Journal watch

Channel 5’s Critical Condition features Mr Golash

Mr Golash has been featured on Channel 5’s Critical Condition television program performing a complex radical nephrectomy (kidney removal) operation for and very large kidney cancer. This type of surgery is very demanding and is safest performed by skilled surgeons at large cancer centres.

Prostate cancer screening with PSA

In an article by Ilic et al published in BMJ 2018, the authors present a meta-analysis of the evidence for prostate cancer screening with the PSA blood test. This evidence came from combining data from 5 studies (Quebec, Stockholm, ERSPC, PLCO and CAP). 721,717 men were included.

When considering the whole dataset, the authors found that screening in this way probably has no effect on death either from prostate cancer or from all causes. At best it may lead to a small reduction of death from prostate cancer after 10 years. This is balanced by harm, such that for every 1,000 patients screened 1,3 and 25 men have serious sepsis from the biopsy, need pads for incontinence and have erectile dysfunction respectively.

Pre-ureteroscopy stent insertion and post-ureteroscopy sepsis

In an article by Nevo et al published in BJUI published in July 2017 the authors discuss the risk of sepsis in patients pre-stented before ureteroscopic stone surgery. Patients often have a ureteric stent inserted before ureteroscopic to enable surgery, however a stent can increase the risk post ureteroscopy infection. The authors conclude that the infection risk is similar between stent end and non-stented patients unless the stent is left for more than a month, when infection rates increase. The sepsis rates were 1, 4.9, 5.5 and 9.2% for stent dwell durations of 1, 2, 3 and >3 months respectively.

Vasectomy and risk of prostate cancer

In an article by Hamilton et al published in BMJ 2016, the authors study the link between vasectomy and prostate cancer. 326607 men who had vasectomy between 1994 and 2012 and equal matched number of men who did not, were studied. After a median of 10 year follow up there was no difference in prostate cancer risk.

Incidence of lymphocoele following lymph node dissection after robot assisted radical prostatectomy

In an article by Keskin et al published in BJUI (2016) the authors Analyse 521 patients. At 1 month 9% had USS detected lymphocoeles, 76%regressed by 3 months. Overall 2.5% developed symptomatic lymphocoeles but if a lymphocoele persisted until 3 months 64% became symptomatic. The authors suggested USS at 3 months and percutaneous drainage if a lymphocoele was detected.

Precision in risk stratification for early prostate cancer

In an editorial in BJUI (2016) Emberton comments that combined MRI and perineal intensive biopsy conferred a sensitivity of 97% and NPV of 91% for clinically significant disease.

Retroperitoneal fibrosis reviewed

In an article by O’Brien et al published in BJUI (2016) the authors review the current state of knowledge on RPF.

They identify 7 types:-

1) IgG4 related

2) Systemic autoimmune eg SLE, Wegemer’s, APS, PMR/GCA

3) degenerative aorto-iliac arterial disease (either aneurysmal or non-dilated (may also be IgG4 positive)

4) idiopathic peri-aortitis

5) drug related

6) paraneoplastic

7) radiation induced

The authors suggest that initial tests should include FBC, CrP, renal profile, ESR and screen for SLE, Wegemer’s, APS, PMR/GCA. CT is normal imaging although PET CT may be a useful investigational marker of inflammation. Biopsy should be attempted

The aim of treatment is preserve renal function, and make stent free. Prednisone with 20md bd is used if there is evidence of inflammation. Azothiprine or methotrexate are useful if steroids are successful but relapse occurs after reducing. Rituximab can control where steroids fail. Ureterolysis should be used early.