The reported post radical prostatectomy incontinence rates are between 5 and 48% according to Bauer et al in an article published in Eur Urol (2011). 6-9% of patients eventually seek treatment for this. Novarra and Ficarra review a number of treatments in an editorial about the AdVance sling in Eur Urol (2012). There is evidence to use behavioural techniques, duloxetine, sling and an artificial urinary sphincter. The sphincter remains the gold standard with continence rates of 70-90% after 5 years and 60-80% after 7. However, it is also the most invasive and costly. Patients treated by the AdVance sling in the subject of the editorial by Rehder et al were cured in 75% of cases and the results were sustainable at 3 years. This was a multi-centred study of 156 patients. Cure rates were better for mild (1or 2 pads per day) and moderate incontinence (3-5 pads per day with 57% cured at 3 years compared to 42% of those with severe incontinence (more than 5 pads per day).
Porpiglia et al investigated renal function loss in 54 patients after laparoscopic partial nephrectomy for tumour and reported their findings in Eur Urol (2012). Loss, judged by a number of different techniques, occurred in the first 3 months and was stable afterwards, with a follow up of 4 years. Length of warm ischaemia during the procedure is of particular importance, with a mean of 28 minutes (range 9-60 mins) reported in this study. There was a change in split renal function of 6%. Patients in this study were on the whole young, fit and slim with small favourably located tumours.
Palou et al report in Eur Urol (2012) that in primary pT1 G3 TCC bladder the only identifiable risk factors for recurrence after Intravesical BCG therapy found in a small single centred study of 146 patients were female gender and CIS of the prostatic urethra. These risk factors increased the risk of recurrence (HR 2.53), progression (HR=3.59) and bladder cancer death (3.53) with a median follow up of 8.7 years.
Botox injected into the bladder is a recognised treatment for patients proven to have detrusor overactivity on urodynamic testing. However, in a small single centre study of 94 patients from Nottingham published in BJMSU (2012) by Jackson et al, Botox has also been shown to be effective in patients with symptoms of bladder overactivity, without evidence of detrusor overactivity on urodynamic studies. this important as if confirmed it questions whether all patients need invasive urodynamics before this treatment.
In an article in BJUI (2012) the authors report that on the basis of an epidemiological model, if French patients with kidney stones drank at least two litres of water a day, it could save the French healthcare system an estimated €68 billion (£55bn, $85bn; assuming 25% compliance) to €273 billion (assuming 100% compliance).
Azouanth et al reported in BMJ (2012) that more than two years daily exposure to pioglitazone doubled the risk of bladder cancer. They also found an association between bladder cancer and both the dose and the duration of pioglitazone treatment.
Mr Golash, Mr Gommersall and Mr Liu presented to a lively audience at JCB on 12th June, on Men’s Health topics. It was an enjoyable and informative evening, with plenty of audience participation. Feedback has been very positive.
Since its launch over 2000 unique visitors have used the Staffordshire Urology Clinic website. With just under 3000 visitors and over 8000 page views, the website is becoming increasingly popular.
Following several very successful Men’s Health events, the Staffordshire Urology Clinic have been invited to host a similar event at JCB World Headquarters. The evening will start after 5:30pm and topics for discussion include prostate, bladder, kidney, testicle and erection problems.
In an article by Nguyen et al published in JAMA (2011) the results of a meta-analysis of 8 studies (4141 men) showed no evidence to link excess cardiovascular death with androgen deprivation therapy used to treat advanced prostate cancer. Observational studies have previously reported an association. The authors did acknowledge that there was still a possibility of excess mortality in a subgroup of men with a history of heart attack or heart failure.