In an article by Holmang et al in Eur Urol (2012) the authors looked at bladder tumour recurrence after intravesical BCG treatment. Recurrent tumours were seen even after 10 recurrence free years and the authors therefore conclude that patients should be followed for at least 15 tumour free years, if not indefinitely.
Oral capsules of lactobacillus effectively reduce recurrent urinary tract infections without causing resistance or interfering with normal human bacterial flora. However, in a head to head trial published in Arch Intern Med (2012) comparing lactobacillus to antibiotic (cotrimoxazole) suppression therapy, lactobacillus treatment was not as effective at reducing recurrent urinary tract infection In post menopausal women as the antibiotics.
Women treated with lactobacilli prophylactically for 12 months saw a reduction in the mean number of UTIs from 6.8 to 3.3, whereas those women treated with prophylactic trimethoprim-sulfamethoxazole had a reduction in the number of UTIs from 7.0 to 2.9.
After a price reduction in the drug arbiraterone the National Institute of Clinical Excellence (NICE) has changed its draft guidelines to approve the drugs use in advanced prostate cancer. It is now recommended for use in advancing prostate cancer which is no longer responsive to hormone treatment or the chemotherapy docetaxol.
In an article published in Eur Urol (2012) by Vickers et al, the authors study a group of 695 men from the Scandinavian prostate cancer group. They randomised the men to watchful waiting or radical prostatectomy. Their model suggests that it is hard to justify surgery in patients with Gleason 6, T1 disease or in those patients much above 70 yr of age. Conversely, surgery seems unequivocally of benefit for patients who have Gleason 8, or Gleason 7, stage T2. For patients with Gleason 6 T2 and Gleason 7 T1, treatment is more of a judgment call, depending on patient preference and other clinical findings, such as the number of positive biopsy cores and comorbidities.
In an article published in Trends in Urology and Men’s health, Scott discusses the role of screening for urological cancer. These cancers accounted for more than 58,000 new diagnoses in UK in 2008, compared 48,000 for breast cancer. They accounted for over 20,000 deaths in 2009 compared to 35,000 for lung cancer. Screening can improve mortality for some cancer types, but screening for urological malignancies is yet to be proven. In the case of prostate cancer 2 large studies show conflicting results using PSA as the screening test; PLCO screened 38343 men with 38350 controls with a relative risk of cancer mortality favouring controls at 1.1. ERSPC, which was methodologically at better trial screened 72952 men with 89245 controls and a relative risk favouring screening of 0.80. The ERSPC study suggested that screening 100,000 men prevents 73 prostate cancer deaths, with treatment causing considerable harm; 3169 cases of erectile dysfunction, 925 cases of incontinence and 11 deaths. Screening for bladder cancer with available tools is similarly not cost effective compared to current opportunistic dipstick testing and investigation of haematuria.
An article published in N Engl J Med (2012) concluded that Women having surgery for uncomplicated stress incontinence can be spared the discomfort and inconvenience of preoperative urodynamic tests. Both women who did, and those who did not, have these tests had equal chances of successful treatment; about 77% success in both groups.
In an article by Park et al in BJUI (2012), the authors study whether repeatedly biopsying the prostate influences survival after treatment for localised prostate cancer. They conclude that neither repeating the biopsies, nor taking more cores influences survival. Whilst interesting and supported by the contemporary literature this article is based on a relatively small sample of 1147 sets of biopsies of which only 83 were repeats.
In a single centre study of 106 men, published in BJUI (2012), Dockray et al describe a cohort of men treated with penile frenuloplasty for pain and/or frenular scarring. 8% of men suffered a minor complication, such as bruising. 8% required circumcision at a later date, as their symptoms were not completely resolved, but 97% would recommend the procedure to a friend.
Badalato et al discuss the role of partial nephrectomy (PN) for large renal tumours in an article in BJUI (2012). PN is widely accepted as the standard of care for many patients with renal tumours smaller than 4 cms in maximum diameter. This large study looked at the outcomes of over 11,000 operations (including over 1,000 PN procedures) and found that survival was equivalent for both PN and radical nephrectomy even in large renal tumours of over 4 cms in size. The evidence for considering PN in the surgical care of most renal tumours is rapidly increasing.