Steady rise in visits to the Staffordshire Urology Clinic website

Lactobacillus for recurrent UTI

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.

Radical prostatectomy versus watchful waiting in patients with localised prostate cancer

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.

Urological malignancy and screening

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.

Repeated prostate biopsies and number of cores taken does not influence survival after treatment for localised prostate cancer

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.

Survival is equivalent after partial nephrectomy and radical nephrectomy for large renal tumours

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.

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