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Tempo JA, Sii S, Ischia J, Bolton DM, D'Onise K, Meng R, Watson DI, O'Callaghan M. Lessons from a population-based bladder cancer registry: exploring why survival is not improving. BJU Int 2024; 133:699-708. [PMID: 38409928 DOI: 10.1111/bju.16286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To explore the causes of the decrease in bladder cancer survival that has occurred over the past four decades. METHODS We extracted data from the South Australian Cancer Registry. Data from the period 1 January 1977 to 31 December 2020 were extracted to explore changes in incidence and survival among a total of 8356 patients diagnosed with ≥pT1 disease. Invasive bladder cancer was defined as ≥pT1 in this study. RESULTS Invasive bladder cancer age-standardized incidence decreased from 7.20 cases per 100 000 people in 1977 to 5.85 cases per 100 000 in 2020. The mean age at diagnosis increased from 68 years to 76 years. The crude incidence for patients aged 80 years and over increased by 3.3% per year (95% confidence interval [CI] 2.1 to 4.6). Overall survival decreased over the study period (hazard ratio [HR] 1.22 [95% CI 1.09 to 1.35]), however, survival increased after adjusting for age at diagnosis (HR 0.80 [95% CI 0.76 to 0.94]). Despite a decrease in non-bladder cancer-specific deaths in older people, there was no change in the bladder cancer-specific death rate in older people (HR 0.94 [95% CI 0.70 to 1.26]). Male sex was associated with higher survival (HR 0.87 [95% CI 0.83 to 0.92]), whereas socioeconomic advantage was not. CONCLUSIONS Invasive bladder cancer survival has decreased over the past 40 years, with the age structure of the population being a significant contributing factor. PATIENT SUMMARY We looked at why bladder cancer survival is decreasing using a large cancer registry with information from 1977 to 2020. We found that people are now more likely to be diagnosed at an older age. Older people often live for a shorter time with bladder cancer compared to younger people. Bladder cancer survival has decreased because there are more older people with the disease than previously.
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Affiliation(s)
- Jake A Tempo
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Urology Unit, Austin Health, Melbourne, VIC, Australia
| | - Samuel Sii
- Urology Unit, Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia
| | - Joseph Ischia
- Urology Unit, Austin Health, Melbourne, VIC, Australia
| | | | - Katina D'Onise
- Prevention and Population Health, Wellbeing SA, Adelaide, SA, Australia
| | - Rosie Meng
- Prevention and Population Health, Wellbeing SA, Adelaide, SA, Australia
| | - David I Watson
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Michael O'Callaghan
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
- Urology Unit, Flinders Medical Centre, Bedford Park, SA, Australia
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Anderson S, Patterson K, Skolarikos A, Somani B, Bolton DM, Davis NF. Perspectives on technology: to use or to reuse, that is the endoscopic question-a systematic review of single-use endoscopes. BJU Int 2024; 133:14-24. [PMID: 37838621 DOI: 10.1111/bju.16206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
OBJECTIVE To compare clinical outcomes of single-use endoscopes with those of reusable endoscopes to better define their role within urology. METHODS A systematic search of electronic databases was performed. All studies comparing the clinical outcomes of participants undergoing urological procedures with single-use endoscopes to those of participants treated with reusable endoscopes were included. Results are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. RESULTS Twenty-one studies in 3943 participants were identified. Six different single-use flexible ureteroscopes and two different single-use flexible cystoscopes were assessed. There were no differences in mean postoperative infection rates (4.0% vs 4.4%; P = 0.87) or overall complication rates (11.5% vs 11.9%; P = 0.88) between single-use and reusable endoscopes. For patients undergoing flexible ureteroscopy there were no differences in operating time (mean difference -0.05 min; P = 0.96), length of hospital stay (LOS; mean difference 0.06 days; P = 0.18) or stone-free rate (SFR; 74% vs 74.3%; P = 0.54) between the single-use and reusable flexible ureteroscope groups. CONCLUSION This study is the largest to compare the clinical outcomes of single-use endoscopes to those of reusable endoscopes within urology, and demonstrated no difference in LOS, complication rate or SFR, with a shorter operating time associated with single-use flexible cystoscope use. It also highlights that the cost efficiency and environmental impact of single-use endoscopes is largely dependent on the caseload and reprocessing facilities available within a given institution. Urologists can therefore feel confident that whether they choose to 'use' or to 'reuse' based on the financial and environmental implications, they can do so without negatively impacting patient outcomes.
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Affiliation(s)
- Steven Anderson
- Department of Urology, Beaumont Hospital, Dublin, Ireland
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Andreas Skolarikos
- Department of Urology, National and Kapodistrian University of Athens, Athens, Greece
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Damien M Bolton
- Department of Urology, Austin Hospital, Melbourne, VIC, Australia
| | - Niall F Davis
- Department of Urology, Beaumont Hospital, Dublin, Ireland
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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3
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Sathianathen NJ, Lawrentschuk N, Konety B, Azad AA, Corcoran NM, Bolton DM, Murphy DG. Cost Effectiveness of Systemic Treatment Intensification for Metastatic Hormone-sensitive Prostate Cancer: Is Triplet Therapy Cost Effective? Eur Urol Oncol 2023:S2588-9311(23)00278-X. [PMID: 38057191 DOI: 10.1016/j.euo.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND AND OBJECTIVE There has been a shift toward systemic treatment intensification for men with metastatic hormone-sensitive prostate cancer (mHSPC). Recent trials have demonstrated the efficacy of triplet therapy with an androgen receptor signalling inhibitor (ARSI), docetaxel, and androgen deprivation therapy (ADT). However, ARSI treatment is expensive. The objective was to determine the cost effectiveness of current treatments strategies for men with mHSPC. METHODS We developed a Markov state-transition model to simulate outcomes for men with newly diagnosed mHSPC. For the simulation, patients were entered in the model in the mHSPC disease state before progressing to castration-resistant disease and finally dying from prostate cancer. Costs were calculated from a USA health sector perspective in 2022 US dollars. Deterministic and probabilistic sensitivity analyses were conducted to account for uncertainty in the parameter estimates. We also performed scenario analyses for costs in the UK and Australian health sectors. KEY FINDINGS AND LIMITATIONS Treatment intensification with doublet and triplet therapy resulted in an improvement in quality-adjusted survival for all strategies in comparison to ADT monotherapy. However, only docetaxel doublet therapy was cost effective at standard thresholds, with an incremental cost-effectiveness ratio of $13 647. The cost of ARSIs needed to be discounted by 47-70% before they were cost effective. Only medication costs impacted the model results. If the generic price for abiraterone acetate is used, then triplet therapy with abiraterone is the best-value option. Similar results were obtained for analyses for the UK and Australian health sectors. CONCLUSIONS AND CLINICAL IMPLICATIONS Treatment intensification with ARSIs in men with mHSPC results in better quality-adjusted survival but is not cost effective according to standard thresholds. The costs of these medications would need to be heavily discounted before they are cost effective. The cost of generic ARSIs, once available, would render these strategies cost effective. PATIENT SUMMARY This report examines whether increasing the number of systemic drugs used to treat a patient's metastatic hormone-sensitive prostate cancer is cost effective for the health care system. We found that the additional cost of triplet therapy does not justify the increase in patient benefit.
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Affiliation(s)
- Niranjan J Sathianathen
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Australia; Department of Urology, Western Health, Footscray, Australia.
| | - Nathan Lawrentschuk
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Australia
| | | | - Arun A Azad
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Parkville, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Niall M Corcoran
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia; Department of Urology, Western Health, Footscray, Australia; Victorian Comprehensive Cancer Centre Alliance, Parkville, Victoria
| | - Damien M Bolton
- Department of Surgery, Austin Health, The University of Melbourne, Parkville, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
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Williams IS, Perera S, Murphy DG, Corcoran NM, Bolton DM, Lawrentschuk N. Active surveillance versus enzalutamide for low-risk prostate cancer- was it really a trial we needed? BJU Int 2022; 130:580-581. [PMID: 35879832 DOI: 10.1111/bju.15860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Isabella Sc Williams
- Department of Urology and Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Australia
| | - Sachin Perera
- Department of Urology and Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Niall M Corcoran
- Department of Urology and Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Australia
| | - Damien M Bolton
- Department of Urology and Department of Surgery, Austin Hospital, University of Melbourne, Australia
| | - Nathan Lawrentschuk
- Department of Urology and Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Australia.,EJ Whitten Prostate Cancer Research Centre at Epworth, Melbourne, Australia
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Kelly BD, Perera M, Bolton DM, Papa N. Social determinants of health: does socioeconomic status affect access to staging imaging for men with prostate cancer. Prostate Cancer Prostatic Dis 2022:10.1038/s41391-022-00508-7. [PMID: 35169274 DOI: 10.1038/s41391-022-00508-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/18/2022] [Accepted: 02/01/2022] [Indexed: 11/09/2022]
Abstract
Socioeconomic status (SES), race and geographical factors are known to impact prostate cancer management and outcomes. We aimed to assess these factors with regard to access to novel imaging in prostate cancer. Using the Prostate Cancer Outcomes Registry of Victoria (PCOR-Vic) we identified 5256 men diagnosed with prostate cancer via biopsy. Following the introduction of government rebate, the access to MRI improved with respect to SES. Access to PET imaging remains poor with respect to SES and geographical location in the absence of Federal funding. Further improvements for men with low SES and regional areas to access PET staging.
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Affiliation(s)
- Brian D Kelly
- Department of Urology, Austin Health, Heidelberg, Melbourne, VIC, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Marlon Perera
- Department of Urology, Austin Health, Heidelberg, Melbourne, VIC, Australia. .,Department of Urology, Memorial Sloan Kettering Cancer Center, NYC, NY, USA.
| | - Damien M Bolton
- Department of Urology, Austin Health, Heidelberg, Melbourne, VIC, Australia
| | - Nathan Papa
- Department of Urology, Austin Health, Heidelberg, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Lundon DJ, Kelly BD, Nair S, Bolton DM, Kyprianou N, Wiklund P, Tewari A. Early mortality risk stratification after SARS-CoV-2 infection. Med Intensiva 2021; 45:e40-e42. [PMID: 34717886 PMCID: PMC8549443 DOI: 10.1016/j.medine.2020.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/18/2020] [Indexed: 11/25/2022]
Affiliation(s)
- D J Lundon
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States.
| | - B D Kelly
- Department of Urology, University of Melbourne, Austin Health, Melbourne, United States
| | - S Nair
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - D M Bolton
- Department of Urology, University of Melbourne, Austin Health, Melbourne, United States
| | - N Kyprianou
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - P Wiklund
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - A Tewari
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States.
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7
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Yu C, Jordahl KM, Bassett JK, Joo JE, Wong EM, Brinkman MT, Schmidt DF, Bolton DM, Makalic E, Brasky TM, Shadyab AH, Tinker LF, Longano A, Hopper JL, English DR, Milne RL, Bhatti P, Southey MC, Giles GG, Dugué PA. Smoking Methylation Marks for Prediction of Urothelial Cancer Risk. Cancer Epidemiol Biomarkers Prev 2021; 30:2197-2206. [PMID: 34526299 DOI: 10.1158/1055-9965.epi-21-0313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/22/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Self-reported information may not accurately capture smoking exposure. We aimed to evaluate whether smoking-associated DNA methylation markers improve urothelial cell carcinoma (UCC) risk prediction. METHODS Conditional logistic regression was used to assess associations between blood-based methylation and UCC risk using two matched case-control samples: 404 pairs from the Melbourne Collaborative Cohort Study (MCCS) and 440 pairs from the Women's Health Initiative (WHI) cohort. Results were pooled using fixed-effects meta-analysis. We developed methylation-based predictors of UCC and evaluated their prediction accuracy on two replication data sets using the area under the curve (AUC). RESULTS The meta-analysis identified associations (P < 4.7 × 10-5) for 29 of 1,061 smoking-associated methylation sites, but these were substantially attenuated after adjustment for self-reported smoking. Nominally significant associations (P < 0.05) were found for 387 (36%) and 86 (8%) of smoking-associated markers without/with adjustment for self-reported smoking, respectively, with same direction of association as with smoking for 387 (100%) and 79 (92%) markers. A Lasso-based predictor was associated with UCC risk in one replication data set in MCCS [N = 134; odds ratio per SD (OR) = 1.37; 95% CI, 1.00-1.90] after confounder adjustment; AUC = 0.66, compared with AUC = 0.64 without methylation information. Limited evidence of replication was found in the second testing data set in WHI (N = 440; OR = 1.09; 95% CI, 0.91-1.30). CONCLUSIONS Combination of smoking-associated methylation marks may provide some improvement to UCC risk prediction. Our findings need further evaluation using larger data sets. IMPACT DNA methylation may be associated with UCC risk beyond traditional smoking assessment and could contribute to some improvements in stratification of UCC risk in the general population.
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Affiliation(s)
- Chenglong Yu
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Kristina M Jordahl
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Julie K Bassett
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Jihoon Eric Joo
- Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Ee Ming Wong
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Maree T Brinkman
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Daniel F Schmidt
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.,Department of Data Science & AI, Faculty of IT, Monash University, Clayton, Victoria, Australia
| | - Damien M Bolton
- Department of Surgery, University of Melbourne and Olivia Newton-John Cancer Centre, Austin Hospital, Melbourne, Victoria, Australia
| | - Enes Makalic
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Theodore M Brasky
- Division of Medical Oncology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anthony Longano
- Department of Anatomical Pathology, Eastern Health, Box Hill Hospital, Box Hill, Victoria, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Roger L Milne
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Parveen Bhatti
- Cancer Control Research, BC Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Melissa C Southey
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Graham G Giles
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Pierre-Antoine Dugué
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia. .,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
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Farag M, Jack GS, Papa N, Wong L, Bolton DM, Lenaghan D. Which has more complications?—Shockwave lithotripsy versus endoscopic treatment of renal calculi with 1‐year follow‐up in an Australian population. BJUI Compass 2021; 2:275-280. [PMID: 35475295 PMCID: PMC8988777 DOI: 10.1002/bco2.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction and objectives Renal calculi are a common medical problem with incidence rates calculated to be approximately 6%‐9% in men & 3%‐4% in women worldwide. Incidence appears to be increasing. This study compares emergency presentations and unplanned readmissions between extracorporeal shock wave lithotripsy (SWL) and pyeloscopic stone treatment in the population of Victoria, Australia after 1‐year follow‐up. Methods This is a population study comparing all patients with renal calculi electively treated with SWL to those initially treated with flexible ureteroscopy (URS) in Victoria, Australia. We used data linkage across the state of Victoria to follow patients treated with either modality in a 12 months period (with no urological surgery in the prior 12 months). Each patient's emergency presentations and subsequent re‐admissions were followed up for 1 year after their index treatment to assess for stone complications. We assessed for selection bias between the two patient groups by comparing age, gender, insurance status, geographical location, and comorbidity scores. Results We report stone‐related complications for 739 flexible URS and 1317 SWL procedures undertaken across public and private hospitals in Victoria over 12 months. Unplanned emergency presentations within 60‐days of surgery were (22/739) 2.98% for flexible URS patients and (83/1317) 6.30% for SWL patients (P = .001); however, at 12 months, this became 16.23% (120/739) for flexible URS patients and 12.83% (169/1317) for SWL patients (P = .034). Flexible URS patients were more likely than SWL patients to be admitted with 71.76% of flexible URS versus 53.97% of SWL patients requiring an admission at any given emergency presentation (P ≤ .001) within 12 months. On multivariate analysis, both flexible URS ([OR] 1.67, CI 1.23‐2.26, P = .001) and being a public patient ([OR] 3.06, CI 2.24‐4.18, P < .001) significantly increased the likelihood that patients required an unplanned re‐admission within 12 months. Conclusions There is work needed to reduce emergency presentations and unplanned re‐admissions after both SWL and flexible URS. At 12‐months follow‐up, unplanned emergency visits and re‐admission rates were significantly more after flexible URS. Symptoms at emergency presentation indicate that better education regarding stent management is needed, especially in the public health care system.
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Affiliation(s)
- Matthew Farag
- Department of Urology Austin Health, University of Melbourne Heidelberg VIC Australia
| | - Gregory S. Jack
- Department of Urology Austin Health, University of Melbourne Heidelberg VIC Australia
| | - Nathan Papa
- Department of Urology Austin Health, University of Melbourne Heidelberg VIC Australia
| | - Lih‐Ming Wong
- Department of Surgery St Vincent's Hospital Melbourne Fitzroy Australia
| | - Damien M. Bolton
- Department of Urology Austin Health, University of Melbourne Heidelberg VIC Australia
| | - Daniel Lenaghan
- Department of Surgery St Vincent's Hospital Melbourne Fitzroy Australia
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9
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Lundon DJ, Kelly BD, Nair S, Bolton DM, Patel G, Reich D, Tewari A. A COVID-19 Test Triage Tool, Predicting Negative Results and Reducing the Testing Burden on Healthcare Systems During a Pandemic. Front Med (Lausanne) 2021; 8:563465. [PMID: 33996839 PMCID: PMC8116585 DOI: 10.3389/fmed.2021.563465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Detecting and isolating cases of COVID-19 are amongst the key elements listed by the WHO to reduce transmission. This approach has been reported to reduce those symptomatic with COVID-19 in the population by over 90%. Testing is part of a strategy that will save lives. Testing everyone maybe ideal, but it is not practical. A risk tool based on patient demographics and clinical parameters has the potential to help identify patients most likely to test negative for SARS-CoV-2. If effective it could be used to aide clinical decision making and reduce the testing burden. Methods: At the time of this analysis, a total of 9,516 patients with symptoms suggestive of Covid-19, were assessed and tested at Mount Sinai Institutions in New York. Patient demographics, clinical parameters and test results were collected. A robust prediction pipeline was used to develop a risk tool to predict the likelihood of a positive test for Covid-19. The risk tool was analyzed in a holdout dataset from the cohort and its discriminative ability, calibration and net benefit assessed. Results: Over 48% of those tested in this cohort, had a positive result. The derived model had an AUC of 0.77, provided reliable risk prediction, and demonstrated a superior net benefit than a strategy of testing everybody. When a risk cut-off of 70% was applied, the model had a negative predictive value of 96%. Conclusion: Such a tool could be used to help aide but not replace clinical decision making and conserve vital resources needed to effectively tackle this pandemic.
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Affiliation(s)
- Dara J Lundon
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, NY, United States
| | - Brian D Kelly
- Department of Urology, Austin Health, Melbourne, VIC, Australia
| | - Sujit Nair
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, NY, United States
| | - Damien M Bolton
- Department of Urology, Austin Health, Melbourne, VIC, Australia
| | - Gopi Patel
- Department of Infectious Diseases, Icahn School of Medicine, Mount Sinai Hospitals, New York, NY, United States
| | - David Reich
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ashutosh Tewari
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, NY, United States
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10
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Farag M, Jack GS, Wong L, Bolton DM, Lenaghan D. What is the best way to manage ureteric calculi in the time of COVID‐19? A comparison of extracorporeal shockwave lithotripsy (SWL) and ureteroscopy (URS) in an Australian health‐care setting. BJUI Compass 2020; 2:92-96. [PMID: 35474891 PMCID: PMC8988776 DOI: 10.1002/bco2.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/25/2020] [Accepted: 10/10/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives To determine the best way to intervene for ureteric stones which still require treatment during the COVID‐19 pandemic, with respect to infection control. In this setting, in which resources are constrained, extracorporeal shockwave lithotripsy (SWL) has prima facie advantages over ureteroscopy (URS). It is also necessary to also consider posttreatment resource consumption in regards to complications and repeat procedures. Subjects and methods The ideal ureteric stone treatment during a pandemic such as COVID‐19 would involve minimum resource consumption and a minimum number of patient attendances. We compared all patients initially treated with SWL to those initially treated with URS for acute ureteral colic within the state of Victoria, Australia in 2017. Results A total of 2724 ureteric stones were analyzed, a cumulative “3‐month exposure and burden on the healthcare system” was calculated for each patient by their initial procedure type. The readmission rate for URS was significantly higher than for SWL, 0.92 readmissions/patient for URS versus 0.54 readmissions/patient for SWL (P < .001). The cumulative hospital stay per patient for these two procedures was 2.35 days for SWL versus 3.21 days for URS (P < .001). The number of procedures per patient was 1.52 for SWL versus 1.89 for URS (P = .0213). Conclusions Patients with ureteric stones treated initially by SWL have shorter length of stay with fewer overall attendances and procedures at 3 months than those treated with URS. During a pandemic such as COVID‐19, SWL may have benefits in preserving hospital resources and limiting opportunity for virus transmission, compared to URS.
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Affiliation(s)
- Matthew Farag
- Department of Urology University of MelbourneAustin Health Heidelberg VIC Australia
- Department of Urology St Vincent’s Melbourne Melbourne VIC Australia
| | - Gregory S. Jack
- Department of Urology University of MelbourneAustin Health Heidelberg VIC Australia
| | - Lih‐Ming Wong
- Department of Urology St Vincent’s Melbourne Melbourne VIC Australia
| | - Damien M. Bolton
- Department of Urology University of MelbourneAustin Health Heidelberg VIC Australia
| | - Daniel Lenaghan
- Department of Urology St Vincent’s Melbourne Melbourne VIC Australia
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Protani MM, Joshi A, White V, Marco DJT, Neale RE, Coory MD, Giles GG, Bolton DM, Davis ID, Wood S, Jordan SJ. The role of renal mass biopsy in the management of small renal masses – patterns of use and surgeon opinion. Journal of Clinical Urology 2020. [DOI: 10.1177/2051415819894181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: Renal mass biopsy (RMB) is advocated to improve management of small renal masses, however there is concern about its clinical utility. This study aimed to elicit opinions about the role of RMB in small renal mass management from surgeons managing renal cell carcinomas (RCC), and examine the frequency of pre-treatment biopsy in those with RCC. Methods: All surgeons in two Australian states (Queensland: n = 59 and Victoria: n = 108) who performed nephrectomies for RCC in 2012/2013 were sent questionnaires to ascertain views about RMB. Response rates were 54% for Queensland surgeons and 38% for Victorian surgeons. We used medical records data from RCC patients to determine RMB frequency. Results: Most Queensland (81%) and Victorian (59%) surgeons indicated they rarely requested RMB; however 34% of Victorians reported often requesting RMB, compared with no Queensland surgeons. This was consistent with medical records data: 17.6% of Victorian patients with T1a tumours received RMB versus 6.7% of Queensland patients ( p < 0.001). Surgeons’ principal concerns regarding RMB related to sampling reliability (90%) and/or histopathological interpretation (76%). Conclusions: Most surgeons report infrequent use of RMB for small renal masses, however we observed practice variation. The principal reasons for infrequent use were concerns about sampling reliability and histopathological interpretation, which may be valid in regions with less access to interventional radiologists and uropathologists. Further evidence is required to define patient groups for whom biopsy results will alter management. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
- Melinda M Protani
- School of Public Health, The University of Queensland, Herston, Australia
- QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Andre Joshi
- QIMR Berghofer Medical Research Institute, Herston, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Australia
| | - Victoria White
- Cancer Council Victoria, Melbourne, Australia
- Deakin University, Geelong, Australia
| | - David JT Marco
- University of Melbourne, Melbourne, Australia
- Centre for Palliative Care, St Vincent’s Hospital, Melbourne, Australia
| | - Rachel E Neale
- School of Public Health, The University of Queensland, Herston, Australia
- QIMR Berghofer Medical Research Institute, Herston, Australia
| | | | - Graham G Giles
- Cancer Council Victoria, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Damien M Bolton
- University of Melbourne, Melbourne, Australia
- Austin Health, Melbourne, Australia
| | - Ian D Davis
- Monash University Eastern Health Clinical School, Box Hill, Melbourne, Australia
- Eastern Health, Box Hill, Melbourne, Australia
| | - Simon Wood
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Australia
| | - Susan J Jordan
- School of Public Health, The University of Queensland, Herston, Australia
- QIMR Berghofer Medical Research Institute, Herston, Australia
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12
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Lundon DJ, Kelly BD, Shukla D, Bolton DM, Wiklund P, Tewari A. A Decision Aide for the Risk Stratification of GU Cancer Patients at Risk of SARS-CoV-2 Infection, COVID-19 Related Hospitalization, Intubation, and Mortality. J Clin Med 2020; 9:jcm9092799. [PMID: 32872607 PMCID: PMC7563697 DOI: 10.3390/jcm9092799] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/23/2020] [Accepted: 08/28/2020] [Indexed: 01/08/2023] Open
Abstract
Treatment decisions for both early and advanced genitourinary (GU) malignancies take into account the risk of dying from the malignancy as well as the risk of death due to other causes such as other co-morbidities. COVID-19 is a new additional and immediate risk to a patient’s morbidity and mortality and there is a need for an accurate assessment as to the potential impact on of this syndrome on GU cancer patients. The aim of this work was to develop a risk tool to identify GU cancer patients at risk of diagnosis, hospitalization, intubation, and mortality from COVID-19. A retrospective case showed a series of GU cancer patients screened for COVID-19 across the Mount Sinai Health System (MSHS). Four hundred eighty-four had a GU malignancy and 149 tested positive for SARS-CoV-2. Demographic and clinical variables of >38,000 patients were available in the institutional database and were utilized to develop decision aides to predict a positive SARS-CoV-2 test, as well as COVID-19-related hospitalization, intubation, and death. A risk tool was developed using a combination of machine learning methods and utilized BMI, temperature, heart rate, respiratory rate, blood pressure, and oxygen saturation. The risk tool for predicting a diagnosis of SARS-CoV-2 had an AUC of 0.83, predicting hospitalization for management of COVID-19 had an AUC of 0.95, predicting patients requiring intubation had an AUC of 0.97, and for predicting COVID-19-related death, the risk tool had an AUC of 0.79. The models had an acceptable calibration and provided a superior net benefit over other common strategies across the entire range of threshold probabilities.
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Affiliation(s)
- Dara J. Lundon
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, NY 10029, USA; (D.J.L.); (D.S.); (P.W.)
| | - Brian D. Kelly
- Department of Urology, Austin Health, Melbourne, VIC 3084, Australia; (B.D.K.); (D.M.B.)
| | - Devki Shukla
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, NY 10029, USA; (D.J.L.); (D.S.); (P.W.)
| | - Damien M. Bolton
- Department of Urology, Austin Health, Melbourne, VIC 3084, Australia; (B.D.K.); (D.M.B.)
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, NY 10029, USA; (D.J.L.); (D.S.); (P.W.)
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, NY 10029, USA; (D.J.L.); (D.S.); (P.W.)
- Correspondence:
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13
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Farag M, Timm B, Davis N, Wong LM, Bolton DM, Jack GS. Pressurized-Bag Irrigation Versus Hand-Operated Irrigation Pumps During Ureteroscopic Laser Lithotripsy: Comparison of Infectious Complications. J Endourol 2020; 34:914-918. [PMID: 32475171 DOI: 10.1089/end.2020.0148] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Introduction and Objectives: A variety of irrigation systems are available during ureteroscopy. We sought to compare gravity-driven pressure bags with hand-operated irrigation pumps in terms of postoperative complications after ureteroscopy with lithotripsy. Methods: A retrospective analysis of 234 patients undergoing flexible ureteropyeloscopy with laser lithotripsy by 24 supervised trainees over 4 years at a single teaching institution. Patients were divided into those who had procedures performed by using gravity-driven pressure bags fixed at 60 to 204 cm H2O, vs those who had procedures performed by using a hand-operated irrigation pump capable of delivering 1 to 10 mL per flush. Variables including surgical duration, hypotension, fever, sepsis, and hematuria were extracted from the charts, along with the surgical techniques utilized. Statistical analyses included chi-squared tests and Student's t-tests. Results: There were no differences in gender, age, indication, or stone size in the two groups. Postoperative systemic inflammatory response syndrome was significantly greater in the hand-assisted n = 11/144 (7.6%) compared with the fixed irrigation group n = 1/90 (1.1%); p = 0.032. Emergency room presentations were greater in the hand irrigation group, n = 46/144 (32%) vs n = 12/90 (13%) in the pressure-bag irrigation, p = 0.002. Postoperative fever was also greater in the hand pump irrigation cohort compared with the continuous pressure cohort (13/144 [9%] vs 1/90 [1%], p = 0.011). No statistical difference was found between the two groups with respect to stone clearance and subsequent procedures required (p = 0.123). Conclusions: This analysis suggests that using continuous flow irrigation at a fixed maximum pressure of 150 mmHg (204 cm H2O) or less may result in decreased pain, infection, and sepsis compared with handheld pressure irrigation.
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Affiliation(s)
- Matthew Farag
- Department of Urology, Austin Health, University of Melbourne, Melbourne, Australia
| | - Brennan Timm
- Department of Urology, Austin Health, University of Melbourne, Melbourne, Australia
| | - Niall Davis
- Department of Urology, Tallaght Hospital, Dublin, Ireland
| | - Lih-Ming Wong
- Department of Urology, St Vincents Hospital, Melbourne, Australia
| | - Damien M Bolton
- Department of Urology, Austin Health, University of Melbourne, Melbourne, Australia
| | - Gregory S Jack
- Department of Urology, Austin Health, University of Melbourne, Melbourne, Australia
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14
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Lundon DJ, Kelly BD, Nair S, Bolton DM, Kyprianou N, Wiklund P, Tewari A. Early mortality risk stratification after SARS-CoV-2 infection. Med Intensiva 2020; 45:S0210-5691(20)30219-9. [PMID: 32912654 PMCID: PMC7334967 DOI: 10.1016/j.medin.2020.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 12/28/2022]
Affiliation(s)
- D J Lundon
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States.
| | - B D Kelly
- Department of Urology, University of Melbourne, Austin Health, Melbourne, United States
| | - S Nair
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - D M Bolton
- Department of Urology, University of Melbourne, Austin Health, Melbourne, United States
| | - N Kyprianou
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - P Wiklund
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - A Tewari
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States.
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15
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Holmes A, Kelly BD, Perera M, Eapen RS, Bolton DM, Lawrentschuk N. A systematic scoping review of multidisciplinary cancer team and decision-making in the management of men with advanced prostate cancer. World J Urol 2020; 39:297-306. [PMID: 32500304 DOI: 10.1007/s00345-020-03265-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/16/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The early diagnosis of prostate cancer and subsequent access to the treatment options helps to achieve optimal cancer outcomes. As the treatment options for patients with advanced prostate cancer continues to evolve, patients need to access a multidisciplinary team (MDT) meeting to receive best-practice care. METHODS In this paper a MEDLINE review was performed to assess clinical decision making in the context of MDT discussions for patients with advanced prostate cancer. RESULTS From 441 returned articles and abstracts, 50 articles were assessed for eligibility and 16 articles included for analysis. Sixteen articles were identified, 9 of the 16 articles used quantitative methodology including three retrospective analysis of clinical registry data, patient medical records and/or MDT meeting notes and three cross-sectional surveys. Other study designs included one observation study and one study using a combination of qualitative and quantitative methodologies and one mini-review. There were also four editorials included in the review and two consensus statements. CONCLUSION This paper highlights the important role the inter-disciplinary MDT has on shared decision making for men with advanced prostate cancer. The application of MDT care is a rapidly growing trend in uro-oncology and an efficient MDT service requires further research to assess its efficiency so that it may expand through all aspect of uro-oncology.
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Affiliation(s)
- A Holmes
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - B D Kelly
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - M Perera
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - R S Eapen
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - D M Bolton
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - N Lawrentschuk
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia. .,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. .,EJ Whitten Prostate Cancer Research Centre at Epworth Healthcare, Melbourne, Australia. .,Department of Urology, Royal Melbourne Hospital, Melbourne, Australia.
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16
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Ellis RJ, Del Vecchio SJ, Gallagher KMJ, Aliano DN, Barber N, Bolton DM, Chew ETS, Coombes JS, Coory MD, Davis ID, Donaldson JF, Francis RS, Giles GG, Gobe GC, Hawley CM, Johnson DW, Laird A, Leung S, Malki M, Marco DJT, McNeill AS, Neale RE, Ng KL, Phipps S, Stewart GD, White VM, Wood ST, Jordan SJ. A Simple Clinical Tool for Stratifying Risk of Clinically Significant CKD after Nephrectomy: Development and Multinational Validation. J Am Soc Nephrol 2020; 31:1107-1117. [PMID: 32238473 DOI: 10.1681/asn.2019121328] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/17/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Clinically significant CKD following surgery for kidney cancer is associated with increased morbidity and mortality, but identifying patients at increased CKD risk remains difficult. Simple methods to stratify risk of clinically significant CKD after nephrectomy are needed. METHODS To develop a tool for stratifying patients' risk of CKD arising after surgery for kidney cancer, we tested models in a population-based cohort of 699 patients with kidney cancer in Queensland, Australia (2012-2013). We validated these models in a population-based cohort of 423 patients from Victoria, Australia, and in patient cohorts from single centers in Queensland, Scotland, and England. Eligible patients had two functioning kidneys and a preoperative eGFR ≥60 ml/min per 1.73 m2. The main outcome was incident eGFR <45 ml/min per 1.73 m2 at 12 months postnephrectomy. We used prespecified predictors-age ≥65 years old, diabetes mellitus, preoperative eGFR, and nephrectomy type (partial/radical)-to fit logistic regression models and grouped patients according to degree of risk of clinically significant CKD (negligible, low, moderate, or high risk). RESULTS Absolute risks of stage 3b or higher CKD were <2%, 3% to 14%, 21% to 26%, and 46% to 69% across the four strata of negligible, low, moderate, and high risk, respectively. The negative predictive value of the negligible risk category was 98.9% for clinically significant CKD. The c statistic for this score ranged from 0.84 to 0.88 across derivation and validation cohorts. CONCLUSIONS Our simple scoring system can reproducibly stratify postnephrectomy CKD risk on the basis of readily available parameters. This clinical tool's quantitative assessment of CKD risk may be weighed against other considerations when planning management of kidney tumors and help inform shared decision making between clinicians and patients.
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Affiliation(s)
- Robert J Ellis
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia .,Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
| | - Sharon J Del Vecchio
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
| | - Kevin M J Gallagher
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Danielle N Aliano
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Logan Hospital, Logan, Queensland, Australia
| | - Neil Barber
- Urology Department, Frimley Park Hospital, Frimley, United Kingdom
| | - Damien M Bolton
- Austin Urology, Austin Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Jeff S Coombes
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Michael D Coory
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Ian D Davis
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Eastern Health, Melbourne, Victoria, Australia
| | - James F Donaldson
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Ross S Francis
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Graham G Giles
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Glenda C Gobe
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
| | - Carmel M Hawley
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
| | - David W Johnson
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
| | - Alexander Laird
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Steve Leung
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Manar Malki
- Urology Department, Frimley Park Hospital, Frimley, United Kingdom
| | - David J T Marco
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Palliative Care, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Alan S McNeill
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Rachel E Neale
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Queensland University of Technology, Brisbane, Queensland, Australia
| | - Keng L Ng
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Urology Department, Frimley Park Hospital, Frimley, United Kingdom
| | - Simon Phipps
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom.,Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Victoria M White
- Cancer Council Victoria, Melbourne, Victoria, Australia.,School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Simon T Wood
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Susan J Jordan
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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17
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Trigos AS, Pasam A, Banks PD, Wallace R, Keam SP, Thorne H, Mitchell C, Clouston D, Murphy DG, Lawrentschuk N, Bolton DM, Moon D, Castro E, Olmos D, Darcy PK, Haupt Y, Williams S, Goode DL, Neeson PJ, Sandhu SK. The tumor immune microenvironment of germline BRCA1/2 and sporadic prostate cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
152 Background: Prostate cancer (PC) is considered an immunologically ‘cold’ tumor and therefore patients are generally not considered good candidates for immunotherapy. Tumors arising in germline (g) BRCA1/2 mutation carriers are associated with higher genomic instability and levels of immune infiltration in breast and ovarian cancer. We investigated how germline mutations in DNA repair genes affect the tumor immune microenvironment (TME) of PC. Methods: Archival primary tumor samples from 26 patients with g BRCA2 mutations, 5 with g BRCA1, 5 with mutations in other DNA repair genes ( ATM, CHEK2, FANCI, PALB2 or BRCA2+ MSH2), and 26 sporadic patients were analyzed. OPAL multiplex immunohistochemistry was used to detect 7 markers (CD3, CD4, CD8, FOXP3, PDL1, AMACR, DAPI) to identify immune subsets and provide the X,Y coordinates of single cells. We developed novel computational distance-based methods to characterize the spatial distribution of cells. Gene expression was evaluated with the Nanostring panel of 770 immune genes. Results: g BRCA1/2 carriers showed lower levels of T cells (9.73% of the tumor stroma) compared to sporadic tumors (14.8%). In in both cothors the T cell population was dominated by CD4+ cells (69.5%), with CD8+ cells representing only 25.6%. Sporadic PCs displayed aggregation of T cells into large clusters in the stroma dominated by CD4+ cells and few CD8+ cells, while 77% of high-grade g BRCA2 patients were enriched in high levels of free, non-aggregated CD8+ T-cells in the tumor area. HLA-A expression was 2.37 times higher in g BRCA2 patients ( p = 3.4x10−8), who also showed higher expression of genes associated with a present but suppressed immune system ( p = 1.4x10−4). gBRCA2 patients with larger T-cell aggregates had an overall poorer prognosis compared to patients without (time to metastasis 55.1 vs. 85.3 months, survival time 67.3 vs. 85.0 months). Conclusions: g BRCA2 carriers displayed higher levels of HLA-A, more free CD8+ T cells infiltrating tumor regions and higher inflammatory signatures, suggesting an immune system that could potentially be harnessed. The degree of clustering of T cells (free vs. aggregated) within the TME may provide valuable prognostic information that warrants further validation.
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Affiliation(s)
- Anna S. Trigos
- Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
| | | | | | | | | | | | | | | | | | | | | | - Daniel Moon
- Peter MacCallum Cancer Centre, The University of Melbourne, Epworth Healthcare, Melbourne, Australia
| | - Elena Castro
- Spanish National Cancer Research Centre, Madrid, Spain
| | - David Olmos
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Center, Madrid, Spain
| | - Phillip K. Darcy
- Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
| | - Ygal Haupt
- Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
| | | | - David L. Goode
- Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
| | - Paul J. Neeson
- Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
| | - Shahneen Kaur Sandhu
- Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
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18
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Cheung E, Nikfarjam M, Jackett L, Bolton DM, Ischia J, Patel O. The Protective Effect of Zinc Against Liver Ischaemia Reperfusion Injury in a Rat Model of Global Ischaemia. J Clin Exp Hepatol 2020; 10:228-235. [PMID: 32405179 PMCID: PMC7212296 DOI: 10.1016/j.jceh.2019.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/16/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Ischaemia-reperfusion injury (IRI) is a major obstacle during liver transplantation and resection surgeries for cancer, with a need for effective and safe drugs to reduce IRI. Zinc preconditioning has been shown to protect against liver IRI in a partial (70%) ischaemia model. However, its efficacy against a clinically relevant Pringle manoeuvre that results in global liver ischaemia (100%) is unknown. AIMS The aim of this study was to test the efficacy of zinc preconditioning in a rat model of global liver ischaemia. METHODS Rats were preconditioned via subcutaneous injection of 10 mg/kg of ZnCl2, 24 h and 4 h before ischaemia. Total liver ischaemia (100%) was induced by placing a clamp across the portal triad for 30 min. Liver injury was assessed by serum alanine transaminase (ALT) and aspartate transaminase (AST) levels in blood taken before ischaemia (baseline) and at 1, 2, 4, 24, 48, 72, 96 and 120 hours after ischaemia. Animals were culled after 7 days, and the harvested livers were histologically analysed. RESULTS On a two-way repeated-measures analysis of variance, there was a statistically significant (p = 0.025) difference in the mean ALT levels between saline- and ZnCl2-treated groups. Specifically at 24 h after ischaemia, the ALT (341 ± 99 U/L) and AST (606 ± 78 U/L) in the zinc-treated group were significantly less than the ALT (2863 ± 828 U/L) and AST (3591 ± 948 U/L) values in the saline-treated group. Zinc significantly reduced neutrophil infiltration and necrosis compared with the saline control. CONCLUSION Zinc preconditioning reduces the overall hepatocellular damage from IRI. These results lay the foundation to assess the benefit of zinc preconditioning for clinical applications.
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Affiliation(s)
- Ernest Cheung
- Department of Surgery, The University of Melbourne, Victoria, Australia
| | - Mehrdad Nikfarjam
- Department of Surgery, The University of Melbourne, Victoria, Australia
| | - Louise Jackett
- Department of Anatomical Pathology, Austin Health, Heidelberg, Victoria, Australia
| | - Damien M. Bolton
- Department of Surgery, The University of Melbourne, Victoria, Australia,Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Joseph Ischia
- Department of Surgery, The University of Melbourne, Victoria, Australia,Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Oneel Patel
- Department of Surgery, The University of Melbourne, Victoria, Australia,Address for correspondence: Dr Oneel Patel, Department of Surgery, Austin Health, Studley Rd., Heidelberg, Victoria 3084, Australia. Tel.: +(613) 9496 3676; fax: +(613) 9458 1650.
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19
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Ischia J, Bolton DM, Patel O. Why is it worth testing the ability of zinc to protect against ischaemia reperfusion injury for human application. Metallomics 2019; 11:1330-1343. [PMID: 31204765 DOI: 10.1039/c9mt00079h] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Ischaemia (interruption in the blood/oxygen supply) and subsequent damage induced by reperfusion (restoration of blood/oxygen supply) ultimately leads to cell death, tissue injury and permanent organ dysfunction. The impact of ischaemia reperfusion injury (IRI) is not limited to heart attack and stroke but can be extended to patients undergoing surgeries such as partial nephrectomy for renal cancer, liver resection for colorectal cancer liver metastasis, cardiopulmonary bypass, and organ transplantation. Unfortunately, there are no drugs that can protect organs against the inevitable peril of IRI. Recent data show that a protocol incorporating specific Zn formulation, dosage, number of dosages, time of injection, and mode of Zn delivery (intravenous) and testing of efficacy in a large preclinical sheep model of IRI strongly supports human trials of Zn preconditioning. No doubt, scepticism still exists among funding bodies and research fraternity on whether Zn, a naturally occurring metal, will work where everything else has failed. Therefore, in this article, we review the conflicting evidence on the promoter and protector role of Zn in the case of IRI and highlight factors that may help explain the contradictory evidence. Finally, we review the literature related to the knowledge of Zn's mechanism of action on ROS generation, apoptosis, HIF activation, inflammation, and signal transduction pathways, which highlight Zn's likelihood of success compared to various other interventions targeting IRI.
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Affiliation(s)
- Joseph Ischia
- Department of Surgery, The University of Melbourne, Austin Health, Studley Rd., Heidelberg, Victoria 3084, Australia. and Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Damien M Bolton
- Department of Surgery, The University of Melbourne, Austin Health, Studley Rd., Heidelberg, Victoria 3084, Australia. and Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Oneel Patel
- Department of Surgery, The University of Melbourne, Austin Health, Studley Rd., Heidelberg, Victoria 3084, Australia.
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20
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Ellis RJ, White VM, Bolton DM, Coory MD, Davis ID, Francis RS, Giles GG, Gobe GC, Neale RE, Wood ST, Jordan SJ. Tumor size and postoperative kidney function following radical nephrectomy. Clin Epidemiol 2019; 11:333-348. [PMID: 31191028 PMCID: PMC6511655 DOI: 10.2147/clep.s197968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/02/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Chronic kidney disease (CKD) following nephrectomy for kidney tumors is common, and both patient and tumor characteristics may affect postoperative kidney function. Several studies have reported that surgery for large tumors is associated with a lower likelihood of postoperative CKD, but others have reported CKD to be more common before surgery in patients with large tumors. Objective: The aim of this study was to clarify inconsistencies in the literature regarding the prognostic significance of tumor size for postoperative kidney function. Study design and setting: We analyzed data from 944 kidney cancer patients managed with radical nephrectomy between January 2012 and December 2013, and 242 living kidney donors who underwent surgery between January 2011 and December 2014 in the Australian states of Queensland and Victoria. Multivariable logistic regression was used to assess the primary outcome of CKD upstaging. Structural equation modeling was used to evaluate causal models, to delineate the influence of patient and tumor characteristics on postoperative kidney function. Results: We determined that a significant interaction between age and tumor size (P=0.03) led to the observed inverse association between large tumor size and CKD upstaging, and was accentuated by other forms of selection bias. Subgrouping patients by age and tumor size demonstrated that all patients aged ≥65 years were at increased risk of CKD upstaging, regardless of tumor size. Risk of CKD upstaging was comparable between age-matched living donors and kidney cancer patients. Conclusion: Larger tumors are unlikely to confer a protective effect with respect to postoperative kidney function. The reason for the previously reported inconsistency is likely a combination of the analytical approach and selection bias.
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Affiliation(s)
- Robert J Ellis
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, QLD, Australia
| | - Victoria M White
- Cancer Council Victoria, Melbourne, VIC, Australia
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Damien M Bolton
- Department of Urology, Austin Health, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Michael D Coory
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Ian D Davis
- Eastern Health Clinical School, Monash University and Eastern Health, Melbourne, VIC, Australia
- Department of Urology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Ross S Francis
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, QLD, Australia
| | - Graham G Giles
- Cancer Council Victoria, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Glenda C Gobe
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, QLD, Australia
| | - Rachel E Neale
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Simon T Wood
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, QLD, Australia
- Department of Urology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Susan J Jordan
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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21
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Ellis RJ, White VM, Bolton DM, Coory MD, Davis ID, Francis RS, Giles GG, Gobe GC, Marco DJT, Neale RE, Wood ST, Jordan SJ. Incident Chronic Kidney Disease After Radical Nephrectomy for Renal Cell Carcinoma. Clin Genitourin Cancer 2019; 17:e581-e591. [PMID: 30975606 DOI: 10.1016/j.clgc.2019.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/12/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) after surgery for kidney cancer is common, and is associated with increased morbidity and mortality. This study aimed to identify factors associated with incident CKD in patients managed with radical nephrectomy. PATIENTS AND METHODS All patients diagnosed with renal cell carcinoma between January 2012 and December 2013 were ascertained from state-based cancer registries in Queensland and Victoria. Information on patient, tumor, and health service characteristics was obtained via chart review. Multivariable logistic regression was used to evaluate exposures associated with incident CKD (estimated glomerular filtration rate [eGFR] <60 mL per minute per 1.73 m2) at 12 months after nephrectomy. RESULTS Older age (adjusted odds ratio [aOR] per 5-year increase, 1.5; 95% confidence interval [CI], 1.4-1.6), male sex (aOR, 1.4; 95% CI, 1.0-2.0), obese compared with not obese (aOR, 1.8; 95% CI, 1.2-2.7), rural compared with urban place of residence (aOR, 1.8; 95% CI, 1.1-3.0) were associated with a higher risk of incident CKD. Lower preoperative eGFR was also associated with a higher risk of incident CKD. Management in private compared with public hospitals was also associated with a higher risk of CKD (aOR, 1.6; 95% CI, 1.2-2.2). Factors related to tumor size and cancer severity were also associated with worse postoperative kidney function, although it is likely this was a consequence of selection bias. CONCLUSION Patient characteristics have the strongest associations with incident CKD after radical nephrectomy. Potential risk factors were reasonably similar to recognized CKD risk factors for the general population. Patients who undergo nephrectomy who have CKD risk factors might benefit from ongoing postoperative screening for deterioration of kidney function.
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Affiliation(s)
- Robert J Ellis
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia.
| | - Victoria M White
- Cancer Council Victoria, Melbourne, Australia; Deakin University, Geelong, Australia
| | - Damien M Bolton
- Austin Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | | | - Ian D Davis
- Monash University, Melbourne, Australia; Eastern Health, Melbourne, Australia
| | - Ross S Francis
- Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia
| | - Graham G Giles
- Cancer Council Victoria, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Glenda C Gobe
- Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
| | - David J T Marco
- University of Melbourne, Melbourne, Australia; Centre for Palliative Care, Melbourne, Australia
| | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Simon T Wood
- Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
| | - Susan J Jordan
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; University of Queensland, Brisbane, Australia
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22
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O'Kane D, Baldwin GS, Bolton DM, Ischia JJ, Patel O. Preconditioning against renal ischaemia reperfusion injury: the failure to translate to the clinic. J Nephrol 2019; 32:539-547. [PMID: 30635875 DOI: 10.1007/s40620-019-00582-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 01/03/2019] [Indexed: 12/22/2022]
Abstract
Acute kidney injury (AKI) as a result of ischaemia-reperfusion represents a major healthcare burden worldwide. Mortality rates from AKI in hospitalized patients are extremely high and have changed little despite decades of research and medical advances. In 1986, Murry et al. demonstrated for the first time the phenomenon of ischaemic preconditioning to protect against ischaemia-reperfusion injury (IRI). This seminal finding paved the way for a broad body of research, which attempted to understand and ultimately harness this phenomenon for human application. The ability of preconditioning to limit renal IRI has now been demonstrated in multiple different animal models. However, more than 30 years later, a safe and consistent method of protecting human organs, including the kidneys, against IRI is still not available. This review highlights agents which, despite strong preclinical data, have recently failed to reduce AKI in human trials. The multiple reasons which may have contributed to the failure to translate some of the promising findings to clinical therapies are discussed. Agents which hold promise in the clinic because of their recent efficacy in preclinical large animal models are also reviewed.
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Affiliation(s)
- Dermot O'Kane
- Department of Surgery, Austin Health, The University of Melbourne, Studley Rd., Heidelberg, VIC, 3084, Australia
- Department of Urology, Austin Health, Heidelberg, VIC, Australia
| | - Graham S Baldwin
- Department of Surgery, Austin Health, The University of Melbourne, Studley Rd., Heidelberg, VIC, 3084, Australia
| | - Damien M Bolton
- Department of Surgery, Austin Health, The University of Melbourne, Studley Rd., Heidelberg, VIC, 3084, Australia
- Department of Urology, Austin Health, Heidelberg, VIC, Australia
| | - Joseph J Ischia
- Department of Surgery, Austin Health, The University of Melbourne, Studley Rd., Heidelberg, VIC, 3084, Australia
- Department of Urology, Austin Health, Heidelberg, VIC, Australia
| | - Oneel Patel
- Department of Surgery, Austin Health, The University of Melbourne, Studley Rd., Heidelberg, VIC, 3084, Australia.
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23
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Davis NF, Mulvihill JJ, Lynch JJ, Browne E, Bolton DM, Jack GS, Walsh MT. Digital and Mechanical Characterization of Ureteral Stent Luminal Reduction in Response to Extrinsic Compression Forces. J Endourol 2018; 32:1148-1153. [DOI: 10.1089/end.2018.0573] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Niall F. Davis
- Department of Urology, The Austin Hospital, Melbourne, Australia
| | - John J.E. Mulvihill
- Bernal Institute and the Health Research Institute, School of Engineering, University of Limerick, Limerick, Ireland
| | - James J. Lynch
- Bernal Institute and the Health Research Institute, School of Engineering, University of Limerick, Limerick, Ireland
| | - Eva Browne
- University Hospital Limerick, Limerick, Ireland
| | - Damien M. Bolton
- Department of Urology, The Austin Hospital, Melbourne, Australia
| | - Gregory S. Jack
- Department of Urology, The Austin Hospital, Melbourne, Australia
| | - Michael T. Walsh
- Bernal Institute and the Health Research Institute, School of Engineering, University of Limerick, Limerick, Ireland
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24
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Ow D, Gray D, Lawrentschuk N, Bolton DM, Sengupta S. Correspondence from specialist surgical outpatient clinics to general practitioners. ANZ J Surg 2018; 88:818-819. [PMID: 30182409 DOI: 10.1111/ans.14510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 02/16/2018] [Accepted: 02/25/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Darren Ow
- Austin Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Gray
- Olivia Newton-John Cancer & Wellness Centre, Austin Health, Melbourne, Victoria, Australia
| | - Nathan Lawrentschuk
- Austin Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Urology, Austin Health, Melbourne, Victoria, Australia
| | - Damien M Bolton
- Austin Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Urology, Austin Health, Melbourne, Victoria, Australia
| | - Shomik Sengupta
- Austin Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Urology, Austin Health, Melbourne, Victoria, Australia
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25
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Davis NF, Jack GS, Witjes WP, Bjartell A, Caris C, Patel A, de la Taille A, Lawrentschuk N, Bolton DM, Tubaro A. Medical therapy versus transurethral resection of the prostate (TURP) for the treatment of symptomatic benign prostatic enlargement (BPE): a cost minimisation analysis. World J Urol 2018; 37:873-878. [PMID: 30145778 DOI: 10.1007/s00345-018-2454-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/14/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE A cost minimisation analysis compares the costs of different interventions' to ascertain the least expensive over time. We compared different prostate targeted drug treatments with TURP to identify the optimal cost saving duration of a medical therapy for symptomatic benign prostatic enlargement (BPE). METHODS The Evolution registry is a prospective, multicentre registry, conducted by the European Association of Urology Research Foundation (EAUrf) for 24 months in 5 European countries. Evolution was designed to register the management of symptomatic BPE in clinical practice settings in 5 European countries. Direct cost evaluation associated with prostate targeted medical therapies and TURP was also recorded and analysed. RESULTS In total, 1838 men were enrolled with 1246 evaluable at 24 months. Medical therapies were more cost saving than TURP for treatment durations ranging from 2.9 to 70.4 years. Cost saving depended on both medication class and individual country assessed. Daily tamsulosin monotherapy was more cost saving than TURP for ≤ 13.9 years in Germany compared to ≤ 32.7 years in Italy. Daily finasteride monotherapy was more cost saving for ≤ 5.9 years in France compared to ≤ 36.9 years in Spain. Combination therapy was more cost saving for ≤ 5.9 years for Italian patients versus ≤ 13.8 years in Germany. CONCLUSIONS BPE medical management was more cost saving than TURP for different specific treatment durations. Information from this study will allow clinicians to convey medical and surgical costs over time, to both patients and payors alike, when considering BPE treatment.
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Affiliation(s)
- Niall F Davis
- Department of Urology, The Austin Hospital, Heidelberg, Melbourne, 3084, Australia.
| | - G S Jack
- Department of Urology, The Austin Hospital, Heidelberg, Melbourne, 3084, Australia
| | - W P Witjes
- EAU Research Foundation, P.O. Box 30016, 6803 AA, Arnhem, The Netherlands
| | - A Bjartell
- EAU Research Foundation, P.O. Box 30016, 6803 AA, Arnhem, The Netherlands.,Department of Urology, Lund University, Skane Hospital, Malmö, Sweden
| | - C Caris
- EAU Research Foundation, P.O. Box 30016, 6803 AA, Arnhem, The Netherlands
| | - A Patel
- Department of Urology, Spire London East Hospital, Roding Lane South, Redbridge, Essex, Ilford, IG4 5PZ, UK
| | - A de la Taille
- Department of Urology, Assistance Publique des Hopitaux de Paris, 54 av du Mal de Lattre de Tassigny, 94000, Créteil, France
| | - N Lawrentschuk
- Department of Urology, The Austin Hospital, Heidelberg, Melbourne, 3084, Australia
| | - D M Bolton
- Department of Urology, The Austin Hospital, Heidelberg, Melbourne, 3084, Australia
| | - A Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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26
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Sathianathen NJ, Kuntz KM, Alarid-Escudero F, Lawrentschuk NL, Bolton DM, Murphy DG, Weight CJ, Konety BR. Incorporating Biomarkers into the Primary Prostate Biopsy Setting: A Cost-Effectiveness Analysis. J Urol 2018; 200:1215-1220. [PMID: 29906434 DOI: 10.1016/j.juro.2018.06.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE We performed a cost-effectiveness analysis using the PHI (Prostate Health Index), 4Kscore®, SelectMDx™ and the EPI (ExoDx™ Prostate [IntelliScore]) in men with elevated prostate specific antigen to determine the need for biopsy. MATERIALS AND METHODS We developed a decision analytical model in men with elevated prostate specific antigen (3 ng/ml or greater) in which 1 biomarker test was used to determine which hypothetical individuals required biopsy. In the current standard of care strategy all individuals underwent biopsy. Model parameters were derived from a comprehensive review of the literature. Costs were calculated from a health sector perspective and converted into 2017 United States dollars. RESULTS The cost and QALYs (quality adjusted life-years) of the current standard of care, which was transrectal ultrasound guided biopsy, was $3,863 and 18.085, respectively. Applying any of the 3 biomarkers improved quality adjusted survival compared to the current standard of care. The cost of SelectMDx, the PHI and the EPI was lower than performing prostate biopsy in all patients. However, the PHI was more costly and less effective than the SelectMDx strategy. The EPI provided the highest QALY with an incremental cost-effectiveness ratio of $58,404 per QALY. The use of biomarkers could reduce the number of unnecessary biopsies by 24% to 34% compared to the current standard of care. CONCLUSIONS Applying biomarkers in men with elevated prostate specific antigen to determine the need for biopsy improved quality adjusted survival by decreasing the number of biopsies performed and the treatment of indolent disease. Using SelectMDx or the EPI following elevated prostate specific antigen but before proceeding to biopsy is a cost-effective strategy in this setting.
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Affiliation(s)
- Niranjan J Sathianathen
- Department of Urology, University of Minnesota, Minneapolis, Minnesota; Department of Surgery, Urology Unit and Olivia Newton-John Cancer Research Institute Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Karen M Kuntz
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Fernando Alarid-Escudero
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Nathan L Lawrentschuk
- Department of Surgery, Urology Unit and Olivia Newton-John Cancer Research Institute Austin Health, University of Melbourne, Melbourne, Victoria, Australia; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Damien M Bolton
- Department of Surgery, Urology Unit and Olivia Newton-John Cancer Research Institute Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Declan G Murphy
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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27
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Ahn T, Ellis RJ, White VM, Bolton DM, Coory MD, Davis ID, Francis RS, Giles GG, Gobe GC, Hawley CM, Johnson DW, Marco DJT, McStea M, Neale RE, Pascoe EM, Wood ST, Jordan SJ. Predictors of new-onset chronic kidney disease in patients managed surgically for T1a renal cell carcinoma: An Australian population-based analysis. J Surg Oncol 2018; 117:1597-1610. [PMID: 29790163 DOI: 10.1002/jso.25037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/09/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND New-onset chronic kidney disease (CKD) following surgical management of kidney tumors is common. This study evaluated risk factors for new-onset CKD after nephrectomy for T1a renal cell carcinoma (RCC) in an Australian population-based cohort. METHODS There were 551 RCC patients from the Australian states of Queensland and Victoria included in this study. The primary outcome was new-onset CKD (eGFR <60 mL/min per 1.73 m2 ) and the secondary outcome was new-onset moderate-severe CKD (<45 mL/min per 1.73 m2 ). Multivariable logistic regression was used to evaluate associations between patient, tumor and health-service characteristics and these outcomes. RESULTS Forty percent (219/551) of patients developed new-onset CKD, and 12% (68/551) experienced new-onset moderate-severe CKD. Risk factors for new-onset CKD were age, lower preoperative eGFR, tumor size >20 mm, radical nephrectomy, lower hospital caseloads (<20 cases/year), and rural place of residence. The associations between rural place of residence and low center volume were a consequence of higher radical nephrectomy rates. CONCLUSION Risk factors for CKD after nephrectomy generally relate to worse baseline health, or likelihood of undergoing radical nephrectomy. Surgeons in rural centres and hospitals with low caseloads may benefit from formalized integration with specialist centers for continued professional development and case-conferencing, to assist in management decisions.
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Affiliation(s)
- Thomas Ahn
- Princess Alexandra Hospital, Brisbane, Australia
| | - Robert J Ellis
- Princess Alexandra Hospital, Brisbane, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Victoria M White
- Cancer Council Victoria, Melbourne, Australia.,Deakin University, Geelong, Australia
| | - Damien M Bolton
- Austin Health, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | | | - Ian D Davis
- Monash University, Melbourne, Australia.,Eastern Health, Melbourne, Australia
| | - Ross S Francis
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Graham G Giles
- Cancer Council Victoria, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Glenda C Gobe
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Carmel M Hawley
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - David W Johnson
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | | | - Megan McStea
- University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Elaine M Pascoe
- University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Simon T Wood
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Susan J Jordan
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,University of Queensland, Brisbane, Australia
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28
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Davis NF, Cunnane EM, Mulvihill JJ, Quinlan MR, Bolton DM, Walsh MT, Jack GS. The Role of Stem Cells for Reconstructing the Lower Urinary Tracts. Curr Stem Cell Res Ther 2018; 13:458-465. [PMID: 29697030 DOI: 10.2174/1574888x13666180426113907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The urinary bladder and urethra comprise the lower urinary tracts. Pathological conditions that affect both structures necessitate reconstructive urological intervention with autologous tissue sources that cause neuromechanical and metabolic complications. Stem-cell therapies may offer an attractive alternative as they can replicate important host derived cellular functions such as mitosis, proliferation, differentiation and apoptosis. OBJECTIVE To provide an overview on the application of stem cell therapies for regenerating the lower urinary tracts and to discuss factors that need to be addressed before stem-cells can be reliably introduced into clinical urological practice. RESULTS Advantages of stem cells in reconstructive urology are their ability to self-renew and their durability. Mesenchymal stem cells (MSCs), embryonic stem cells (ESCs) and adult stem cells (ASCs) demonstrate excellent urological regenerative properties. Repairing defective lower urinary tract structures with various stem-cell derived therapies has been widely reported with encouraging results in vitro and in pre-clinical in vivo trials. Ethical considerations, cost, regulation, manufacturing and reimbursement need to be fully transparent before stem-cells are routinely applied to urological patients. International collaboration with consensus guidelines should be considered to facilitate standards that allow safe use of stem-cell therapies in urology. CONCLUSION Stem cells therapies in urology are developing rapidly with many important achievements to date. Despite promising in vitro and pre-clinical data; implementation of stem cells into daily urological practice is not imminent. Further investigation is required to determine whether stem-cells will provide better clinical outcomes than current urological tissue replacement strategies.
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Affiliation(s)
- Niall F Davis
- Department of Urology, The Austin Hospital, Melbourne, Australia
| | - Eoghan M Cunnane
- School of Engineering, Bernal Institute and the Health Research Institute, University of Limerick, Limerick, Ireland
| | - John J Mulvihill
- School of Engineering, Bernal Institute and the Health Research Institute, University of Limerick, Limerick, Ireland
| | - Mark R Quinlan
- Department of Urology, The Austin Hospital, Melbourne, Australia
| | - Damien M Bolton
- Department of Urology, The Austin Hospital, Melbourne, Australia
| | - Michael T Walsh
- School of Engineering, Bernal Institute and the Health Research Institute, University of Limerick, Limerick, Ireland
| | - Gregory S Jack
- Department of Urology, The Austin Hospital, Melbourne, Australia
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29
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Cabarkapa S, Perera M, Sikaris K, O’Brien JS, Bolton DM, Lawrentschuk N. Reporting and ideal testosterone levels in men undergoing androgen deprivation for prostate cancer-time for a rethink? Prostate Int 2018; 6:1-6. [PMID: 29556482 PMCID: PMC5857188 DOI: 10.1016/j.prnil.2017.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 05/01/2017] [Accepted: 05/18/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study aims to review current laboratory reporting strategies across Australia and New Zealand with a view to propose a more useful template for reporting serum testosterone in the context of prostate cancer. MATERIALS AND METHODS Registered pathology laboratories in Australia and New Zealand were enrolled into the current study. An electronic or a phone survey was utilized to collect data from each participating laboratory. Obtained information included assay utilized, units reported, reference intervals, lowest reported value, and lowest detectable value. To identify recommendations for testosterone testing, a systematic search was performed across Web of Science (including MEDLINE), EMBASE, and Cochrane libraries. RESULTS Assessment of national pathology laboratories identified significant heterogeneity in the reporting methods. Reports typically used a "normal healthy male of 35 years of age" as a comparator but did not refer to optimal castrate levels, the lowest level that their assay was able to detect, nor did they include appended clinical guidelines relating to the prostate cancer patient cohort. CONCLUSIONS Across Australia and New Zealand, various methods for testing and reporting serum testosterone exist, while international guidelines remain vague. The fashion in which serum testosterone levels are displayed should be re-evaluated to address the relevant clinical population and reflect an agreed-upon castrate threshold in patients undergoing androgen deprivation therapy.
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Affiliation(s)
- Sonja Cabarkapa
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia
| | - Marlon Perera
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia
| | - Ken Sikaris
- Department of Pathology, University of Melbourne, Melbourne, Australia
| | - Jonathan S. O’Brien
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia
| | - Damien M. Bolton
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia
- Department of Pathology, University of Melbourne, Melbourne, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia
- Olivia Newton-John Cancer Research Institute, Austin Hospital, Melbourne, Australia
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
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30
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Ma JL, Hennessey DB, Newell BP, Bolton DM, Lawrentschuk N. Radiotherapy-related complications presenting to a urology department: a more common problem than previously thought? BJU Int 2018; 121 Suppl 3:28-32. [PMID: 29360286 DOI: 10.1111/bju.14145] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To quantify the burden of the side effects of radiotherapy on a tertiary referral urology department. PATIENTS AND METHODS A prospective study of all urology admissions to a public urology department at a tertiary hospital in a 6-month period was performed. Patients admitted with complications attributable to radiotherapy were included in the study. Data obtained included patient demographics, radiotherapy details, complication type and management required. RESULTS A total of 1198 patients were admitted; 921 (77%) were elective and 277 (23%) were emergency admissions. Thirteen out of the 921 (1.4%) elective admissions and 20 out of the 277 (7.2%) emergency admissions were attributable to radiotherapy complications. Radiotherapy complications was the fourth most common reason for emergency admission, ahead of acute urinary retention. These 33 admissions were accounted for by 21 patients. A total of 39 separate complications attributable to radiotherapy were diagnosed, with some patients having multiple complications. The median (interquartile range) time to onset of complications was 4 (1-9) years. The surgical intervention rate was 67%. The commonest procedures were washout with/without clot evacuation or diathermy in theatre (15.8%) and urethral dilatation/bladder neck incision (15.8%). Two urinary diversions and two cystoprostatectomies plus urinary diversion were performed. CONCLUSION Radiotherapy complications are consequential and account for a substantial proportion of a tertiary urology department's emergency workload. These complications generally occur years after radiotherapy and frequently require surgical intervention.
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Affiliation(s)
- Joyce L Ma
- Department of Urology, Austin Health, Heidelberg, Vic., Australia
| | | | - Bradley P Newell
- Department of Urology, Austin Health, Heidelberg, Vic., Australia
| | - Damien M Bolton
- Department of Urology, Austin Health, Heidelberg, Vic., Australia.,Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia
| | - Nathan Lawrentschuk
- Department of Urology, Austin Health, Heidelberg, Vic., Australia.,Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia
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Davis NF, McGrath S, Quinlan M, Jack G, Lawrentschuk N, Bolton DM. Carbon Footprint in Flexible Ureteroscopy: A Comparative Study on the Environmental Impact of Reusable and Single-Use Ureteroscopes. J Endourol 2018; 32:214-217. [PMID: 29373918 DOI: 10.1089/end.2018.0001] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE There are no comparative assessments on the environmental impact of endourologic instruments. We evaluated and compared the environmental impact of single-use flexible ureteroscopes with reusable flexible ureteroscopes. PATIENTS AND METHODS An analysis of the typical life cycle of the LithoVue™ (Boston Scientific) single-use digital flexible ureteroscope and Olympus Flexible Video Ureteroscope (URV-F) was performed. To measure the carbon footprint, data were obtained on manufacturing of single-use and reusable flexible ureteroscopes and from typical uses obtained with a reusable scope, including repairs, replacement instruments, and ultimate disposal of both ureteroscopes. The solid waste generated (kg) and energy consumed (kWh) during each case were quantified and converted into their equivalent mass of carbon dioxide (kg of CO2) released. RESULTS Flexible ureteroscopic raw materials composed of plastic (90%), steel (4%), electronics (4%), and rubber (2%). The manufacturing cost of a flexible ureteroscope was 11.49 kg of CO2 per 1 kg of ureteroscope. The weight of the single-use LithoVue and URV-F flexible ureteroscope was 0.3 and 1 kg, respectively. The total carbon footprint of the lifecycle assessment of the LithoVue was 4.43 kg of CO2 per endourologic case. The total carbon footprint of the lifecycle of the reusable ureteroscope was 4.47 kg of CO2 per case. CONCLUSION The environmental impacts of the reusable flexible ureteroscope and the single-use flexible ureteroscope are comparable. Urologists should be aware that the typical life cycle of urologic instruments is a concerning source of environmental emissions.
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Affiliation(s)
- Niall F Davis
- Department of Urology, Austin Hospital , Melbourne, Australia
| | - Shannon McGrath
- Department of Urology, Austin Hospital , Melbourne, Australia
| | - Mark Quinlan
- Department of Urology, Austin Hospital , Melbourne, Australia
| | - Gregory Jack
- Department of Urology, Austin Hospital , Melbourne, Australia
| | | | - Damien M Bolton
- Department of Urology, Austin Hospital , Melbourne, Australia
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Manning TG, O’Brien JS, Christidis D, Perera M, Coles-Black J, Chuen J, Bolton DM, Lawrentschuk N. Three dimensional models in uro-oncology: a future built with additive fabrication. World J Urol 2018; 36:557-563. [DOI: 10.1007/s00345-018-2201-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/19/2018] [Indexed: 02/06/2023] Open
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Hennessey DB, Wei G, Moon D, Kinnear N, Bolton DM, Lawrentschuk N, Chan YK. Strategies for success: a multi-institutional study on robot-assisted partial nephrectomy for complex renal lesions. BJU Int 2017; 121 Suppl 3:40-47. [DOI: 10.1111/bju.14059] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Derek B. Hennessey
- Department of Surgery; Austin Health; University of Melbourne; Melbourne Vic. Australia
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
| | - Gavin Wei
- Department of Surgery; Austin Health; University of Melbourne; Melbourne Vic. Australia
| | - Daniel Moon
- Olivia Newton-John Cancer and Wellness Centre; Austin Health; Heidelberg Vic. Australia
- Epworth Freemasons Hospital; East Melbourne Vic. Australia
| | - Ned Kinnear
- Department of Surgery; Austin Health; University of Melbourne; Melbourne Vic. Australia
| | - Damien M. Bolton
- Department of Surgery; Austin Health; University of Melbourne; Melbourne Vic. Australia
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
| | - Nathan Lawrentschuk
- Department of Surgery; Austin Health; University of Melbourne; Melbourne Vic. Australia
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
- Olivia Newton-John Cancer and Wellness Centre; Austin Health; Heidelberg Vic. Australia
- Epworth Richmond Hospital; Richmond Vic. Australia
| | - Yee K. Chan
- Department of Surgery; Austin Health; University of Melbourne; Melbourne Vic. Australia
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
- Epworth Richmond Hospital; Richmond Vic. Australia
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Davis NF, Mulvihill JJE, Mulay S, Cunnane EM, Bolton DM, Walsh MT. Urinary Bladder vs Gastrointestinal Tissue: A Comparative Study of Their Biomechanical Properties for Urinary Tract Reconstruction. Urology 2017; 113:235-240. [PMID: 29197522 DOI: 10.1016/j.urology.2017.11.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/14/2017] [Accepted: 11/18/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the mechanical properties of gastrointestinal (GI) tissue segments and to compare them with the urinary bladder for urinary tract reconstruction. METHODS Urinary bladders and GI tissue segments were sourced from porcine models (n = 6, 7 months old [5 male; 1 female]). Uniaxial planar tension tests were performed on bladder tissue, and Cauchy stress-stretch ratio responses were compared with stomach, jejunum, ileum, and colonic GI tissue. RESULTS The biomechanical properties of the bladder differed significantly from jejunum, ileum, and colonic GI tissue. Young modulus (kPa-measure of stiffness) of the GI tissue segments was on average 3.07-fold (±0.21 standard error) higher than bladder tissue (P < .01), and the strain at Cauchy stress of 50 kPa for bladder tissues was on average 2.27-fold (±0.20) higher than GI tissues. There were no significant differences between the averaged stretch ratio and Young modulus of the horizontal and vertical directions of bladder tissue (315.05 ± 49.64 kPa and 283.62 ± 57.04, respectively, P = .42). However, stomach tissues were 1.09- (±0.17) and 0.85- (±0.03) fold greater than bladder tissues for Young modulus and strain at 50 kPa, respectively. CONCLUSION An ideal urinary bladder replacement biomaterial should demonstrate mechanical equivalence to native tissue. Our findings demonstrate that GI tissue does not meet these mechanical requirements. Knowledge on the biomechanical properties of bladder and GI tissue may improve development opportunities for more suitable urologic reconstructive biomaterials.
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Affiliation(s)
- N F Davis
- Department of Urology, The Austin Hospital, Melbourne, Victoria, Australia.
| | - J J E Mulvihill
- School of Engineering, Bernal Institute and the Health Research Institute, University of Limerick, Limerick, Ireland
| | - S Mulay
- School of Engineering, Bernal Institute and the Health Research Institute, University of Limerick, Limerick, Ireland
| | - E M Cunnane
- School of Engineering, Bernal Institute and the Health Research Institute, University of Limerick, Limerick, Ireland
| | - D M Bolton
- Department of Urology, The Austin Hospital, Melbourne, Victoria, Australia
| | - M T Walsh
- School of Engineering, Bernal Institute and the Health Research Institute, University of Limerick, Limerick, Ireland
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Davis NF, Quinlan MR, Browne C, Bhatt NR, Manecksha RP, D'Arcy FT, Lawrentschuk N, Bolton DM. Single-use flexible ureteropyeloscopy: a systematic review. World J Urol 2017; 36:529-536. [PMID: 29177820 DOI: 10.1007/s00345-017-2131-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/13/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Data assessing the effectiveness of single-use flexible ureteropyeloscopy (FURS) are limited. This study evaluates and compares single-use FURS with conventional reusable FURS. METHODS A systematic search using electronic databases (Pubmed and Embase) was performed for studies evaluating single-use FURS in the setting of urinary tract stone disease. Outcome measures included a comparative evaluation of their mechanical, optical and clinical outcomes. RESULTS Eleven studies on 466 patients met inclusion criteria. In vitro comparative data were available on three single-use flexible ureteropyeloscopes (LithoVue™, Polyscope™ and SemiFlex™) and clinical data were available on two (LithoVue™ and Polyscope™). The overall stone-free rate and complication rate associated with single-use FURS was 87 ± 15% and 9.3 ± 9%, respectively. There were no significant differences in procedure duration, stone size, stone clearance and complication rates when single-use FURS and reusable FURS were compared (duration: 73 ± 27 versus 74 ± 13 min, p = 0.99; stone size: 1.36 ± 0.2 versus 1.34 ± 0.18 cm, p = 0.93; stone-free rate: 77.8 ± 18 versus 68.5 ± 33%, p = 0.76; complication rate 15.3 ± 10.6 versus 15 ± 1.6%, p = 0.3). CONCLUSIONS Single-use FURS demonstrates comparable efficacy with reusable FURS in treating renal calculi. Further studies on clinical efficacy and cost are needed to determine whether single-use FURS will reliably replace its reusable counterpart.
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Affiliation(s)
- N F Davis
- Department of Urology, Austin Hospital, Melbourne, Australia
| | - M R Quinlan
- Department of Urology, Austin Hospital, Melbourne, Australia
| | - C Browne
- Department of Urology, Tallaght Hospital, Dublin, Ireland
| | - N R Bhatt
- Department of Urology, Tallaght Hospital, Dublin, Ireland
| | - R P Manecksha
- Department of Urology, Tallaght Hospital, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - F T D'Arcy
- Department of Urology, University Hospital Galway, Galway, Ireland
| | - N Lawrentschuk
- Department of Urology, Austin Hospital, Melbourne, Australia
| | - D M Bolton
- Department of Urology, Austin Hospital, Melbourne, Australia.
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Porter LH, Hashimoto K, Lawrence MG, Pezaro C, Clouston D, Wang H, Papargiris M, Thorne H, Li J, Ryan A, Norden S, Moon D, Bolton DM, Sengupta S, Frydenberg M, Murphy DG, Risbridger GP, Taylor RA. Intraductal carcinoma of the prostate can evade androgen deprivation, with emergence of castrate-tolerant cells. BJU Int 2017; 121:971-978. [DOI: 10.1111/bju.14043] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Laura H. Porter
- Department of Anatomy and Developmental Biology; Biomedicine Discovery Institute; Cancer Program; Monash University; Melbourne Vic. Australia
- Prostate Cancer Research Program; Cancer Research Division; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
| | - Kohei Hashimoto
- Department of Anatomy and Developmental Biology; Biomedicine Discovery Institute; Cancer Program; Monash University; Melbourne Vic. Australia
- Department of Urology; Sapporo Medical University School of Medicine; Sapporo Hokkaido Japan
| | - Mitchell G. Lawrence
- Department of Anatomy and Developmental Biology; Biomedicine Discovery Institute; Cancer Program; Monash University; Melbourne Vic. Australia
- Prostate Cancer Research Program; Cancer Research Division; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
| | - Carmel Pezaro
- Department of Anatomy and Developmental Biology; Biomedicine Discovery Institute; Cancer Program; Monash University; Melbourne Vic. Australia
- Eastern Health Clinical School; Monash University; Melbourne Vic. Australia
| | | | - Hong Wang
- Department of Anatomy and Developmental Biology; Biomedicine Discovery Institute; Cancer Program; Monash University; Melbourne Vic. Australia
| | - Melissa Papargiris
- Department of Anatomy and Developmental Biology; Biomedicine Discovery Institute; Cancer Program; Monash University; Melbourne Vic. Australia
- Australian Prostate Cancer Bioresource; Victorian Node; Monash University; Melbourne Vic. Australia
| | - Heather Thorne
- kConFab, Research Department; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Vic. Australia
| | - Jason Li
- Bioinformatics Core; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
| | | | - Sam Norden
- TissuPath; Mount Waverley Vic. Australia
| | - Daniel Moon
- Epworth Healthcare; Richmond Vic. Australia
- Central Clinical School; Monash University; Melbourne Vic. Australia
| | - Damien M. Bolton
- Department of Urology; Austin Hospital, Melbourne; Heidelberg Vic. Australia
- Department of Surgery; University of Melbourne; Melbourne Vic. Australia
| | - Shomik Sengupta
- Department of Urology; Austin Hospital, Melbourne; Heidelberg Vic. Australia
- Department of Surgery; University of Melbourne; Melbourne Vic. Australia
| | - Mark Frydenberg
- Department of Anatomy and Developmental Biology; Biomedicine Discovery Institute; Cancer Program; Monash University; Melbourne Vic. Australia
- Department of Surgery; Monash University; Melbourne Vic. Australia
| | - Declan G. Murphy
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Vic. Australia
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
| | - Gail P. Risbridger
- Department of Anatomy and Developmental Biology; Biomedicine Discovery Institute; Cancer Program; Monash University; Melbourne Vic. Australia
- Prostate Cancer Research Program; Cancer Research Division; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
| | - Renea A. Taylor
- Department of Anatomy and Developmental Biology; Biomedicine Discovery Institute; Cancer Program; Monash University; Melbourne Vic. Australia
- Department of Physiology; Biomedicine Discovery Institute; Cancer Program; Monash University; Melbourne Vic. Australia
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Abstract
OBJECTIVE To evaluate the minimally invasive percutaneous nephrolithotomy (MIP) system for renal calculi. PATIENTS AND METHODS Consecutive patients undergoing mini-percutaneous nephrolithotomy (mPCNL) procedures with the MIP system were enrolled. Patient position, American Society of Anesthesiologists classification, puncture location, stone clearance, postoperative drainage and complications were recorded, and features unique to MIP were noted. RESULTS In all, 30 patients underwent 32 mPCNL procedures. The mean stone size was 17 (10.75-21.25) mm and the mean number of stones was 1 (1-2). The median stone clearance rate was 96.5 (95-100)%. The complication rate was 9.3%. No patient required a transfusion. In addition to these outcomes, we noted that the MIP system has many advantages over conventional PCNL (cPCNL). It is easy to learn and can be performed in both supine and prone positions. It is safe for supracostal puncture, provides excellent access to nearly all calyces and upper ureter, has multiple stone treatment options, can be used as an adjunct to cPCNL, and can be performed as a tubeless procedure. CONCLUSION Our experience with the MIP system has shown several advantages over cPCNL. mPCNL with the MIP system has several features that suggest it should be considered as an alternative or adjunct to cPCNL, ureteroscopy and extracorporeal shockwave lithotripsy.
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Affiliation(s)
| | - Ned K Kinnear
- Department of Urology, Austin Health, Heidelberg, Vic., Australia
| | - Andrew Troy
- Department of Urology, Austin Health, Heidelberg, Vic., Australia.,Epworth Freemasons Hospital, East Melbourne, Vic., Australia
| | - David Angus
- Department of Urology, Austin Health, Heidelberg, Vic., Australia.,Warringal Private Hospital, Heidelberg, Vic., Australia
| | - Damien M Bolton
- Department of Urology, Austin Health, Heidelberg, Vic., Australia.,Warringal Private Hospital, Heidelberg, Vic., Australia
| | - David R Webb
- Department of Urology, Austin Health, Heidelberg, Vic., Australia.,Epworth Freemasons Hospital, East Melbourne, Vic., Australia
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Affiliation(s)
| | - John Yaxley
- Wesley Urology Clinic; Brisbane Qld Australia
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Goonewardene SS, Bolton DM, Lawrentschuk N. Erratum to: Robotic radical cystectomy: technical tips and tricks. J Robot Surg 2017; 11:387. [PMID: 28405873 DOI: 10.1007/s11701-017-0698-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - D M Bolton
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia
| | - N Lawrentschuk
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia.,Olivia Newton John Cancer Research Institute, Melbourne, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Porter LH, Lawrence MG, Ilic D, Clouston D, Bolton DM, Frydenberg M, Murphy DG, Pezaro C, Risbridger GP, Taylor RA. Systematic Review Links the Prevalence of Intraductal Carcinoma of the Prostate to Prostate Cancer Risk Categories. Eur Urol 2017; 72:492-495. [PMID: 28342640 DOI: 10.1016/j.eururo.2017.03.013] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/07/2017] [Indexed: 02/08/2023]
Abstract
Intraductal carcinoma of the prostate (IDC-P) is associated with poor prognosis. While it is often regarded as a rare pathology, the prevalence of IDC-P remains unclear, with variable reports from small and disparate patient populations. To determine how common IDC-P is across the spectrum of prostate cancer, we conducted a systematic review correlating IDC-P prevalence with prostate cancer risk. Electronic searches of the OVID Medline, PubMed, and Scopus literature databases identified 38 patient cohorts in 24 articles, which were divided between four prostate cancer risk categories (low, moderate, high, and recurrent or metastatic disease). This review, which included radical prostatectomy and prostate biopsy specimens from >7000 patients, revealed an unexpectedly high rate of IDC-P. The IDC-P prevalence increased from 2.1% in low-risk patient cohorts to 23.1%, 36.7%, and 56.0% in moderate-risk, high-risk, and metastatic or recurrent disease risk categories, respectively (p<0.0001). IDC-P was also highly prevalent in tumours following androgen deprivation therapy or chemotherapy (60%). Contrary to common perceptions, this study demonstrates a strong association between IDC-P prevalence and aggressive prostate cancer, with a significantly higher frequency in high-risk disease. Greater recognition and systematic reporting of IDC-P may improve patient risk stratification. PATIENT SUMMARY Prostate cancer can grow within ducts of the prostate, as well as in prostate tissue. By reviewing all reports describing prostate cancer growing within ducts, we found that it occurs more commonly than many scientists and clinicians appreciate, especially in aggressive prostate cancers. We conclude that there should be more awareness of this pattern of prostate cancer.
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Affiliation(s)
- Laura H Porter
- Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Melbourne, Australia; Prostate Cancer Research Program, Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Mitchell G Lawrence
- Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Melbourne, Australia; Prostate Cancer Research Program, Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Dragan Ilic
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Damien M Bolton
- Department of Urology, Austin Hospital, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Mark Frydenberg
- Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Australian Prostate Cancer Research Centre, Epworth Healthcare, Richmond, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
| | - Carmel Pezaro
- Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Melbourne, Australia; Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Gail P Risbridger
- Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Melbourne, Australia; Prostate Cancer Research Program, Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Renea A Taylor
- Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Melbourne, Australia; Prostate Cancer Research Program, Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Australia.
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Ow D, Papa N, Perera M, Liodakis P, Sengupta S, Clarke S, Bolton DM, Lawrentschuk N. Trends in the surgical treatment of benign prostatic hyperplasia in a tertiary hospital. ANZ J Surg 2017; 88:95-99. [PMID: 28317227 DOI: 10.1111/ans.13904] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/06/2016] [Accepted: 12/09/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND To assess current treatment trends and perioperative outcomes of transurethral resection of the prostate (TURP) and photoselective vaporization of the prostate (PVP) in a tertiary institution. METHODS We prospectively collected a database of all patients undergoing TURP and PVP for benign prostatic hyperplasia (BPH) at a tertiary hospital between January 2011 and December 2013. Patient characteristics such as length of stay, readmission, anticoagulation status, American Society of Anesthesiologists (ASA) score and need for blood transfusion were recorded and analysed. RESULTS In total, 560 cases were included: 204 (36.4%) underwent TURP and 356 (63.6%) PVP. Patients undergoing PVP had higher ASA scores (P < 0.001) and were more frequently on continuing anticoagulant therapy (P < 0.001). With regards to non-aspirin/asasantin coagulation therapy, 61 (17.1%) patients underwent PVP with their anticoagulants continued while no patients who received TURP continued anticoagulation. Blood transfusion percentages were similar at 1.0% for TURP and 1.7% for PVP but readmission proportions were higher after PVP (32 patients, 9.0%) compared to TURP (10 patients, 4.9%). These differences were attenuated when excluding patients continuing anticoagulation during the procedure. CONCLUSION At our institution, the use of PVP has been increasing on a year-by-year basis. The results of the current study demonstrated that PVP is safe in patients with increased anaesthetic risk or on active anticoagulation when compared to traditional TURP. While this makes PVP an attractive alternative to TURP in high-risk anticoagulated patients, these patients may have complex post-discharge issues that should be addressed during the informed consent process.
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Affiliation(s)
- Darren Ow
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nathan Papa
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marlon Perera
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Liodakis
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shomik Sengupta
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.,Olivia Newton-John for Cancer Research Institute, Heidelberg Branch, Austin Health, Melbourne, Victoria, Australia
| | - Stephen Clarke
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Damien M Bolton
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.,Olivia Newton-John for Cancer Research Institute, Heidelberg Branch, Austin Health, Melbourne, Victoria, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.,Olivia Newton-John for Cancer Research Institute, Heidelberg Branch, Austin Health, Melbourne, Victoria, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Yow MA, Tabrizi SN, Severi G, Bolton DM, Pedersen J, Giles GG, Southey MC. Characterisation of microbial communities within aggressive prostate cancer tissues. Infect Agent Cancer 2017; 12:4. [PMID: 28101126 PMCID: PMC5237345 DOI: 10.1186/s13027-016-0112-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/13/2016] [Indexed: 12/11/2022] Open
Abstract
Background An infectious aetiology for prostate cancer has been conjectured for decades but the evidence gained from questionnaire-based and sero-epidemiological studies is weak and inconsistent, and a causal association with any infectious agent is not established. We describe and evaluate the application of new technology to detect bacterial and viral agents in high-grade prostate cancer tissues. The potential of targeted 16S rRNA gene sequencing and total RNA sequencing was evaluated in terms of its utility to characterise microbial communities within high-grade prostate tumours. Methods Two different Massively Parallel Sequencing (MPS) approaches were applied. First, to capture and enrich for possible bacterial species, targeted-MPS of the V2-V3 hypervariable regions of the 16S rRNA gene was performed on DNA extracted from 20 snap-frozen prostate tissue cores from ten “aggressive” prostate cancer cases. Second, total RNA extracted from the same prostate tissue samples was also sequenced to capture the sequence profile of both bacterial and viral transcripts present. Results Overall, 16S rRNA sequencing identified Enterobacteriaceae species common to all samples and P. acnes in 95% of analyzed samples. Total RNA sequencing detected endogenous retroviruses providing proof of concept but there was no evidence of bacterial or viral transcripts suggesting active infection, although it does not rule out a previous ‘hit and run’ scenario. Conclusions As these new investigative methods and protocols become more refined, MPS approaches may be found to have significant utility in identifying potential pathogens involved in disease aetiology. Further studies, specifically designed to detect associations between the disease phenotype and aetiological agents, are required. Electronic supplementary material The online version of this article (doi:10.1186/s13027-016-0112-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Melissa A Yow
- Genetic Epidemiology Laboratory, Department of Pathology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, VIC, Australia 3010
| | - Sepehr N Tabrizi
- Department of Microbiology and Infectious Diseases, Royal Women's Hospital, Parkville, VIC Australia 3052 ; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC Australia 3010 ; Murdoch Childrens Research Institute, Parkville, VIC Australia 3052
| | - Gianluca Severi
- Human Genetics Foundation (HuGeF), Via Nizza, 52-10126 Torino, Italy
| | - Damien M Bolton
- Department of Surgery, University of Melbourne, Austin Health, 145 Studley Road, Heidelberg, VIC Australia 3084
| | - John Pedersen
- TissuPath, 92-96 Ricketts Road, Mount Waverley, VIC Australia 3149
| | | | - Graham G Giles
- Cancer Epidemiology and Intelligence Division, Cancer Epidemiology Centre, Cancer Council Victoria, Level 2, 615 St Kilda Road, Melbourne, VIC Australia 3004 ; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC Australia 3053
| | - Melissa C Southey
- Genetic Epidemiology Laboratory, Department of Pathology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, VIC, Australia 3010
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Rukstalis D, Rashid P, Bogache WK, Tutrone RF, Barkin J, Chin PT, Woo HH, Cantwell AL, Cowan BE, Bolton DM. 24-month durability after crossover to the prostatic urethral lift from randomised, blinded sham. BJU Int 2016; 118 Suppl 3:14-22. [DOI: 10.1111/bju.13666] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Prem Rashid
- Urology Centre; Port Macquarie NSW Australia
| | | | | | - Jack Barkin
- Toronto Urology Clinical Study Group; Toronto ON Canada
| | | | - Henry H. Woo
- Sydney Adventist Hospital Clinical School; Wahroonga NSW Australia
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Toner L, Papa N, Perera M, Katelaris N, Weerakoon M, Chin K, Harewood L, Bolton DM, Lawrentschuk N. Multiparametric magnetic resonance imaging for prostate cancer—a comparative study including radical prostatectomy specimens. World J Urol 2016; 35:935-941. [DOI: 10.1007/s00345-016-1960-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/19/2016] [Indexed: 01/26/2023] Open
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O'Kane D, Papa N, Manning T, Quinn J, Hawes A, Smith N, McClintock S, Lawrentschuk N, Bolton DM. Contemporary Accuracy of Digital Abdominal X-Ray for Follow-Up of Pure Calcium Urolithiasis: Is There Still a Role? J Endourol 2016; 30:844-9. [DOI: 10.1089/end.2016.0173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Dermot O'Kane
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Surgery, University of Melbourne, Victoria, Australia
| | - Nathan Papa
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Todd Manning
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Surgery, University of Melbourne, Victoria, Australia
| | - Jonathan Quinn
- School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Alice Hawes
- School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Neil Smith
- Department of Urology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Scott McClintock
- Department of Urology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Nathan Lawrentschuk
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Surgery, University of Melbourne, Victoria, Australia
| | - Damien M. Bolton
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Surgery, University of Melbourne, Victoria, Australia
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Lawrentschuk N, Abouassaly R, Hewitt E, Mulcahy A, Bolton DM, Jobling T. Health information quality on the internet in gynecological oncology: a multilingual evaluation. EUR J GYNAECOL ONCOL 2016; 37:478-483. [PMID: 29894070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Oncological internet information quality is considered variable, but no comprehensive analysis of gynecological malig- nancies exists. The present authors' objectives were to compare the quality of common malignancy websites and to assess for language or disease differences; and secondly, to perform a quality comparison between medical and layperson terminology. MATERIALS AND METHODS World Health Organization (WHO) Health on the Net (HON) principles may be applied to websites using an automated toolbar function. Using a search engine (www.Google.com) 8,400 websites were assessed using keywords 'endometrial, 'uterine', 'cervical', 'ovarian', 'vaginal', 'vulvar', plus 'cancer', in English, French, German, and Spanish; repeated for alternate terms e.g. 'cervix', 'womb'. RESULTS Searches for "vaginal' 'uterine', 'cervical', and 'endometrial' each returned millions of websites. The total percentage of all assessed HON-accredited sites was notably low across all search terms (median 15%; range 3-19%). Significant differences by malignancy type (p < 0.0001), language (p < 0.0001), and tertiles (thirds) of the first 150 websites returned (p < 0.0001). French language had most accredited websites. Using alternate terms demonstrated significant differences (p < 0.001) in accredited websites for most gynecological cancers. CONCLUSIONS Internet data on gynecological malignancies is overwhelming. Further, a lack of validation of the majority of gynecological oncologic sites should be appreciated with discrepancies in quality and number of websites across diseases, languages, and also between medical and layperson terms. Physicians should encourage and more importantly their professional bodies should participate in the development of informative, ethical, and reliable health websites on the internet and direct patients to them.
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Manley L, Gibson L, Papa N, Beharry BK, Johnson L, Lawrentschuk N, Bolton DM. Evaluation of pelvic floor muscle strength before and after robotic-assisted radical prostatectomy and early outcomes on urinary continence. J Robot Surg 2016; 10:331-335. [DOI: 10.1007/s11701-016-0602-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
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O'Kane DB, Lawrentschuk N, Bolton DM. Prostate cancer nodal oligometastasis accurately assessed using prostate-specific membrane antigen positron emission tomography-computed tomography and confirmed histologically following robotic-assisted lymph node dissection. Urol Ann 2016; 8:255-7. [PMID: 27141207 PMCID: PMC4839254 DOI: 10.4103/0974-7796.179237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We herein present a case of a 76-year-old gentleman, where prostate-specific membrane antigen positron emission tomography-computed tomography (PSMA PET-CT) was used to accurately detect prostate cancer (PCa), pelvic lymph node (LN) metastasis in the setting of biochemical recurrence following definitive treatment for PCa. The positive PSMA PET-CT result was confirmed with histological examination of the involved pelvic LNs following pelvic LN dissection.
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Affiliation(s)
- Dermot B O'Kane
- Department of Surgery, University of Melbourne, Melbourne, Australia; Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, University of Melbourne, Melbourne, Australia; Department of Urology, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Surgery, Ludwig Institute for Cancer Research, Melbourne, Australia
| | - Damien M Bolton
- Department of Surgery, University of Melbourne, Melbourne, Australia; Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
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Crozier J, Papa N, Sengupta S, Bolton DM, Lawrentschuk N. Changing practice of pelvic lymph node dissection in management of primary bladder cancer. MINERVA UROL NEFROL 2016; 68:106-111. [PMID: 26633553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Surgical management of bladder cancer has seen a significant period of change over the last decade. This has largely been driven by recognition of the importance of pelvic lymph node dissection (PLND) - yet debate still continues regarding the extent of dissection required. Our aim was to ascertain how the practice of PLND has evolved over the last decade in the setting of bladder cancer and cystectomy at a tertiary referral centre. METHODS Analysis of a retrospectively collected database including all cystectomies conducted at a tertiary centre in the last 10 years. Cases of non-primary bladder cancer were excluded. Histopathology records were scanned for data regarding PLND. Extent of PLND was defined according to levels. These were numbered level 1 (perivesical, pelvic and obturator), level 2 (internal and external iliac) and level 3 (common iliac). Trends in extent of dissection and number of nodes harvested were assessed. RESULTS One hundred and thirty cases of primary bladder cancer undergoing cystectomy were identified. Dissection to level 3 has increased from zero cases in 2005-2008 to 40% of cases in 2013-2015. We have seen a corresponding rise in number of lymph nodes collected. Increasing extent of dissection has improved staging by identifying positive nodes that would otherwise be missed. CONCLUSIONS The extent of PLND has increased over time. The current standard template at our institution includes a bilateral dissection of perivesical, obturator, internal iliac, external iliac and common iliac LN. This change has resulted in more accurate staging and increased total lymph node yield.
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Affiliation(s)
- Jack Crozier
- Department of Surgery, The University of Melbourne, Melbourne, Australia -
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Abstract
Purpose Urosepsis is the most feared complication of transrectal prostate biopsy. The incidence may be increasing from <1% to 2%–3% in contemporary series. Historically, fluoroquinolones have been effective antibiotic prophylaxis to prevent infective complications but antibiotic resistance is increasing. The increase in antibiotic resistance may contribute to reported increases in urosepsis and hospitalization after transrectal biopsy. This article will review other methods clinicians may employ to reduce the incidence of infective complications after prostate biopsy. Materials and Methods A systematic review of the literature was conducted using literature databases PubMed and Ovid MEDLINE in August 2015 in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) criteria. Results Effective strategies to reduce infective complications after transrectal prostate biopsy include augmented prophylaxis with other antibiotics, rectal swab culture directed antibiotic prophylaxis or a transperineal biopsy approach. Needle disinfection, minimizing the number of biopsy needles and rectal disinfectants may also be of use. These methods may be of particular utility in patients with risk factors for developing urosepsis such as recent antibiotic use and overseas travel. Conclusions The scientific literature describes various techniques designed to reduce infective complications caused by prostate biopsy. Clinicians should consider incorporating these novel techniques into their contemporary practice.
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Affiliation(s)
- Liam Toner
- Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia
| | - Damien M Bolton
- Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia.; Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia.; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.; School of Cancer Medicine, La Trobe University, Melbourne, Australia
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