Laparoscopic Nephroureterectomy: The Distal Ureteral Dilemma

Transitional cell carcinoma affecting the upper urinary tract, though uncommon, constitutes a serious urologic disease. Radical nephroureterectomy remains the treatment of choice but has undergone numerous modifications over the years. Although the standard technique has not been defined, the laparoscopic approach has gained in popularity in the last two decades. The most appropriate oncological management of the distal ureteral and bladder cuff has been a subject of much debate. The aim of the nephroureterectomy procedure is to remove the entire ipsilateral upper tract in continuity while avoiding extravesical transfer of tumor-containing urine during bladder surgery. A myriad of technical modifications have been described. In this article, we review the literature and present an overview of the options for dealing with the lower ureter during radical nephroureterectomy

Upper Tract Imaging in Patients with Initial or Terminal Hematuria Suggestive of Bleeding from the Lower Urinary Tract: How Often is the Upper Urinary Tract Responsible for the Hematuria?

Objectives: Visible hematuria (VH) is a common urological complaint. A history of initial or terminal VH in men is indicative of a lower urinary tract (LUT) source. A careful clinical history could limit unnecessary extensive upper tract imaging in this group of patients with VH. We conducted a single-center prospective study to examine the usefulness of investigating the upper tract in patients with a history of VH likely from a LUT source (initial and/or terminal VH) with specific reference to the incidence of demonstrable significant upper tract abnormalities. Methods: We conducted a single-center prospective study of consecutive male patients presenting with VH over eight months. All patients underwent standard investigations including physical examination, flexible cystoscopy (FC), and radiological imaging (ultrasound scan (USS) and/or computed tomography urogram (CTU)). Those with a clear history of initial or terminal VH were identified for further scrutiny with regards to detectable upper tracts abnormalities. Results: In total, 57 patients (aged 23–95 years) with initial or terminal VH were identified. Of these, 56 had FC and nine patients were subsequently diagnosed with a LUT malignancy. With regards to upper urinary tract (UUT), 35 patients (61.4%) had an USS, 46 (80.7%) underwent a CTU, and 25 (43.9%) patients had both. In this group, no UUT malignancy was identified on upper tract imaging. Conclusions: Initial or terminal VH patients may not need extensive upper tract imaging. FC is recommended, but a non-invasive USS can be a safe initial investigation for the UUT, with a CTU subsequently considered in those with abnormalities on USS and those with ongoing bleeding. Further combined multicenter analysis will help corroborate these findings and could have several beneficial outcomes including a reduction in investigations cost, patient inconvenience, and ionizing radiation

THE SOCIETY FOR ACADEMIC PRIMARY CARE’S REGIONAL/NORTH CONFERENCE

The regional SAPC conference for the North will take place on UCLan’s main campus in Preston on 28th and 29th of November 2019. The SAPC conferences are the main venues for discussing improvements in Primary Care provision in the UK. The Society provides a clear voice for Academic Primary Care in the complex and ever-changing Primary Care environment and offers a point of reference and contact for those seeking academic solutions to the problems in Primary Care and working for the advancement of Academic Primary Care

Pain related and overall morbidity with TRUS guided prostate biopsy a prospective study

Objective To assess analgesia requirement after trans-rectal ultrasound guided prostate biopsy(TRUSBx) for appropriate counselling. Materials and Methods Prospectively, successive patients undergoing TRUSBx between July 2009 and November 2011 were given questionnaires prior to procedure. Standard 12-core TRUSBx under peri-prostatic block (10 mL of 1% lidocaine) and antibiotic prophylaxis (oral ciprofloxacin, intravenous gentamicin and metronidazole suppository) were performed. Pain perception was assessed using a Visual Analogue Score (VAS). Results Mean (range) age of the 405 patients was 67.3 years (48-88). Mean VAS during the procedure was 2.93 and 2.20 on reaching home. Mean maximum VAS for the cohort on day 1 and day 2 were 1.27 and 0.7 respectively. 140 (35%) were independent with some or minimal discomfort. 14 patients required assistance for some of their basic daily needs. 9 patients (2.2%) were hospitalised due to sepsis. 131 patients (32.4%) required additional oral analgesia following TRUSBx on days 0, 1 and 2. These patients were generally younger with a mean age for this group of 63.6 years (46-88). The difference in the mean age between those self-medicating and not was not statistically significant (p > 0.005). This group had mean VAS during the procedure of 4 and when patients reached home was 3.5. Mean maximum VAS on day 1 and 2 was 2.1 and 1.3 respectively. 11 patients required assistance from another adult. Conclusion A third of patients required self-medicated analgesia post-procedure. Age alone cannot be used as a criterion to identify patients who will subsequently require analgesia post-procedure, but a higher VAS during the procedure may be indicative. These patients must be counselled appropriately

Medium-term outcomes of urolift (minimum 12 months follow-up): evidence from a systematic review

The urolift device has emerged as a novel intervention for men with lower urinary tract symptoms secondary to benign prostatic hyperplasia, and in recent years there has been an increasing amount of primary research published on it. However, critical medium-term appraisal remains lacking. Our objective was to perform a systematic review and therefore identify, appraise, and synthesize the existing evidence for the minimally invasive technique.</p