Journal watch

Medical management of kidney stones

In a recent article in BMJ 2016 the authors discuss the investigation and medical treatment of urolithiasis. They include a useful algorithm.

  

Daily Calis for the treatment of prostatitis.

In an article by Kirby et al published in Trends in Urology and men’s health (2015), the authors propose that 5mg Cialis daily may improve the symptoms of prostatitis. This is a hypothesis driven case report of several cases, which is an interesting observation more than scientific evidence.it is proposed that the effect is a consequence of increased pelvic blood flow/anti inflammatory effect.

Follow-up of Testicular microlithiasis

The implications and follow up of testicular microlithiasis have been widely debated since a possible link with testicular germ cell tumour was reported. In 2015 the European Society of Urogenital Radiology (ESUR) have published the first guidelines on follow up of this condition. As a general rule it does not need follow up, unless there is a seperate risk factor for germ call cancer. Testicular maldescent/orchidopexy, previous germ cell tumour and atrophic testis require annual testicular ultrasound (USS) follow up. Genetic disease requires an USS at 6 and 12 months then discharge. Family history of germ cell tumour requires advice of self examination.

Targeted fusion biopsies of the prostate find more high risk tumours

In an article published in the journal JAMA the authors compared targeted prostate biopsy compared to standard extended sextant biopsies in 1003 men suspected to have prostate cancer. MRI/USS fusion biopsy detected 30% more high risk prostate cancers than standard biopsy. An additional benefit was that the targeted technique picked up17% fewer low risk cancers. When radical prostatectomy specimens from 170 men were examined, targeted biopsies had a higher PPV for intermediate and high risk cancers than standard biopsies.

Robotic Surgery Explained

Staffordshire Urology Clinic surgeon Lyndon Gommersall explains the new Da Vinci Si Robotic surgical system.

If you are worried about prostate cancer or wish to discuss private assessment or treatment of prostate cancer please contact the North Staffordshire Nuffield Hospital on 01782 382507 and ask for an appointment with Mr Christopher Luscombe of Mr Lyndon Gommersall.

MR guided prostate biopsies improve diagnosis of significant prostate cancer compared to random biopsies

In article by Pirkorny et al published in Eur Urol (2014) the authors report a study of223 consecutive patients referred with raises PSA. All had an MRI and random biopsies with additional guided biopsies for suspicious lesions. 63.7% were diagnosed with cancer. Random biopsies detected 56.5% including 37.3% with low risk disease. Guided biopsies would have 69.7% with only 6.1% low risk. Estimated NPV for significant cancer was 71.9% for random and 96.9% for guided biopsies. Follow up of this cohort is required.

Tadalafil and chronic prostatitis

In an article by Kirby et al published in BJUI (2014), the authors discuss the rationale and efficacy and tadafil treatment for chronic male pelvic pain. Anecdotally, it has been associated with immediate and sustained improvement especially in daily dosing at 5mg strength.