Journal watch

Post prostatectomy incontinence can be effectively treated by the AdVance sling in some patients

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).

Loss of renal function due to partial nephrectomy is stable after 3 months

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.

Female gender and CIS of the prostatic urethra predict bladder tumour recurrence after Intravesical BCG treatment for pT1G3 TCC bladder

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.

Intravesical botox is effective for over active bladder syndrome without detrusor overactivity

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.

Androgen deprivation therapy does not increase cardiovascular death in men treated for prostate cancer

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.

International Cystitis Network has developed an app for iPhones and iPads that helps over active bladder patients to select bladder friendly foods

The International Cystitis Network has developed an app for iPhones and iPads that gives patients with overactive bladders the confidence to select foods and drinks that should not aggravate their condition. It contains a list of more than 250 items divided into three categories: bladder friendly foods, foods worth trying cautiously, and foods to avoid. Users will also find highlighted foods and beverages that will be soothing to them during interstitial cystitis flare-ups. There are even recommendations for lower acid wines, pale ale beers and mixed drink mixers. The app can be purchased for 99 cents and downloaded from Apple’s App store.

A recently updated Cochraine review concludes that extracts of Seronoa repens does not improve urinary symptoms

A recently updated Cochraine review published in BJU Int (2012) concludes that extracts of the fruit of Seronoa repens (otherwise known as the American saw palmetto) does not improve the urinary symptoms associated with benign prostatic enlargement compared to placebo (sham treatment). The reviewers studied 17 randomised controlled published studies to reach this conclusion.