 9.4 and QOL assessment showed a similar change. Mean Qmax at 12 weeks was 10.3 ml/s and although no pre-retention data is given the Qmax gradually increased throughout the follow up period. Obviously longer term follow up on greater numbers of patients together with greater understanding of the natural history of acute retention and comparative trials are needed before firm conclusions can be drawn about the use of this modality. However, it may be that in the future HE-TUMT will provide an option for those patients unable or unwilling to undergo TURP.
Reviewer: Danny Painter
| MONTH PUBLISHED | June - 1999 |
Journal: British Journal of Urology Authors: Molina-Navarro C, Bhatia BS, Awogu O, Ochai J and Jones MA Issue: 1999, 83: 948-953
Title: The re-use of irrigating equipment for flexible cystoscopy is not safe
Abstract: This study elegantly demonstrates the risks associated with the re-use of irrigating equipment during flexible cystoscopy in males. In a small preliminary survey, the authors discovered this was routine practise in two-thirds of local departments and that this did not contravene current BAUS guidelines. A thermocouple sensor was incorporated into the irrigating equipment to detect reflux of irrigant. Sixty-five male and 29 female patients were included. Reflux was only demonstrated in males. Out of 65 patients, reflux was observed in 11 and was felt to be of significant volume (>2.25ml) in 6. The volume of irrigant used, duration of procedure and patient discomfort did not affect results. The implications of this work are obvious in terms of risks of transmission of blood-borne or urinary pathogens . The five-fold increase in costs resulting from a change of practise suggested by the authors is likely to be significantly less than future medico-legal claims against departments not heeding this advice.
Reviewer: Danny Painter
| MONTH PUBLISHED | May - 1999 |
Journal: British Journal of Urology Authors: Kulkarni RPand Bellamy EA Issue: 1999, 83: 755-759
Title: A new thermo-expandable shape-memory nickel-titanium alloy stent for the management of ureteric strictures
Abstract: Management of patients with ureteric strictures caused by extrinsic malignant compression or recurrent benign disease can be difficult. Usually long-term JJ stenting is employed and is associated with significant morbidity and with the need for repeated stent changes. The Memokath 051 is made of a nickel-titanium ‘shape memory’ alloy that takes up a pre-determined form on heating to 50oC and maintains this at body temperature. Insertion is performed under a general anaesthetic and the precise nature of the stricture is determined with a retrograde ureterogram. A guide-wire is passed through and the stricture dilated to 12Ch. The Memokath is inserted and it’s position optimised under fluoroscopic control. The authors report the use of this device at 22 sites of ureteric stricture in 15 patients, the majority of whom had malignant extrinsic compression. Problems were encountered during the first 3 patients due to stent migration. Using a wider stent in a further 12 individuals no complications were seen. Complete relief of ureteric obstruction was seen in all patients during mean follow up of 10.6 (2-21) months, as assessed on 3-monthly repeat IVU. Further, there was no associated morbidity in terms of discomfort, infection, encrustation or urothelial overgrowth. The Memokath 051 may well have an important role to play in this group of patients but longer follow-up and an analysis of cost are required.
Reviewer: Danny Painter
Journal: British Journal of Urology Authors: Pachler J and Frimodt-Moller C Issue: 1999, 83: 767-769
Title: A comparison of prelubricated hydrophilic and non-hydrophilic polyvinyl chloride catheters for urethral catheterisation
Abstract: This paper comprises a prospective crossover study comparing single use hydrophilic coated and re-useable self-lubricated non-hydrophilic PVC catheters for short term CISC. Assessments were made of patients’ subjective opinion of ease of use, preference and infection rates. Out of 45 patients, 11 did not complete the study. Overall, there was no statistical difference between the two catheters in terms of frequency or ease of use, discomfort and bacteruria. This study suggests that re-use of self lubricated catheters does not impinge on patient comfort or lead to higher complication rates. This has obvious significant financial implications and the authors suggest a four-fold decrease in cost under one protocol. A larger study with a more rigorous crossover design would help confirm these findings.
Reviewer: Danny Painter
| MONTH PUBLISHED | February - 1999 |
Journal: Urology Authors: Djavan B, Shariat S, Fakhari M, Ghawidel K, Seitz C, Partin A, Roehrborn C and Marberger M. Issue: 53(2): 251-259
Title: Neoadjuvant and adjuvant alpha-blockade improves early results of high-energy transurethral microwave thermotherapy for lower urinary tract symptoms of benign prostatic hyperplasia: a randomised, prospective clinical trial.
Abstract: Patients undergoing transurethral microwave thermotherapy therapy were randomised to receive either tamsulosin (0.4 mg) from a period 2 weeks prior to operation to 6 weeks after operation, or no additional therapy. There was no placebo. The authors report that at 2 weeks and 6 weeks post-op, the patients on alpha-blocker had a significantly lower International Prostate Symptom Score (IPSS) than those on no additional therapy by 12 weeks, however, no difference was evident. There was no difference in Qmax between groups. The authors conclude that adding an alpha-blocker leads to a greater early symptom reduction following transurethral microwave thermotherapy.
Reviewer: Jon Cartledge
| MONTH PUBLISHED | December - 1998 |
Journal: Journal of Urology Authors: Teichman JM, Champion PC, Wollin TA and Denstedt JD. Issue: 1998, 160: 2130-2132
Title: Holmium:YAG lithotripsy of uric acid calculi.
Abstract: Uric acid stones irradiated with holmium:YAG energy have been shown to produce cyanide. Concerned about the possibility of clinical cyanide toxicity when using the holmium:YAG laser to treat uric acid stones the authors present a retrospective series of 18 patients with uric acid stones treated with holmium:YAG laser. No patient had increased end tidal C02, ECG changes, or significant decrease in post-operative serum bicarbonate. No cyanide related neurological, cardiac or respiratory complications were noted.
Reviewer: Andrew Elves
| MONTH PUBLISHED | November - 1998 |
Journal: Journal of Urology Authors: Tawfiek ER, Liu J and Bagely DH. Issue: 1998, 160: 1643-1647
Title: Ureteroscopic treatment of ureteropelvic junction obstruction.
Abstract: The methodology of endopyelotomy continues to evolve. A potential problem with endopyelotomy is crossing vessels near the pelviureteric junction injury which may give rise to significant morbidity. In this small series, the authors present their experience with ureteroscopic endopyelotomy guided by endoluminal ultrasound. Prior to endopyelotomy endoluminal ultrasound was performed using catheters from 3.5-6.2 F containing an ultrasound transducer. Endoscopic incision was performed using either electrocautery or holmium-YAG laser and a stent placed at the end of the procedure. Five of the 37 patients based upon the sonographic findings were considered not to be candidates for the procedure. Crossing vessels were identified in 53% of patients and a septum denoting high insertion in 36%. In 16 patients, sonographic findings changed the location of the incision. While other series report bleeding requiring transfusion in up to 23% of cases, and distal ureteral stricture in 21% of cases, no patient in this series required transfusion or developed distal ureteral stricture. Success rate defined as pain-free with resolution of obstruction on diuretic renography was achieved in 87.5% over a mean follow-up of 10 months.
Reviewer: Andrew Elves
| MONTH PUBLISHED | October - 1998 |
Journal: Urology Authors: Klotz L and Herschorn S. Issue: 1998, 52 (4): 537-542
Title: Early experience with intra-operative cavernous nerve stimulation with penile tumescence monitoring to improve nerve sparing during radical prostatectomy.
Abstract: The authors report the application of cavernous nerve stimulation and monitoring for penile tumescence during radical prostatectomy in patients with T1c or T2a-c, Gleason <8 prostate cancer, PSA<15 ng/ml, and no pre-operative adjuvant treatment. Nerve stimulation was performed in 23 patients. If a tumescent response was noted the pedicle was dissected medial to the site of stimulation, therefore presumably preserving the cavernous complex. Pre-operatively, 19 patients had normal erectile function. Of these, 16 demonstrated a tumescent response intra-operatively. One year post-operatively, 5 of 16 had full erections, 11 of 16 had partial erections and 3 of 19 had no erections. The authors do not report an overall rate for erectile potency, but from the data presented 21% (5/23) had normal erections and 48% (11/23) partial erections. The authors conclude that this procedure can aid the surgeon in identifying the cavernous nerve at radical prostatectomy.
Reviewer: Jonathan Cartledge
Journal: Urology Authors: Gill IS, Novick AC, Soble JJ, Tak Sung G, Remer EM, Hale J and O’Malley CM. Issue: 1998, 52 (4): 543-551
Title: Laparoscopic renal cryoablation: initial clinical series.
Abstract: The authors report a series of 10 patients treated by renal cryoablation for renal lesions less than 4 cm diameter, peripheral, exophytic, enhancing on CT and away from the collecting system. Cryoablation is performed through retroperitoneal laparoscopic access and after complete renal mobilisation the 4.8 mm diameter probe inserted into the lesion under Doppler ultrasound guidance to produce a 2 cm or 4 cm ice ball. Average operative time was 2.4 hours with 9/10 patients discharged in 23 hours. The authors state that this technique is a feasible alternative to open partial nephrectomy in these patients but long term follow-up will be necessary.
Reviewer: Jonathan Cartledge
| MONTH PUBLISHED | July - 1998 |
Journal: Urology Authors: Campbell SC, Krishnamurthi V, Chow G, Hale J, Myles J and Novick AC. Issue: 1998, 52 (1): 29-34
Title: Renal cryosurgery: experimental evaluation of treatment parameters.
Abstract: The authors tested an animal model for treating solid renal lesions with intra-renal cryosurgery. Nephrectomy was performed in 10 dogs. In the remaining kidney a 3.4 mm cryoprobe was inserted 10 mm into the lower pole with a thermometer probe 10 mm away. The probe was chilled to -195oC until the recorded temperature fell to -40oC. Ultrasound examination measured an ice ball of 16mm diameter formed after 10 minutes of freezing. After 28 days the animals were sacrificed. Histological examination revealed chronic inflammation and necrosis with no visible renal parenchyma for a mean diameter of 18.9 mm. The authors suggest a future role of cryosurgical ablation via laparoscopy for the conservative management of small renal lesions.
Reviewer: Jonathan Cartledge
Journal: Urology Authors: Uchida T, Muramoto M, Kyunou H, Iwamura M, Egawa S and Koshiba K. Issue: 1998, 52 (1): 66-71
Title: Clinical outcome of high-intensity focused ultrasound for treating benign prostatic hyperplasia: preliminary report.
Abstract: Fifty-seven men with mild to moderate lower urinary tract symptoms were treated with High Intensity Focussed Ultrasound (HIFU) by a previously published regime, and a new HIFU2 protocol. HIFU2 uses a smaller trans-rectal probe with concurrent transverse monitoring and an automatic temperature cut out at 37oC. All patients had epidural anaesthesia and IV sedation, average treatment time was 55 minutes. At 12 months both HIFU and HIFU2 significantly improved IPSS and quality of life. Qmax and prostate volume only improved with HIFU2. The authors conclude that HIFU2 is effective technology at destroying prostate tissue, but more development is needed.
Reviewer: Jonathan Cartledge
Journal: British Journal of Urology Authors: Gill HS and Liao JC. Issue: 1998, 82: 8-11
Title: Pelvi-ureteric junction obstruction treated with Acucise retrograde endopyelotomy.
Abstract: We have a gold standard for the treatment of PUJ obstruction, the open dismembered pyeloplasty. Although endoscopic techniques appear attractive, they appear to have a success rate of about 60-70% at best, and little long-term follow up is available. This study reminds us that an endourological approach to the PUJ is attractive. We await a randomised controlled study with long term follow up.
Reviewer: Jonathan Glass
| MONTH PUBLISHED | January - 1998 |
Journal: Urology Authors: Roehrborn CG, Preminger G, Newhall P, Denstedt J, Razvi H, Chin LJ, Perlmutter A, Barzell W, Whitmore W, Fritzsh R, Sanders J, Sech S and Womack S. Issue: 1998, 51 (1): 19-27.
Title: Microwave thermotherapy for benign prostatic hyperplasia with the Dornier urowave: Results of a randomized, double blind, multicenter, sham-controlled trial.
Abstract: A total of 220 patients in 5 institutions with BPH were randomised to receive 90W transurethral microwave therapy, with monitoring of urethral and rectal temperature, or a sham treatment which involved catheterisation but no delivery of energy, under local anaesthetic. The authors do not report treatment time. Primary outcome measure was improvement in AUA score, secondary outcome measures flow rate, problem index, BPH impact index & QOL. At six months follow up they report improvement (p<0.05) in AUA score & flow rate for treatment over sham. Active treated patients experienced more frequency, dysuria and ejaculatory dysfunction. The authors conclude that microwave thermotherapy improves patients perceptions of symptoms more than the recorded improvement, and point out that longer follow up is required.
Reviewer: Mark Feneley
| MONTH PUBLISHED | December - 1997 |
Journal: British Journal of Urology Authors: Sabnis RB, Naik K, Patel SH, Desai MR, Bapat SD. Issue: 1997, 80: 853-857.
Title: Extracorporeal shock wave lithotripsy for lower calyceal stones: can clearance be predicted?
Abstract: PCNL is the treatment most likely to give stone clearance for most lower pole stones but ESWL is still used extensively in an attempt to avoid an invasive procedure. This simple and clear paper defines 3 parameters that will prerdict if stone clearance is likely to follow ESWL: pelvicalyceal angle, lower pole calyceal diameter and lower pole calyceal pattern.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: Schlick RW, Planz K. Issue: 1997, 80: 908-910.
Title: Potentiallly useful materials for biodegradable ureteric stents
Abstract: As the BJU editorial points out this paper could have been much improved with better experimental design but the concept remains very interesting. The idea is a plastic that dissolves when the pH of the solution bathing it changes. Thus by controlling urinary pH a stent can be kept in situ for a desired length and the dissolved.
Reviewer: Mark Feneley
| MONTH PUBLISHED | September - 1997 |
Journal: British Journal of Urology Authors: Eden CG, Sultana SR, Murray KHA, and Carruthers RK. Issue: 1997, 80 (3): 382-389.
Title: Extraperitoneal laparoscopic dismembered fibrin-glued pyeloplasty: medium term results.
Abstract: This is one of three articles on the subject of pyeloplasty in this months issue, including a review by the first author of this paper on minimally invasive approaches to relieving PUJ obstruction. Although the authors recognise there is a need for a randomised study comparing the technique they describe here with the more traditional open procedure, the method they describe is exciting as they have reduced operating time down to 180 minutes by reducing the number of sutures needed. With laparoscopic colposuspension becoming established, perhaps urologists will not be able to avoid the laparoscope after all!
Reviewer: Mark Feneley
| MONTH PUBLISHED | July - 1997 |
Journal: European Urology Authors: Hansen MV, Zdanowski A. Issue: 1997, 32: 34-38.
Title: The use of a simple home flow test as a quality indicator for male patients treated for lower urinary tract symptoms suggestive of bladder outlet obstruction.
Abstract: The home flow test was assessed in this study as an adjunct to the follow-up of patients with lower urinary tract symptoms (LUTS). Patients (172) treated with TURP or transurethral microwave therapy (TUMT) were included in this study. Patients were asked to produce perform uroflowmetry and home flow tests. The home flow tests agreed well with the maximum flow on uroflowmetry and to the subjective effect of therapy. This could usefully be included in assessment of patients.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: Ramon J, Lynch TH, Eardley I, Elkman P, Frick J, Jungwirth A, Pillai M, Wiklund P, Goldwasser B, Fitzpatrick JM. Issue: 1997, 80: 128-135.
Title: Transurethral needle ablation of the prostate for the treatment of benign prostatic hyperplasia: a collaborative multicentre study.
Abstract: A case series of 68 patients undergoing TUNA for BPH. Again, like many of the alternative treatments for BPH, TUNA appears to produce a satisfactory short-term symptomatic improvement with only a small change in the flow rate, which are shown also in sham studies. This makes the interpretation of the results unreliable.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: Mostafid AH, Harrison NW, Thomas PJ, Fletcher MS. Issue: 1997, 80: 116-122.
Title: A prospective randomized trial of interstitial radiofrequency versus transurethral resection for the treatment of benign prostatic hyperplasia.
Abstract: A good study using the P(det) Q(max), IPSS and QOL scores as outcome measures following IRFT and TURP. P(det) Q(max) fell significantly in both groups but half the IRFT treated group remained obstructed on the Abrams-Griffiths nomogram and the flow rates at 6 months were disappointing. Both had good symptomatic results but TURP always came out better. The results of long term follow-up are awaited.
Reviewer: Mark Feneley
| MONTH PUBLISHED | May - 1997 |
Journal: Journal of Urology Authors: Preminger GM, Clayman RV, Nakada SY, Babayan RK, Albala DM, Fuchs GJ and Smith AD. Issue: 1997, 157: 1625-1629.
Title: A multicenter clinical trial investigating the use of a fluoroscopically controlled cutting balloon catheter for the management of ureteral and ureteropelvic junction obstruction.
Abstract: The authors assess the efficacy of a fluoroscopically controlled cutting balloon in the treatment of 63 patients with ureteropelvic junction obstructions (n=66) and 45 patients with ureteral strictures (n=49). There appears to be no standard pre-operative investigation protocol, and outcome was assessed by either IVP and/or diuretic renogram at 2 weeks following removal of the stent. Successful incision of pelviureteric junction was achieved in 98% of patients undergoing endopyelotomy, and incision of the ureteral stricture was successful in 92% of patients undergoing endoureterotomy. The patency rate with a mean follow-up of 7.8 months was 77% for endopyelotomy; 72% of the primary and 100% of the secondary ureteropelvic obstructions remained patent. The patency rate among those patients undergoing endoureterotomy was 55% with a mean follow-up of 8.7 months.
Reviewer: Mark Feneley
| MONTH PUBLISHED | March - 1997 |
Journal: Journal of Urology Authors: Meretyk S, Gofrit ON, Gafni O, Pode D, Shapiro A, Verstandig A, Sasson T, Katz G and Landau EH. Issue: 1997, 157: 780-786.
Title: Complete staghorn calculi: random prospective comparison between extracorporeal shock wave lithotripsy monotherapy and combined with percutaneous nephrostolithotomy.
Abstract: This prospective randomised study compared ESWL monotherapy using a Dornier HM3 lithotriptor with combined percutaneous lithotripsy and ESWL for the treatment of 50 staghorn calculi. Stone-free rate at 6 months was significantly higher in those patients receiving combined PCNL and ESWL (74% verses 22%). Therefore the number needed to treat is 2 to increase the stone-free rate for 6 months. Interestingly, morbidity was significantly higher in the ESWL group particularly with respect to sepsis. Unplanned ancillary procedure rate was higher in the ESWL monotherapy group though there was no significant difference in the number of procedures performed with anaesthesia. The authors conclude that PCNL with ESWL should be the treatment of choice for most patients with staghorn calculi.
Reviewer: Mark Feneley
Journal: Cancer Authors: Wong WS, Chinn DO, Chinn M, Chinn J and Tom WL. Issue: 1997, 79: 963-974.
Title: Cryosurgery as a treatment for prostate carcinoma.
Abstract:
Reviewer: Mark Feneley
| MONTH PUBLISHED | February - 1997 |
Journal: British Journal of Urology Authors: Thomas KJ, Cornaby AJ, Hammadeh M, Philp T and Matthews PN. Issue: 1997, 79: 186-189.
Title: Transurethral vaporization of the prostate: a promising new technique.
Abstract: This was a pilot study assessing the efficacy and safety of transurethral vaporization of the prostate (TUVP) using a grooved roller electrode in 116 patients with symptomatic BPH. Assessment was by flow rate, residual volume and symptom score. The authors found the technique easy to master although glands greater than 60g were considered too large to vaporize. Mean symptom scores improved by 67% and mean peak flow increased from 8.5ml/s to 20.5ml/s. One advantage of TUVP is said to be a reduction in haemorrhage. No patients required blood transfusion. Another advantage is said to be a shorter hospital stay although only 57% of patients had their catheters removed within 24 hours. There were 11 UTI's and 15% developed retrograde ejaculation. None of the sexually-active patients developed post-operative erectile dysfunction. The authors rightly point out that a randomized trial of TUVP against TURP is required.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: Ahmed M, Bell T, Lawrence WT, Ward JP and Watson GM. Issue: 1997, 79: 181-185.
Title: Transurethral microwave thermotherapy (Prostatron version 2.5) compared with transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: a randomized, controlled, parallel study.
Abstract: This was a well-constructed, randomized trial of a high-energy protocol with transurethral microwave thermotherapy (TUMT) against TURP in 60 patients with moderate to severe bladder outflow obstruction who were unequivocally obstructed on the Abrams-Griffiths nomogram. Follow up was for 6 months so durability was not assessed. The AUA symptom score in the TUMT group did show a significant reduction (18.4 to 5.2). However, in contrast to TURP, the TUMT patients remained urodynamically obstructed after treatment. The most likely explanation for the improved symptom score after TUMT is a placebo response. The trial also showed that TUMT is not without significant complications: three patients needed an indwelling catheter for 10 days to 6 weeks and 4 of 18 sexually-active men suffered with retrograde ejaculation after TUMT.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: Mulligan ED, Lynch TH, Mulvin D, Greene D, Smith JM and Fitzpatrick JM. Issue: 1997, 79: 177-180.
Title: High-intensity focused ultrasound in the treatment of benign prostatic hyperplasia.
Abstract: This study also evaluated transrectal delivery of HIFU in thirteen patients. Two patients required TURP within 5 months because of no subjective symptomatic improvement and one other developed a urethral stricture. In the other patients the mean IPSS was reduced from 23 to 6 after 6 months and this appeared to be maintained at 2 years. The mean Qmax initially improved from 9.9 pre-treatment to 14.2ml/s at 6 months but by two years had reduced to 10.6ml/s. Although HIFU is at an early stage of clinical evaluation, neither of these studies demonstrate results which match the objective improvement after TURP and as with all of the new technology treatments of BPH, durability will need to be carefully assessed in long-term randomised trials.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: Sullivan LD, McLoughlin MG, Goldenberg LG, Gleave ME and Marich KW. Issue: 1997, 79: 172-176.
Title: Early experience with high-intensity focused ultrasound for the treatment of benign prostatic hyperplasia.
Abstract: This study, the first of two in this issue which look at high intensity focused ultrasound (HIFU) for BPH, used the transrectal Sonablate 200 probe in 25 patients with BPH. Patients with large prostates, middle lobes and many prostatic calculi were found to be unsuitable for this treatment. The best results were obtained when the bladder neck was treated. In these patients the mean AUA symptom score decreased from 20.25 to 9.5 and Qmax increased from 9.18 to 13.7. 10 patients required catheterisation for between 3 and 6 days. This new treatment modality is now reaching the stage of development at which a randomised trial against TURP may be justified.
Reviewer: Mark Feneley
| MONTH PUBLISHED | January - 1997 |
Journal: Journal of Urology Authors: Petas A, Talja M, Tammela T, Taari K, Lehtoranta K, Valimaa T and Tormala P. Issue: 1997, 157: 173-176.
Title: A randomized study to compare biodegradable self-reinforced polyglycolic acid spiral stents to suprapubic and indwelling catheters after visual laser ablation of the prostate.
Abstract: In this small randomised study a self-reinforced polyglycolic acid spiral stent is compared to suprapubic catheters and indwelling catheters following neodynium: YAG laser ablation of the prostate. Of the 27 patients receiving the spiral stent, 20 voided freely on day 1 or 2 post-operatively, compared to 8 of 23 with suprapubic catheters alone. In those patients with an indwelling urethral catheter, mean time to removal of the catheter was 6.5 days. There was no significant difference in outcome with regard to flow rates or symptom scores between the groups. While the results would indicate a significant reduction in the catheterisation time following use of the spiral stent, suprapubic catheterisation was still required for 1-2 days in most patients and there would appear to be no advantage with regard to outcome.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: Desgrandchamps F, Moulinier F, Daudon M, Teillac P and Le Duc A. Issue: 1997, 79: 24-27.
Title: An in vitro comparison of urease-induced encrustation of JJ stents in human urine
Abstract: This Paris group compared the ability of four types of JJ stent to encrust in vitro after immersion in human urine for 24 hours. The polyurethane, silicone and purcuflex stents showed no crystal deposits. The C-flex and hydrogel-coated stents showed crystal deposition and the latter stent showed a significantly higher calcium and magnesium concentration. They conclude that care should be taken to follow-up patients in whom there is a hydrogel (= a wettable polymeric biomaterial) stent.
Reviewer: Mark Feneley
| MONTH PUBLISHED | December - 1996 |
Journal: European Urology Authors: Madersbacher S, Klingler CH, Schatzl G, Schmidbauer G, Marberger M. Issue: 1996, 30: 437-455.
Title: The urodynamic impact of transrectal high-intensity focused ultrasound on bladder outflow obstruction.
Abstract: This uncontrolled prospective study analysed the use of high intensity focused ultrasound (HIFU) in the treatment of BPH. Temperatures greater than 80oC are generated resulting in necrosis of all cellular elements within the focal area. Of 30 patients, 80% were obstructed pre-operatively on urodynamic grounds, but only 37% post-operatively. However, only 4 patients were clearly unobstructed after the procedure. The authors conclude the HIFU should not be considered as an alternative for severely obstructed patients or those with an absolute indication for surgery.
Reviewer: Mark Feneley
Journal: European Urology Authors: Jung P, Matttelaer P, Wolff JM, Mersdorf A, Jakse G. Issue: 1996, 30: 418-423.
Title: Visual laser ablation of the prostate: efficacy evaluated by urodynamics and compared to TURP.
Abstract: In this unrandomised study, patients with significant morbidity underwent visual laser ablation of the prostate and those without underwent TURP. Both groups underwent pre-operative pressure/flow studies to clarify the nature of their disease. Patients in the TURP group did significantly better regarding peak urinary flow compared to VLAP, which performed very badly in big prostates. However, it did cause less morbidity.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: Carter AC / BLUES Issue: 1996, 78: 876-885.
Title: A standard protocol for the evaluation of laser treatment of the prostate
Abstract: A protocol suggested by the British Laser Urological Evaluation Society for use in any trial of operative intervention for benign prostatic obstruction. It includes sections for demographic details, operative details such as anaesthetic details, peri- and post-operative complications and progress at three follow-up visits, plus a patient acceptability and sexual function questionnaire. More sophisticated evaluations such a section for pre- and post-operative cystometry is not included in the "core" dataset.
Reviewer: Mark Feneley
Journal: Journal of Urology Authors: Kamihira O, Ono Y, Katoh N, Yamada S, Mizutani K, and Ohshima S. Issue: 1996, 156: 1267-71.
Title: Long-term stone recurrence rate after extracorporeal shockwave lithotripsy.
Abstract: This 5 year study attempted to follow 903 patients who were stone free at three months following ESWL identifying recurrence rate and a number of prognostic factors. Mean follow up was 25 months (55 patients were followed to 5 years) with a recurrence rate of 20.3%. Recurrence was most common among those patients with multiple calculi. Most common site for recurrence was the lower pole calix.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: Shoroff S, Watson GM, Parikh A, Thomas R, Soonawalla PF and Pope A Issue: 1996, 78: 836-839.
Title: The holmium: YAG laser for ureteric stones
Abstract: The holmium: YAG laser is a multifunctional laser since it can cut and coagulate tissue such as prostate (trials are in progress) as well as drill holes in calculi with a pulse duration of 350ms. This makes it potentially interesting to the endourologist/healthcare provider from an economic point of view. This report from London describes its successful use in fragmenting 134 ureteric stones accessed using semi-rigid or flexible ureteroscopes. Total clearance was achieved in 87% cases (96% from the lower ureter), but 3 ureters were perforated during the treatment and these were treated by JJ stent insertion for 6 weeks.
Reviewer: Mark Feneley
| MONTH PUBLISHED | November - 1996 |
Journal: British Journal of Urology Authors: van Iersel MP, Thomas CMG, Witjes WPJ, de Graaf R, de la Rosette J Issue: 1996, 78: 742-746.
Title: Clinical implications of the rise and fall of prostate specific antigen after laser prostatectomy.
Abstract: The effect of visual laser ablation of the prostate on serum PSA has not previously been described. Forty-five patients undergoing this procedure had serial estimations postoperatively up to 52 weeks. At 24 hours the mean PSA was 23 times higher than the preoperative level, dependent upon the prostate size and energy applied. Gradually the PSA reached a new level, mean 1.7 ng/ml below the preoperative level, by 78 days postoperatively. The authors conclude that the serum PSA is potentially misleading until 4 months after laser prostatectomy.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: MacFarlane JP, Foley SJ and Shah PJR Issue: 1996, 78: 729-732.
Title: Long-term outcome of permanent urethral stents in the treatment of detrusor-sphincter dyssynergia.
Abstract: This paper from the spinal injuries unit at Stanmore reviews 5-year followup of 11 urethral stents. Two stents had to be removed within a year because of encrustation and pain/UTI respectively. Five others developed bladder neck obstruction which was treated by bladder neck incision. Of the remaining four patients, one died, one had haematuria and one suffered recurrent UTI. The authors conclude that urethral stenting is an effective alternative to sphincterotomy.
Reviewer: Mark Feneley
Journal: Journal of Urology Authors: Elashry O M, DiMeglio R B, Nakada S Y, McDougall E M and Clayman R V. Issue: 1996, 156: 1581-1585.
Title: Intracorporeal electrohydraulic lithotripsy of ureteral and renal calculi using small calibre (1.9F) electrohydraulic lithotripsy probes
Abstract: This paper reviews the use of 1.9F or small electrohydraulic lithotripsy probes in conjunction with rigid or flexible ureteroscopes in the treatment of 45 patients (57 with renal and 32 ureteral calculi). Fragmentation (fragments 2mm or smaller) was achieved in 98% of patients with no significant morbidity. Overall stone free rate was 92% , with a stone free rate of 87% for patients with lower pole calculi at 8.7 months.
Reviewer: Mark Feneley
Journal: Journal of Urology Authors: Chen R N and Steem S B. Issue: 1996, 156: 1572-1575.
Title: Extracorporeal shock wave lithotripsy for lower pole calculi: Long-term radiographic and clinical outcome
Abstract: The efficacy of ESWL as a primary treatment for lower pole calculi is reported to range from 25 to 80%. Overall stone free rate determined by meta-analysis has been reported as 59.2%. This finding has lead to suggestions that patient with lower pole calculi may be better managed by a percutaneous approach rather than ESWL. This paper reports the outcome of ESWL in 206 patients with a stone burden of 4 to 625 mm2 (mean 88) treated on an unmodified Dornier HM3. Eight patients received more than 1 treatment for fragments larger than 4mm after a single treatment. Ninety nine patients (48%) were rendered stone free by 1 month after ESWL. Among patients with residual stone 13 patients (6.3%) had decreased stone burden, 71 (34%) were stable, and 10 (4.8%) increased in size at a mean follow-up of 14.5 months. One hundred and eighty patients remained asymptomatic during the follow-up period (1 - 99 months), while 26 patients (12.6%) became symptomatic requiring medical attention, and 19 went on to require intervention. The authors conclude that ESWL is the treatment of choice for stone less than 20 ml as the stone free rate for these stones was comparable to that for stones at other sites, although the data presented does not support this.
Reviewer: Mark Feneley
Journal: European Urology Authors: Madersbacher S, Klingler CH, Schatzl G, Schmidbauer G, Marberger M. Issue: 1996, 30: 437-455.
Title: The urodynamic impact of transrectal high-intensity focused ultrasound on bladder outflow obstruction.
Abstract: This uncontrolled prospective study analysed the use of high intensity focused ultrasound (HIFU) in the treatment of BPH. Temperatures greater than 80oC are generated resulting in necrosis of all cellular elements within the focal area. Of 30 patients, 80% were obstructed pre-operatively on urodynamic grounds, but only 37% post-operatively. However, only 4 patients were clearly unobstructed after the procedure. The authors conclude the HIFU should not be considered as an alternative for severely obstructed patients or those with an absolute indication for surgery.
Reviewer: Mark Feneley
| MONTH PUBLISHED | September - 1996 |
Journal: European Urology Authors: te Slaa E, de la Rosette JJMCH. Issue: 1996, 30: 1-10.
Title: Lasers in the treatment of benign prostatic obstruction: past, present, and future.
Abstract: This review article describes the broad areas of laser use in TURP, its problems and outcomes and the hopes for the future.
Reviewer: Mark Feneley
Journal: Journal of Urology Authors: Sun B Y -C, Lee Y -H, Jiaan B -P, Chen K -K, Chang L S and Chen K -T Issue: 1996, 156: 903-906.
Title: Recurrence rate and risk factors for urinary calculi after extracorporeal shockwave lithotripsy.
Abstract: This is a retrospective review of 841 patients who underwent extracorporeal shock wave lithotripsy (ESWL) attempting to identify risk factors for recurrent stone formation. Recurrence was rather loosely defined as new stones confirmed by plain abdominal film after being free of stone within three months of ESWL, physician diagnosis, spontaneous passage of stones, renal colic, or patient self-report of recurrence more than 1 year after ESWL. Follow-up was by questionnaire and ranged from 6 to 9 years. 47 patients had radiological evidence of a new stone and 27 reported the passage of a stone. The risk or recurrence was increased by male gender, diseases predisposing to urinary calculi, multiple stones, residual stones after ESWL and raised serum uric acid.
Reviewer: Mark Feneley
| MONTH PUBLISHED | August - 1996 |
Journal: Journal of Urology Authors: De La Rossette JJMCH, de Wildt MJAM, Hofner K, Carter S St C, Debruyne FMJ and Tubaro A. Issue: 1996, 156: 97-102.
Title: High energy thermotherapy in the treatment of benign prostatic hyperplasia: results of the European benign prostatic hyperplasia study group.
Abstract: Many new therapies for BPH are now available though long-term follow up is presently awaited for many modalities before the benefits can be assessed. This paper reports the results of high energy transurethral microwave thermotherapy in the treatment of BPH. One hundred and sixteen patients were evaluated using symptom scores, trans-rectal ultrasound, free voiding and pressure flow studies. Sixty seven patients have achieved 1 year follow up. Improvement in all parameters was observed at three months and this appears to be sustained at 1 year in those patients in whom follow up is available. Irritative symptoms were noted in a large number of patients for up to 4 weeks. The authors conclude that high energy transurethral microwave thermotherapy shows significant improvement in subjective and objective outcome measures, and best candidates for this procedure are those patients with moderate to severe bladder outlet obstruction.
Reviewer: Mark Feneley
Journal: European Urology Authors: Saporta L, Aridogan IA, Erlich N, Yachia D. Issue: 1996, 29: 439-445.
Title: Objective and subjective comparison of transurethral resection, transurethral incision and balloon dilatation of the prostate.
Abstract: This study evaluated transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP), and transurethral balloon dilatation of the prostate (TUBDP) in the treatment of patients with bladder outflow obstruction. There were 20 patients in each group and within 3 years 5 patients in the TUBDP had required additional treatment, 3 patients in the TUIP group and 1 patient in the TURP group. Overall, the TURP group did better regarding objective and subjective features of the disease.
Reviewer: Mark Feneley
Journal: British Journal of Urology Authors: Eden CG and Coptcoat MJ. Issue: 1996, 78: 234-242.
Title: Assessment of alternative tissue approximation techniques for laparoscopy.
Abstract: Recognising that laparoscopic suturing is clumsy, time-consuming and leaky, these reconstructive laparoscopy enthusiasts tested the strength of gelatin/resorcin/formaldehyde glue, fibrin glue and laser tissue-welding by performing open porcine uretero-ureterostomies. Evaluations included operating time and leak pressures, a Whitaker test, light and scanning electron microscopy 6 weeks later. Fibrin glue gave the best results. Six retroperitoneoscopic dismembered pyeloplasties were then performed, using either interrupted 4/0 polyglactin sutures or fibrin glue, subsequently assessed by the same criteria. Again, the fibrin glued anastomoses performed better, particularly since they did not leak at physiological pressures. Employment of this technique in patients is underway.
Reviewer: Mark Feneley