The Staffordshire Urology Clinic website went live 1 year ago. In this year it has attracted 4,500 unique visitors from every continent. Almost 1,500 visitors have then returned and there have been just under 15,000 page views. There are now 87 pages of content covering virtually all aspects of Urology. Over 100 posts have been uploaded in 3 categories (news, journal watch and Q&A) with over 5,000 external comments published.
The Staffordshire Urology Clinic has run clinics at the North Staffordshire Nuffield Hospital since its formation in 2011. For the convenience of patients that have previously travelled from South Cheshire and from further North, it has now introduced a clinic at the BMI South Cheshire Hospital. This new clinic will offer the same high level of expertise and facilities that patients have come to expect from the Staffordshire Urology Clinic at the North Staffordshire Nuffield hospital, and will also offer limited NHS appointments.
In an article in BMJ (2012), the author discusses PSA screening for prostate cancer. Several studies have shown that a small number of prostate deaths could be avoided by screening for prostate cancer. However, a significant number of men may be harmed by treatment that they may never have needed. The authors believe that by using a genetic test looking for the presence of common prostate cancer genes, followed by a personalised use of PSA screening depending on genetic risk starting at the age of 45, would reduce the cost of screening and improve the pickup of significant prostate cancer compared to insignificant disease, thus reducing over treatment.
In an article in BMJ (2012), the author discusses the increasing numbers of NHS patients treated in Private Hospitals. Individuals in the UK with private medical insurance have reduced by 1.5 million (19%) since 2009, thought to be due to the recession. This has left capacity at private hospitals, which is being increasingly filled by the treatment of NHS patients.
Erectile dysfunction (ED) affects about 34 million men in the U.S.A with 9% of men 18 to 39 and up to 70% of men 60 and older. However, in an article by Harte et al published in Journal of Sexual Medicine (2012), men aged 18 to 45 are responsible for the largest increase in the use of Viagra among U.S. adults. From 1998 to 2002, the use by this age category grew 312%. They report a study of 1,207 men with an average age of 22. The men completed an online survey that asked about their sexual functioning in the past four weeks. 72 were recreational (used for perceived enhancement in performance) users of medication used to treat erectile dysfunction, 1111 were non-users and 24 were prescribed theses drugs. They answered questions about their erectile function, orgasm, sexual desire, and their satisfaction with intercourse and overall sex. they also reported their levels of confidence in their ability to get and maintain an erection. Compared to non-users, recreational users reported lower erectile confidence and overall satisfaction.
Although recreational users are a self selected group that may worry more about performance, the authors conclude that recreational use of ED medication reduces sexual confidence, leading to reduced ability and satisfaction.
It has been standard of care to remove the adrenal gland aswell as kidney during radical nephrectomy for suspected renal cancer. However, Finelli et al show that survival is better if it is spared. In an article published in BJUI (2012) they report a study of 1,651 patients with a final pathological diagnosis of T1a RCC, including 490 patients (30%) who had concurrent ipsilateral adrenalectomy. By 10 years, the overall survival was 74.1% with adrenalectomy vs 79.8% when the adrenal was left behind (p<0.001), whilst cancer-specific survival did not differ. In a Cox proportional hazard model, ipsilateral adrenalectomy increased the risk of overall mortality by 23%, but it didn't affect cancer-specific survival.
In an article by Patel et al published in BJUI (2012) the authors studied 234 patients with suspected renal cancer less than 4cms in size. 71 were treated by surveillance, 41 by radical nephrectomy and 90 by partial nephrectomy. After a median follow up of 34 months over 53% of masses managed by surveillance had not increased in size and only 1 (with multiple tumours) had spread. 20% went on to ablative therapy. Cancer specific survival was 99%, 93% and 97% with overall survival of 83%, 80% and 90% for surveillance, radical and partial nephrectomy groups respectively. The authors conclude that active surveillance of renal masses <4cms is as safe as surgery in the short term.
New guidelines (2012) have been published by the American Urological Association (AUA) for the investigation of symptomatic haematuria. There are several differences between these guidelines and UK guidelines. For example, UK guidelines suggest investigating all patients with cystoscopy over 40 years old, whereas AUA guidelines suggest over 35. AUA guidelines suggest CT urogram or MR urogram imaging, but UK guidelines do not specify. AUA guidelines suggest full reevaluation of persistent asymptomatic haematuria within 3 to 5 years, whereas UK guidelines suggest limited annual reevaluation with blood pressure and urinary protein:creatinine testing, with full evaluation only in the presence of symptoms or visible haematuria.
In an article by Vargas et al published in J Urol (2012), the authors showed that MRI could predict aggressive prostate cancer in patients initially thought to have low risk prostate cancer. Such upgrading is a barrier to the acceptance of active surveillance for men with prostate cancer. A total of 388 consecutive men (mean age 60.6 years, range 33 to 89) with clinically low risk prostate cancer (initial biopsy Gleason score 6 or less, prostate specific antigen less than 10 ng/ml, clinical stage T2a or less) underwent MRI before confirmatory biopsy. Three radiologists independently and retrospectively scored tumour visible on MRI using a 5-point scale (1—definitely no tumour to 5—definitely tumour). Associations between magnetic resonance imaging scores and confirmatory biopsy findings were evaluated.
On confirmatory biopsy, Gleason score was upgraded in 79 of 388 (20%) patients. Magnetic resonance imaging scores of 2 or less had a high negative predictive value (0.96–1.0) and specificity (0.95–1.0) for upgrading on confirmatory biopsy. A magnetic resonance imaging score of 5 was highly sensitive for upgrading on confirmatory biopsy (0.87–0.98).
The authors concluded that MRI was useful in the selection of patients for management with active surveillance.