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Wani M, Al-Mitwalli A, Mukherjee S, Nabi G, Somani BK, Abbaraju J, Madaan S. Venous Thromboembolism (VTE) in Post-Prostatectomy Patients: Systematic Review and Meta-Analysis. J Clin Med 2023; 12:3979. [PMID: 37373673 DOI: 10.3390/jcm12123979] [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: 05/15/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Radical prostatectomy (RP) is one of the recommended treatments to achieve oncological outcomes in localized prostate cancer. However, a radical prostatectomy is a major abdominopelvic surgery. Venous thromboembolism (VTE) is a well-known complication associated with surgical procedures, including RP. There is a lack of consensus regarding VTE prophylaxis in urological procedures. The aim of this systematic review and meta-analysis was to investigate different aspects of VTE in post-radical prostatectomy patients. A comprehensive literature search was performed, and relevant data were extracted. The primary aim was to perform a systematic review and meta-analysis (wherever possible) of VTE occurrence in post-RP patients in relation to surgical approach, pelvic lymph node dissection, and type of prophylaxis (mechanical or combined prophylaxis). The secondary aim was to investigate the incidence and other risk factors of VTE in post-RP patients. A total of 16 studies were included for quantitative analysis. Statistical methods for analysis included the DerSimonian-Laird random effects. We were able to conclude that the overall incidence of VTE in post-radical prostatectomy is 1% (95% CI) and minimally invasive procedures (MIS), including laparoscopic, as well as robotic procedures for radical prostatectomy and RP without pelvic lymph node dissection (PLND), are associated with less risk of developing VTE. Additional pharmacological prophylaxis to mechanical methods may not be necessary in all cases and should be considered in high-risk patients only.
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Affiliation(s)
- Mudassir Wani
- Department of Urology, Swansea Bay University Health Board, Swansea SA6 6NL, UK
| | | | | | - Ghulam Nabi
- School of Medicine, Centre for Medical Engineering and Technology, University of Dundee, Dundee DD1 9SY, UK
| | - Bhaskar K Somani
- Urological Surgery Department, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Jayasimha Abbaraju
- Department of Urology & Nephrology, Dartford, and Gravesham NHS Trust, Dartford DA2 8DA, UK
| | - Sanjeev Madaan
- Department of Urology & Nephrology, Dartford, and Gravesham NHS Trust, Dartford DA2 8DA, UK
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Mukherjee S, Papadopoulos D, Norris JM, Wani M, Madaan S. Comparison of Outcomes of Active Surveillance in Intermediate-Risk Versus Low-Risk Localised Prostate Cancer Patients: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12072732. [PMID: 37048815 PMCID: PMC10094761 DOI: 10.3390/jcm12072732] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/20/2023] [Accepted: 03/25/2023] [Indexed: 04/08/2023] Open
Abstract
Currently, there is no clear consensus regarding the role of active surveillance (AS) in the management of intermediate-risk prostate cancer (IRPC) patients. We aim to analyse data from the available literature on the outcomes of AS in the management of IRPC patients and compare them with low-risk prostate cancer (LRPC) patients. A comprehensive literature search was performed, and relevant data were extracted. Our primary outcome was treatment-free survival, and secondary outcomes were metastasis-free survival, cancer-specific survival, and overall survival. The DerSimonian–Laird random-effects method was used for the meta-analysis. Out of 712 studies identified following an initial search, 25 studies were included in the systematic review. We found that both IRPC and LRPC patients had nearly similar 5, 10, and 15 year treatment-free survival rate, 5 and 10 year metastasis-free survival rate, and 5 year overall survival rate. However, cancer-specific survival rates at 5, 10, and 15 years were significantly lower in IRPC compared to LRPC group. Furthermore, IRPC patients had significantly inferior long-term overall survival rate (10 and 15 year) and metastasis-free survival rate (15 year) compared to LRPC patients. Both the clinicians and the patients can consider this information during the informed decision-making process before choosing AS.
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Affiliation(s)
- Subhabrata Mukherjee
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Rd, London W6 8RF, UK
| | - Dimitrios Papadopoulos
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Rd, London W6 8RF, UK
| | - Joseph M. Norris
- Department of Urology, West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation, Twickenham Rd, Isleworth TW7 6AF, UK
| | - Mudassir Wani
- Department of Urology, Swansea Bay University Health Board, Swansea SA6 6NL, UK
| | - Sanjeev Madaan
- Department of Urology, Dartford and Gravesham NHS Trust, Dartford DA2 8DA, UK
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Mohamed A, Yao M, Saw S, Clark A, Madaan S. Collision metastasis from prostate adenocarcinoma and pancreatic ductal adenocarcinoma to a lung nodule. JRSM Open 2023; 14:20542704231153562. [PMID: 36911789 PMCID: PMC9996729 DOI: 10.1177/20542704231153562] [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] [Indexed: 03/11/2023] Open
Abstract
Introduction Prostate cancer and pancreatic cancer are often complex pathologies that affect millions of patients worldwide. However, the incidence of a distant collision metastasis of both malignancies remains a rare and often poorly documented incidence. Case presentation A 75-year-old male patient with past history of prostate cancer on maximal androgen blockade was recently diagnosed with pancreatic cancer for which he underwent radical surgical resection of pancreas with curative intent. A metastatic lung nodule was noted on surveillance CT imaging and, subsequently, biopsied. A diagnosis of collision metastasis from two distinct primary malignancies was histopathologically confirmed following immunohistochemical evaluation. Conclusion We report the first case of collision metastasis of prostate and pancreatic adenocarcinomata to a lung nodule to the best of our knowledge.
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Affiliation(s)
- Ahmed Mohamed
- Department of Urology, Dartford and Gravesham NHS Foundation Trust, Dartford, UK
| | - Mark Yao
- Department of Urology, Dartford and Gravesham NHS Foundation Trust, Dartford, UK
| | - Sonia Saw
- Department of Pathology, Maidstone and Tunbridge Wells NHS Foundation Trust, Maidstone, Kent, UK
| | - Amanda Clark
- Department of Pathology, Maidstone and Tunbridge Wells NHS Foundation Trust, Maidstone, Kent, UK
| | - Sanjeev Madaan
- Department of Urology, Dartford and Gravesham NHS Foundation Trust, Dartford, UK
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Wani M, Mohamed AHA, Brown G, Sriprasad S, Madaan S. Challenges and options for management of stones in anomalous kidneys: a review of current literature. Ther Adv Urol 2023; 15:17562872231217797. [PMID: 38146488 PMCID: PMC10749522 DOI: 10.1177/17562872231217797] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/09/2023] [Indexed: 12/27/2023] Open
Abstract
Introduction Congenital anomalies of the kidney and urinary tract (CAKUT) represent a wide range of disorders that result from developmental abnormalities of the kidneys, urinary collecting tract, and lower urinary tract. There has been extensive development in approaches to the management of stones in normal kidneys with the advent of retrograde intra-renal surgeries (RIRS)/ureteroscopies, extracorporeal shock wave lithotripsy (ESWL) percutaneous nephrolithotomy (PCNL), and minimally invasive surgery (laparoscopy/robotics). However, the management of stones in CAKUT is not straightforward and is often challenging for urologists. There are no clear guidelines available to help navigate stone management in such patients. Materials and methods The aim of this literature review was to focus on stone management in anomalous kidneys. Most common abnormalities were considered. The studies were very heterogeneous with different approaches. The methodology involved evaluating studies looking into individual surgical approaches to the management of stones in these anomalous kidneys as well as looking at different approaches to stone management, in particular renal abnormality. Results We found RIRS is a feasible approach in most stones with sizes <20 mm and PCNL holds the upper hand in stones more than 20 mm. However, ESWL, laparoscopy, and robotics have their places in managing some of these cases. Conclusion We concluded that stones in anomalous kidneys can be challenging but can be managed safely. There is no straightforward answer to the right technique but rather the right planning based on the anatomy of the kidney in terms of vascularity and drainage, stone size and density, and expertise available.
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Affiliation(s)
- Mudassir Wani
- Department Of Urology, Cardiff, and Vale University Health Board, Cardiff, UK
- Canterbury Christ Church University Faculty of Social and Applied Sciences, Chatham, UK
| | - Ahmed Haider Abdalla Mohamed
- Department of Urology, Dartford, and Gravesham NHS Trust, Dartford, UK
- Canterbury Christ Church University Faculty of Social and Applied Sciences, Chatham, UK
| | - Gareth Brown
- Department of Urology, Royal Glamorgan Hospital, Rhondda Cynon Taff, UK
| | - Seshadri Sriprasad
- Department of Urology, Dartford, and Gravesham NHS Trust, Dartford, UK
- Canterbury Christ Church University Faculty of Social and Applied Sciences, Chatham, UK
| | - Sanjeev Madaan
- Department of Urology, Dartford, and Gravesham NHS Trust, Darent Valley Hospital, Darenth Wood Road, Dartford, DA2 8DA, UK
- Canterbury Christ Church University Faculty of Social and Applied Sciences, Chatham ME4 4UF, UK
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Osinibi E, Doan H, Mercado-Campero A, Abbaraju J, Masood S, Madaan S. The implications when offering percutaneous nephrostomy for the management of malignant obstructive uropathy secondary to urological malignancy: can we be more selective? Ther Adv Urol 2023; 15:17562872231207729. [PMID: 37901283 PMCID: PMC10612453 DOI: 10.1177/17562872231207729] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Background & Objectives Percutaneous nephrostomy (PN) for malignant ureteric obstruction (MUO) is increasingly accessible with high success rates. However, it is not without associated risks and morbidity, impacting quality of life, while not improving overall survival. In two UK hospitals, we investigated the outcomes of undergoing PN for MUO, to inform future patient counselling and selection for this intervention. Methods A retrospective audit of electronic records identified patients that received PN for bladder, and prostate cancer (PCa) between January 2015 and December 2018. Hospital 1 had a 24-h nephrostomy service, while Hospital 2 had a limited service; Group A: recurrent or treatment-resistant PCa, Group B: primary PCa, Group C: Bladder cancer. Results A total of 261 patients (Hospital 1 = 186, Hospital 2 = 75), had PN insertion. Seventy-eight had prostate or bladder cancer. Group A n = 30, Group B n = 12, Group C n = 36. Median age = 79 [interquartile range (IQR) = 72-86]. Following PN insertion, 12-month mortality was significantly greater in Hospital 1 at 82%, versus 52% in Hospital 2 (p = 0.015). Median survival: Group A: 177 days (IQR = 80-266), Group B: 209 days (IQR = 77-352), Group C: 145 days (IQR = 97-362). There was no significant difference in same-admission mortality, although group A had the greatest same-admission mortality at 17%. A total of 69% of all patients received bilateral nephrostomies. Patients with bilateral versus unilateral PN had no difference in mortality or nadir creatinine. Conclusion Most patients with malignant obstruction secondary to prostate or bladder cancer lived less than 12 months after PN insertion. When offering PN, careful consideration of disease prognosis should be made, and frank discussion of the implications of a life-long nephrostomy with patients and relatives.
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Affiliation(s)
- Elizabeth Osinibi
- Darent Valley Hospital Medway Maritime Hospital, Darenth Wood Road, Dartford, DA2 8DA, UK
| | - Hong Doan
- Medway Maritime Hospital, Gillingham, UK
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Tzelves L, Nagasubramanian S, Pinitas A, Juliebø-Jones P, Madaan S, Sienna G, Somani B. Transperineal laser ablation as a new minimally invasive surgical therapy for benign prostatic hyperplasia: a systematic review of existing literature. Ther Adv Urol 2023; 15:17562872231198634. [PMID: 37745187 PMCID: PMC10515526 DOI: 10.1177/17562872231198634] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Transperineal laser ablation (TPLA) of the prostate is a new, minimally invasive technique for benign prostatic hyperplasia (BPH) with promising effectiveness and safety outcomes. This systematic review aims to provide an update of existing literature. Methods A literature review was performed in Pubmed/MEDLINE, Embase, Cochrane Library, and clinicaltrials.gov from January 2000 up to April 2023. Data extraction and risk of bias were performed independently by three authors. Results A total of 11 studies were included, among which 9 were observational, 1 randomized controlled trial, 1 animal study, while 2 of them were comparative (1 with prostatic artery embolization and 1 with transurethral resection of the prostate). Functional outcomes were improved in the majority of studies both for objective (maximum flow rate and post-void residual) and subjective outcomes (improvement of International Prostate Symptom Score and quality of life). Complication rates ranged between 1.9% and 2.3% for hematuria, 3.7% and 36.3% for dysuria, 1.9% and 19% for acute urinary retention, 0.6% and 9.1% for orchitis/urinary tract infections, and 0.6% and 4.8% for prostatic abscess formation. Regarding sexual function, >95% of patients retained their ejaculation while erectile function was maintained or improved. Conclusion TPLA of the prostate is an innovative, minimally invasive technique for managing patients with BPH. Existing studies indicate an effective technique in reducing International Prostate Symptom Score and quality of life scores, post-void residual reduction, and increase in Qmax, albeit the measured improvements in terms of Qmax are not equal to transurethral resection of the prostate. Although sexual function is maintained, the mean catheterization time is 7 days, and no long-term data are available for most patients.
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Affiliation(s)
- Lazaros Tzelves
- Department of Urology, University College London Hospitals, London, UK
| | | | - Alexandros Pinitas
- Department of Urology, General Hospital of Athens ‘Gennimatas’, Athens, Greece
| | | | - Sanjeev Madaan
- Department of Urology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Giampaolo Sienna
- Department of Urology, Careggi Hospital, University of Florence, San Luca Nuovo, Florence, Italy
| | - Bhaskar Somani
- University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, UK
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Wani MM, Gilbert JHV, Mohammed CA, Madaan S. Factors Causing Variation in World Health Organization Surgical Safety Checklist Effectiveness-A Rapid Scoping Review. J Patient Saf 2022; 18:e1150-e1159. [PMID: 35675706 DOI: 10.1097/pts.0000000000001035] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This review was conducted to determine what factors might be responsible for prejudicing the outcomes after the implementation of a World Health Organization Surgical Safety Checklist (WHO SSC), grouping them appropriately and proposing strategies that enable the SSC a more helpful and productive tool in the operating room. METHODS It was a rapid scoping review conducted as per Preferred Reporting Items for Systematic Review and Meta-analyses extension guidelines for scoping reviews (PRISMA-Scr). Comprehensive search on MEDLINE and Embase was carried out, to include all relevant studies published during last 5 years. Twenty-seven studies were included in analysis. The barriers to SSC implementation were classified into 5 main groups, with further subdivisions in each. RESULTS The results of review revealed that there are 5 major barriers to SSC at the following levels: organizational, checklist, individual, technical, and implementation. Each of these major barriers, on further evaluation, was found to have more than one contributing factors. All these factors were analyzed individually. CONCLUSIONS This rapid scoping review has consolidated data, which may pave the way for experts to further examine steps that might be taken locally or globally in order that the WHO SSC to successfully achieve all its desired goals.
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Affiliation(s)
| | | | - Ciraj Ali Mohammed
- Medical Education, MAHE-FAIMER International Institute for Leadership in Interprofessional Education, Manipal Academy of Higher Education, India and Professor and Head, Medical Education, College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Muscat, Oman
| | - Sanjeev Madaan
- Department Of Urology, Darent Valley Hospital, Dartford Visiting Professor, Canterbury Christ Church University, Canterbury, United Kingdom
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Whiting D, Giona S, Yao M, Hassan R, Doan H, Karanjia R, Hicks J, Eddy B, Madaan S, Bott S. Are staging bone scans necessary in patients with T3a prostate cancer? A multicentre study. Journal of Clinical Urology 2022. [DOI: 10.1177/20514158221137110] [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: 11/24/2022]
Abstract
Objective: Studies reporting increased risk of metastases in T3a disease are based on clinical staging (Digital rectal examination) in the pre-multiparametric–magnetic resonance imaging (MRI) (mp-MRI) era. The aim of our study was to assess the rate of positive bone scans in patients ascribed with T3a prostate cancer on a pre-biopsy mp-MRI. Methods: We performed a multicentre, retrospective analysis of all patients with T3a prostate cancer staged by mp-MRI who had a bone scan between January 2017 and April 2020. Results: A total of 586 patients were diagnosed with T3a prostate cancer on mp-MRI, with a median age of 71 years (range: 47–87). The median presenting PSA was 11 ng/mL (range: 1–537); 125 patients (21.3%) had a PSA ⩽ 20 and either grade group (GG) 1 or 2 in their prostate biopsy; none of these patients had bone metastases. Eighteen patients (3.1%) were found to have bone metastases: 11 patients had GG ⩾ 3 disease on biopsy and nodal disease, 6 had GG ⩾ 3 without evidence of nodal disease and 1 had a PSA of 103. Conclusion: The use of bone scans in patients with T3a prostate cancer staged on mp-MRI but without other evidence of high-risk disease (GG ⩾ 3 and PSA > 20 ng/mL) appears to be unnecessary and could be safely avoided. Level of evidence: 2b
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Affiliation(s)
- Danielle Whiting
- Department of Urology, Frimley Park Hospital, UK
- Department of Urology, Worthing Hospital, UK
- Department of Urology, St Richard’s Hospital, UK
| | - Simone Giona
- Department of Urology, Frimley Park Hospital, UK
| | - Mark Yao
- Department of Urology, Kent and Canterbury Hospital, UK
| | - Roa Hassan
- Department of Urology, Kent and Canterbury Hospital, UK
| | - Hong Doan
- Department of Urology, Darent Valley Hospital, UK
| | | | - James Hicks
- Department of Urology, Worthing Hospital, UK
- Department of Urology, St Richard’s Hospital, UK
| | - Ben Eddy
- Department of Urology, Kent and Canterbury Hospital, UK
| | | | - Simon Bott
- Department of Urology, Frimley Park Hospital, UK
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Wani M, Hamdoon M, Dewar G, Buakuma P, Madaan S. Urological Implications Associated with the Use of Recreational Drugs: A Narrative Review. Turkish Journal of Urology 2022; 48:254-261. [PMID: 35913440 PMCID: PMC9612696 DOI: 10.5152/tud.2022.22066] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
About 275 million people worldwide aged between 15 and 64 years used drugs at least once since 2016. Initial estimations suggest that 13.8 million young people between 15 and 16 years used cannabis every year. Recreational drug use contributes significantly to mortality as well as physical and mental health problems. A number of urological complications can arise from the use of common and emerging recreational drugs which can present as wide spectrum affecting lower and upper urinary tracts, kidneys, sexual organs as well as sexual dysfunction. In order to effectively manage these issues, urologists need to be cognizant of these complications in their patients, particularly among youths. This review attempted to consolidate available data and provide insight into this issue; however, further population-based epidemiological studies are needed to provide necessary guidelines.
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Affiliation(s)
- Mudassir Wani
- Urology Trainee, Royal Glamorgan Hospital, Cardiff, UK
| | - Musaab Hamdoon
- Urology registrar, Royal Liverpool and Broadgreen university hospital, UK
| | - Greg Dewar
- Registrar Dunedin Hospital, Southern District Health Board, New Zealand
| | | | - Sanjeev Madaan
- Consultant Urological Surgeon, Darrent Valley Hospital, UK & Visiting Professor, Canterbury Christchurch University, UK
- Corresponding author:Sanjeev MadaanE-mail:
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Melhem M, Burki J, Algurabi O, Gilani S, Ghumman F, Sheriff M, Wani M, Haddad R, Madaan S. The safety and feasibility of simultaneous robotic repair of an inguinal hernia during robotic-assisted laparoscopic prostatectomy: a systematic review and meta-analysis. Scand J Urol 2022; 56:197-205. [PMID: 35665635 DOI: 10.1080/21681805.2022.2065358] [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] [Indexed: 10/18/2022]
Abstract
PURPOSE This study intended to assess the safety and feasibility of performing concurrent robotic-assisted laparoscopic prostatectomy (RALP) and robotic inguinal hernia repair (RIHR). METHOD We systematically searched the PubMed, Embase and Cochrane Library database up to the year 2020 to identify studies that assessed patients who underwent RALP and RIHR in the same settings. RESULTS Thirteen studies were considered suitable for a systematic review and seven for Meta-analysis. RALP and RIHR were associated with significantly longer operative time. RIHR added on average 26 min to the operation time (8, 45 95% CI, p = 0.005, I2 97%). Concurrent RALP and RIHR was not associated with a higher incidence of blood loss (-13, 6 95% CI, p = 0.43, I2 18%), length of stay (-0.08, 0.06 95% CI, p = 0.73, I2 0%) or early postoperative complications. CONCLUSION Concurrent robotic repair of an inguinal hernia during RALP appears feasible and safe. Urologists should be encouraged to repair hernias encountered during RALP keeping in mind possible complications including wound infection, mesh infection, chronic inguinal pain and recurrence of hernia.
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Affiliation(s)
- Motaz Melhem
- Department of Urology, Medway Maritime Hospital, Kent, United Kingdom
| | - Javid Burki
- Department of Urology, Medway Maritime Hospital, Kent, United Kingdom
| | - Omar Algurabi
- Department of Urology, Medway Maritime Hospital, Kent, United Kingdom
| | - Sayed Gilani
- Department of Urology, Medway Maritime Hospital, Kent, United Kingdom
| | - Faisal Ghumman
- Department of Urology, Medway Maritime Hospital, Kent, United Kingdom
| | - Matin Sheriff
- Department of Urology, Medway Maritime Hospital, Kent, United Kingdom
| | - Mudassir Wani
- Department of Urology Glangwili Hospital, Wales, United Kingdom
| | - Ra'ed Haddad
- Department of Urology, Oxford University Hospitals, Oxford, United Kingdom
| | - Sanjeev Madaan
- Department of Urology and Nephrology, Darent Valley Hospital, Dartford, United Kingdom.,Institute of Medical Sciences, Canterbury Christchurch University, Canterbury, United Kingdom
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Wani MM, Rai BP, Webb WR, Madaan S. Is there a role for stem cell therapy in erectile dysfunction secondary to cavernous nerve injury? Network meta-analysis from animal studies and human trials. Ther Adv Urol 2022; 14:17562872221086999. [PMID: 35371295 PMCID: PMC8972940 DOI: 10.1177/17562872221086999] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/22/2021] [Accepted: 02/24/2022] [Indexed: 12/09/2022] Open
Abstract
Introduction: We carried out systematic review and network meta-analysis to investigate the role of stem cell therapy (SCT) in the management of erectile dysfunction (ED) secondary to cavernous nerve injury in rats and post-radical prostatectomy (RP) in humans. Patients and Methods: The protocol was registered with PROSPERO database. We searched studies analyzing the efficacy of SCT for ED due to bilateral cavernous nerve injury (BCNI) in rats using Healthcare Databases Advanced Search (HDAS) Export software (MEDLINE, EMBASE, Scopus) from inception to September 2020. The outcome measurements, for 29 animal studies, were intracavernosal pressure (ICP), ICP/MAP (mean arterial pressure) ratio, and histological/molecular changes. All three available human trials evaluating SCT in post-RP ED were assessed for International Index for Erectile Function (IIEF) Score and Erection Hardness Score (EHS). Results: For ICP measurement, animal studies were divided into adipose-derived stem cells (ADSCs) subgroup and bone marrow–derived stem cells (BMSCs) subgroup. Pooled analysis of these studies showed a beneficial effect of SCT in improving erectile function in rats with BCNI using network meta-analysis (95% confidence interval, CI; p < 0.001). There was an increase in ICP/MAP ratio in stem cell groups (including co-intervention) compared with control BCNI group. Histological and molecular evaluation of penile tissue revealed an increase in neuronal nitric oxide synthase (nNOS), smooth muscle content, and anti-apoptotic activity. Human trials revealed improved IIEF (70–150% from baseline at 6 months) and EHS (80–200% from baseline). Conclusion: Our results confirm that SCT does improve the erectile function in rats having cavernous nerve injury. Similarly, early human results have shown promising results. PROSPERO registration ID: CRD42020201343.
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Affiliation(s)
- Mudassir M. Wani
- Royal Glamorgan Hospital, Cardiff, UK
- Institute of Medical Sciences, Faculty of Medicine, Health and Social Sciences, Canterbury Christ Church University, Kent, UK
| | | | - William Richard Webb
- SCRABEL, Institute of Medical Sciences, Faculty of Medicine, Health and Social Sciences, Canterbury Christ Church University, Kent, UK
| | - Sanjeev Madaan
- Darent Valley Hospital, Darenth Wood Road, Dartford DA2 8DA, UK. Canterbury Christ Church University, Kent, UK
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Affiliation(s)
- Anika Madaan
- Faculty of Medicine, Imperial College London, London, UK
| | - Naimish Gandhi
- Jubilee Medical Centre, Kent House Surgery, Longfield, UK
| | - Sanjeev Madaan
- Department of Urology and Nephrology, Dartford and Gravesham NHS Trust; Institute of Medical Sciences, Canterbury Christchurch University, UK
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Whiting D, Challacombe B, Madaan S, Fowler S, Napier-Hemy R, Sriprasad S. Complications after radical nephrectomy according to age: analysis from the British Association of Urological Surgeons Nephrectomy Audit. J Endourol 2021; 36:188-196. [PMID: 34663080 DOI: 10.1089/end.2021.0165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction To compare complication rates in radical nephrectomy for renal cell carcinoma across different age groups. Methods Retrospective analysis of the British Association of Urological Surgeons Nephrectomy Audit database between 1st January 2012 and 31st December 2017 was performed. Comparisons were made between different age groups (<60, 60-79, ≥80) in patients undergoing radical nephrectomy for renal cell carcinoma. Results 18438 patients with renal cell carcinoma underwent radical nephrectomy: 6128 (33.2%) aged <60, 10785 (58.5%) aged 60-79 and 1525 (8.3%) aged ≥80. There was a significantly lower pre-operative haemoglobin and eGFR with advancing age (p<0.001). Patients ≥80 had a higher Charlson co-morbidity index and WHO performance status (p<0.001). There was also significant variability in the approach to RN (p<0.001): laparoscopy was most commonly performed (68.8% vs. 69.3% vs. 75.0%). Patients ≥80 years were found to have the shortest operating time (p<0.001). There were significant differences in T stage between groups with patients aged ≥80 having a higher T stage (p<0.001). The incidence of intra-operative complications did not significantly differ between age groups (p=0.18). The incidence of post-operative complications was 15.7%, 18.2% and 20.5% and major post-operative complications was 1.4%, 2.1% and 2.8% in patients <60, 60-79 and ≥80, respectively (p<0.001). The most common complication in all age groups was blood transfusion (7.6% <60, 8.6% 60-79, 9.1% ≥80). Stepwise logistic regression analysis adjusting for additional variables found the odds of a post-operative complication increased with age with an odds ratio of 1.25 in patients ≥80 and an odds ratio of 1.09 in patients aged 60-70 compared with <60. Conclusion Overall complications in all age groups are low but advancing age should be considered as an independent risk factor for post-operative complications after radical nephrectomy and should be appropriately considered when counselling elderly patients prior to treatment.
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Affiliation(s)
- Danielle Whiting
- Darent Valley Hospital, 156489, Darent Valley Hospital, Darenth Wood Road, Dartford, United Kingdom of Great Britain and Northern Ireland, DA2 8DA;
| | - Benjamin Challacombe
- Guy's Hospital, Urology, London, London, United Kingdom of Great Britain and Northern Ireland, SE1 7RT;
| | - Sanjeev Madaan
- Darent Valley Hospital, 156489, Dartford, United Kingdom of Great Britain and Northern Ireland;
| | - Sarah Fowler
- British Association of Urological Surgeons, London, United Kingdom of Great Britain and Northern Ireland;
| | - Richard Napier-Hemy
- Manchester University NHS Foundation Trust, 5293, Manchester, Greater Manchester, United Kingdom of Great Britain and Northern Ireland;
| | - Seshadri Sriprasad
- Darent Valley Hospital, 156489, Dartford, United Kingdom of Great Britain and Northern Ireland;
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14
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Thurtle D, Jenkins V, Freeman A, Pearson M, Recchia G, Tamer P, Leonard K, Pharoah P, Aning J, Madaan S, Goh C, Hilman S, McCracken S, Ilie PC, Lazarowicz H, Gnanapragasam V. Clinical Impact of the Predict Prostate Risk Communication Tool in Men Newly Diagnosed with Nonmetastatic Prostate Cancer: A Multicentre Randomised Controlled Trial. Eur Urol 2021; 80:661-669. [PMID: 34493413 DOI: 10.1016/j.eururo.2021.08.001] [Citation(s) in RCA: 5] [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: 02/15/2021] [Accepted: 08/03/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Predict Prostate is a freely available online personalised risk communication tool for men with nonmetastatic prostate cancer. Its accuracy has been assessed in multiple validation studies, but its clinical impact among patients has not hitherto been assessed. OBJECTIVE To assess the impact of the tool on patient decision-making and disease perception. DESIGN, SETTING, AND PARTICIPANTS A multicentre randomised controlled trial was performed across eight UK centres among newly diagnosed men considering either active surveillance or radical treatment. A total of 145 patients were included between 2018 and 2020, with median age 67 yr (interquartile range [IQR] 61-72) and prostate-specific antigen 6.8 ng/ml (IQR 5.1-8.8). INTERVENTION Participants were randomised to either standard of care (SOC) information or SOC and a structured presentation of the Predict Prostate tool. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Validated questionnaires were completed by assessing the impact of the tool on decisional conflict, uncertainty, anxiety, and perception of survival. RESULTS AND LIMITATIONS Mean Decisional Conflict Scale scores were 26% lower in the Predict Prostate group (mean = 16.1) than in the SOC group (mean = 21.7; p = 0.027). Scores on the "support", "uncertainty", and "value clarity" subscales all favoured Predict Prostate (all p < 0.05). There was no significant difference in anxiety scores or final treatment selection between the two groups. Patient perception of 15-yr prostate cancer-specific mortality (PCSM) and overall survival benefit from radical treatment were considerably lower and more accurate among men in the Predict Prostate group (p < 0.001). In total, 57% of men reported that the Predict Prostate estimates for PCSM were lower than expected, and 36% reported being less likely to select radical treatment. Over 90% of patients in the intervention group found it useful and 94% would recommend it to others. CONCLUSIONS Predict Prostate reduces decisional conflict and uncertainty, and shifts patient perception around prognosis to be more realistic. This randomised trial demonstrates that Predict Prostate can directly inform the complex decision-making process in prostate cancer and is felt to be useful by patients. Future larger trials are warranted to test its impact upon final treatment decisions. PATIENT SUMMARY In this national study, we assessed the impact of an individualised risk communication tool, called Predict Prostate, on patient decision-making after a diagnosis of localised prostate cancer. Men were randomly assigned to two groups, which received either standard counselling and information, or this in addition to a structured presentation of the Predict Prostate tool. Men who saw the tool were less conflicted and uncertain in their decision-making, and recommended the tool highly. Those who saw the tool had more realistic perception about their long-term survival and the potential impact of treatment upon this. TAKE HOME MESSAGE The use of an individualised risk communication tool, such as Predict Prostate, reduces patient decisional conflict and uncertainty when deciding about treatment for nonmetastatic prostate cancer. The tool leads to more realistic perceptions about survival outcomes and prognosis.
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Affiliation(s)
- David Thurtle
- Department of Surgery, University of Cambridge School of Clinical Medicine, Cambridge, UK.
| | - Val Jenkins
- Brighton and Sussex Medical School, Brighton, UK
| | - Alex Freeman
- Winton Centre for Risk and Evidence Communication, University of Cambridge, Cambridge, UK
| | - Mike Pearson
- Winton Centre for Risk and Evidence Communication, University of Cambridge, Cambridge, UK
| | - Gabriel Recchia
- Winton Centre for Risk and Evidence Communication, University of Cambridge, Cambridge, UK
| | - Priya Tamer
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Kelly Leonard
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Paul Pharoah
- Department of Community Medicine, University of Cambridge, Cambridge, UK; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jonathan Aning
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Chee Goh
- Surrey and Sussex Healthcare NHS Trust, Surrey, UK
| | - Serena Hilman
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | | | - Henry Lazarowicz
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Vincent Gnanapragasam
- Department of Surgery, University of Cambridge School of Clinical Medicine, Cambridge, UK
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15
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Madaan A, Kuusk T, Hamdoon M, Elliott A, Pearce D, Madaan S. Nurse‐led one stop hematuria clinic: Outcomes from 2,714 patients. BJUI Compass 2021; 2:385-394. [PMID: 35474702 PMCID: PMC8988527 DOI: 10.1002/bco2.100] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/08/2021] [Accepted: 05/26/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives Objective of this study is to report the results of nurse led hematuria clinic service outcome of 2,714 patients. Subjects and methods We conducted a retrospective, single center review of 2714 patients with visible and nonvisible hematuria managed by a well‐trained nurse specialist in a rapid access clinic (RAC) between 2014 and 2020. All patients received a full review, flexible cystoscopy performed by a nurse, and ultrasound of urinary tracts. After investigations, patients were reassured and discharged or referred for rigid cystoscopy, TURBT, and CT urography. Results In total, 2714 patients attended the RAC between October 2014 and March 2020. Of these, 1684 (62%) were males and 1030 (38%) females. The median age of patients was 68.3 (IQR 58‐79). Of the 1030 females, 500 (48.5%) presented with nonvisible hematuria (NVH), and 530 (51.5%) presented with visible hematuria (VH). The median age was 66 (IQR 56‐76). The number of females diagnosed with any form of malignancy was 72 (7% of all females). Of the 1684 males, 288 (17.1%) presented with NVH, and 1396 (82.9%) presented with VH. The median age was 72 (IQR 59‐81). The number of males diagnosed with some form of malignancy was 258 (15.3% of all males). Overall, 1926 patients presented with VH and 788 patients presented with NVH. After investigations, 290 patients (15.1%) with VH and 40 (5.1%) patients with NVH had some form of malignancy. The highest number of malignancies found in VH was bladder cancer (n = 222, 11.5%), followed by prostate (n = 28, 1%), renal (n = 23, 0.8%), UT urothelial (n = 17, 0.6%), gynaecological (n = 7, 0.3%), and gastrointestinal (n = 5, 0.2%) cancer. The highest number of pathologies found in NVH was infection (n = 44, 5.6%). Cancer detection rate for symptomatic NVH was more than double that of asymptomatic NVH, 6.5% versus 3.1%, respectively. Conclusion Overall, 15.1% with VH and 5.1% with NVH present with malignancy. Nurse‐led rapid access hematuria clinic and flexible cystoscopy investigation by trained nurse is safe and feasible.
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Affiliation(s)
- Anika Madaan
- Faculty of Medicine Imperial College London London UK
| | - Teele Kuusk
- Department of Urology and Nephrology Dartford and Gravesham NHS Trust Dartford UK
| | - Musaab Hamdoon
- Department of Urology and Nephrology Royal Liverpool University Hospital Liverpool UK
| | - Angela Elliott
- Department of Urology and Nephrology Dartford and Gravesham NHS Trust Dartford UK
| | - Dianne Pearce
- Department of Urology and Nephrology Dartford and Gravesham NHS Trust Dartford UK
| | - Sanjeev Madaan
- Department of Urology and Nephrology Dartford and Gravesham NHS Trust Dartford UK
- Department of Urology and Nephrology Canterbury Christ Church University Canterbury UK
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16
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Thurtle D, Jenkins V, Freeman A, Pearson M, Recchia G, Tamer P, Leonard K, Pharoah P, Aning J, Madaan S, Goh C, Hilman S, Mccracken S, Ilie C, Lazarowicz H, Gnanapragasam V. Clinical impact of the predict prostate risk communication tool in men newly diagnosed with non-metastatic prostate cancer: A multi-centre randomised controlled trial. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01401-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Advanced and metastatic prostate cancer is often managed with hormonal blockage. Luteinising hormone-releasing hormone antagonists achieve rapid testosterone suppression and are used for the treatment of advanced or metastatic prostate cancer. Degarelix is a luteinising hormone-releasing hormone antagonist and is given as a loading dose, followed by a monthly maintenance dose. We report a case where a patient was inadvertently given a second loading dose of Degarelix that resulted in acute psychosis in the form of panic attacks, delusions, suicidal thoughts, insomnia and some visual hallucinations, which are not reported as side-effects of Degarelix.
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Affiliation(s)
- Musaab Hamdoon
- Department of Urology, Darent Valley Hospital, Dartford DA2 8DA, UK
| | - Maria Satchi
- Department of Urology, Darent Valley Hospital, Dartford DA2 8DA, UK
| | - Fay Fawke
- Department of Urology, Darent Valley Hospital, Dartford DA2 8DA, UK
| | - Sanjeev Madaan
- Department of Urology, Darent Valley Hospital, Dartford DA2 8DA, UK
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18
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Mukherjee S, Abbaraju J, Russell G, Madaan S. Bladder-to-bladder metastasis: gallbladder cancer metastasising to the urinary bladder. Ann R Coll Surg Engl 2021; 103:e116-e119. [PMID: 33682446 DOI: 10.1308/rcsann.2020.7048] [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] [Indexed: 11/22/2022] Open
Abstract
We report a 48-year-old fit and healthy woman who was incidentally diagnosed to have adenocarcinoma of gallbladder after laparoscopic cholecystectomy. Subsequent imaging showed no evidence of regional or distant spread. She was scheduled for elective laparotomy and resection of gallbladder bed, but during laparotomy frozen section analysis of an incidentally discovered peritoneal deposit confirmed metastasis, so the procedure was abandoned. Thereafter, she received cisplatin and gemcitabine chemotherapy. However, surveillance computed tomography incidentally noted a urinary bladder mass which had not been present before. Transurethral resection of the bladder lesion revealed moderately differentiated adenocarcinoma of urinary bladder. The appearance and immunoprofile of the lesion confirmed metastasis from the primary gallbladder cancer, which has not been documented in the literature to the best of our knowledge. Her disease progressed and she is being challenged with gemcitabine and carboplatin as second-line palliative chemotherapy. She is still alive two years after the initial diagnosis.
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Affiliation(s)
- S Mukherjee
- Dartford and Gravesham NHS Trust, Dartford, Kent, UK.,Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - J Abbaraju
- Dartford and Gravesham NHS Trust, Dartford, Kent, UK
| | - G Russell
- Dartford and Gravesham NHS Trust, Dartford, Kent, UK
| | - S Madaan
- Dartford and Gravesham NHS Trust, Dartford, Kent, UK
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19
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Langley RE, Gilbert DC, Duong T, Clarke NW, Nankivell M, Rosen SD, Mangar S, Macnair A, Sundaram SK, Laniado ME, Dixit S, Madaan S, Manetta C, Pope A, Scrase CD, Mckay S, Muazzam IA, Collins GN, Worlding J, Williams ST, Paez E, Robinson A, McFarlane J, Deighan JV, Marshall J, Forcat S, Weiss M, Kockelbergh R, Alhasso A, Kynaston H, Parmar M. Transdermal oestradiol for androgen suppression in prostate cancer: long-term cardiovascular outcomes from the randomised Prostate Adenocarcinoma Transcutaneous Hormone (PATCH) trial programme. Lancet 2021; 397:581-591. [PMID: 33581820 DOI: 10.1016/s0140-6736(21)00100-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Androgen suppression is a central component of prostate cancer management but causes substantial long-term toxicity. Transdermal administration of oestradiol (tE2) circumvents first-pass hepatic metabolism and, therefore, should avoid the cardiovascular toxicity seen with oral oestrogen and the oestrogen-depletion effects seen with luteinising hormone releasing hormone agonists (LHRHa). We present long-term cardiovascular follow-up data from the Prostate Adenocarcinoma Transcutaneous Hormone (PATCH) trial programme. METHODS PATCH is a seamless phase 2/3, randomised, multicentre trial programme at 52 study sites in the UK. Men with locally advanced or metastatic prostate cancer were randomly allocated (1:2 from August, 2007 then 1:1 from February, 2011) to either LHRHa according to local practice or tE2 patches (four 100 μg patches per 24 h, changed twice weekly, reducing to three patches twice weekly if castrate at 4 weeks [defined as testosterone ≤1·7 nmol/L]). Randomisation was done using a computer-based minimisation algorithm and was stratified by several factors, including disease stage, age, smoking status, and family history of cardiac disease. The primary outcome of this analysis was cardiovascular morbidity and mortality. Cardiovascular events, including heart failure, acute coronary syndrome, thromboembolic stroke, and other thromboembolic events, were confirmed using predefined criteria and source data. Sudden or unexpected deaths were attributed to a cardiovascular category if a confirmatory post-mortem report was available and as other relevant events if no post-mortem report was available. PATCH is registered with the ISRCTN registry, ISRCTN70406718; the study is ongoing and adaptive. FINDINGS Between Aug 14, 2007, and July 30, 2019, 1694 men were randomly allocated either LHRHa (n=790) or tE2 patches (n=904). Overall, median follow-up was 3·9 (IQR 2·4-7·0) years. Respective castration rates at 1 month and 3 months were 65% and 93% among patients assigned LHRHa and 83% and 93% among those allocated tE2. 157 events from 145 men met predefined cardiovascular criteria, with a further ten sudden deaths with no post-mortem report (total 167 events in 153 men). 26 (2%) of 1694 patients had fatal cardiovascular events, 15 (2%) of 790 assigned LHRHa and 11 (1%) of 904 allocated tE2. The time to first cardiovascular event did not differ between treatments (hazard ratio 1·11, 95% CI 0·80-1·53; p=0·54 [including sudden deaths without post-mortem report]; 1·20, 0·86-1·68; p=0·29 [confirmed group only]). 30 (34%) of 89 cardiovascular events in patients assigned tE2 occurred more than 3 months after tE2 was stopped or changed to LHRHa. The most frequent adverse events were gynaecomastia (all grades), with 279 (38%) events in 730 patients who received LHRHa versus 690 (86%) in 807 patients who received tE2 (p<0·0001) and hot flushes (all grades) in 628 (86%) of those who received LHRHa versus 280 (35%) who received tE2 (p<0·0001). INTERPRETATION Long-term data comparing tE2 patches with LHRHa show no evidence of a difference between treatments in cardiovascular mortality or morbidity. Oestrogens administered transdermally should be reconsidered for androgen suppression in the management of prostate cancer. FUNDING Cancer Research UK, and Medical Research Council Clinical Trials Unit at University College London.
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Affiliation(s)
- Ruth E Langley
- Medical Research Council (MRC) Clinical Trials Units at University College London (UCL), London, UK.
| | - Duncan C Gilbert
- Medical Research Council (MRC) Clinical Trials Units at University College London (UCL), London, UK
| | - Trinh Duong
- Medical Research Council (MRC) Clinical Trials Units at University College London (UCL), London, UK
| | - Noel W Clarke
- The Christie and Salford Royal Hospitals, Manchester, UK
| | - Matthew Nankivell
- Medical Research Council (MRC) Clinical Trials Units at University College London (UCL), London, UK
| | - Stuart D Rosen
- National Heart and Lung Institute, Imperial College, London, UK
| | - Stephen Mangar
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Archie Macnair
- Medical Research Council (MRC) Clinical Trials Units at University College London (UCL), London, UK
| | | | - Marc E Laniado
- Wexham Park Hospital, Frimley Health Foundation Trust, Slough, UK
| | | | - Sanjeev Madaan
- Department of Urology & Nephrology, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Caroline Manetta
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Alvan Pope
- The Hillingdon Hospitals NHS Foundation Trust and Imperial College Healthcare NHS Trust, London, UK
| | | | - Stephen Mckay
- Forth Valley Royal Hospital, Larbert, UK; Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Iqtedar A Muazzam
- Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | - Gerald N Collins
- Macclesfield District General Hospital, East Cheshire NHS Trust, Macclesfield, UK
| | | | | | - Edgar Paez
- Newcastle Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | | | | | - John V Deighan
- Medical Research Council (MRC) Clinical Trials Units at University College London (UCL), London, UK
| | - John Marshall
- Medical Research Council (MRC) Clinical Trials Units at University College London (UCL), London, UK
| | - Silvia Forcat
- Medical Research Council (MRC) Clinical Trials Units at University College London (UCL), London, UK
| | - Melanie Weiss
- Medical Research Council (MRC) Clinical Trials Units at University College London (UCL), London, UK
| | - Roger Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, UK
| | | | - Howard Kynaston
- Division of Cancer and Genetics, Cardiff University Medical School, Cardiff, UK
| | - Mahesh Parmar
- Medical Research Council (MRC) Clinical Trials Units at University College London (UCL), London, UK
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20
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Mukherjee S, Promponas I, Petrides N, Hossain D, Abbaraju J, Madaan S. Active Surveillance-Is It Feasible for Intermediate-risk Localised Prostate Cancer? EUR UROL SUPPL 2021; 24:17-24. [PMID: 34337491 PMCID: PMC8317861 DOI: 10.1016/j.euros.2020.12.005] [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] [Accepted: 12/08/2020] [Indexed: 11/25/2022] Open
Abstract
Background Although active surveillance (AS) is a well-recognised treatment option for localised low-risk prostate cancer (LRPC), its role in the management of localised intermediate-risk prostate cancer (IRPC) is not clear yet and the available literature is slightly contradictory. Objective To compare the outcome of AS between LRPC and IRPC patients. Design, setting, and participants Between November 2002 and August 2019, 372 men with localised prostate cancer (PC) underwent AS in our hospital based on local departmental protocol. Outcome measurements and statistical analysis The primary outcome measures were overall survival, disease progression–free survival, treatment-free survival, and biochemical recurrence–free survival. Survival times in the low- and intermediate-risk groups were compared using Cox regression analysis. Results and limitations Out of 372 localised PC patients, 276 (74%) had LRPC and 96 (26%) IRPC. Overall, 86 (31.2%) low-risk and 25 (26%) intermediate-risk patients developed disease progression, and 86 (31.2%) low-risk and 22 (23%) intermediate-risk patients underwent active treatment. Among the treated patients, eight (2.9%) LRPC patients and one (1%) IRPC patient developed biochemical recurrence. In total, only one patient (from the low-risk group) had metastasis and 25 patients passed away (18 from the low-risk and seven from the intermediate-risk group). No death was recorded due to PC in the cohort. There was no difference in any of the survival outcomes between LRPC and IRPC patients in unadjusted analysis as well as when analysis was performed after adjusting the potentially confounding factors. Limitations include relatively short median follow-up time and failure to objectively define the criteria for the selection of IRPC patients suitable for AS. Conclusions The option of AS could be considered for carefully selected and well-informed patients with IRPC provided close structured monitoring is maintained. Patient summary In this report, we looked at various survival outcomes of active surveillance between low- and intermediate-risk prostate cancer patients in a large British population. There was no difference in any of the survival outcomes between the two groups. We concluded that carefully selected intermediate-risk prostate cancer patients could be offed the option of active surveillance.
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Affiliation(s)
- Subhabrata Mukherjee
- Department of Urology and Nephrology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Ioannis Promponas
- Department of Urology and Nephrology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Neophytos Petrides
- Department of Urology and Nephrology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Dafader Hossain
- Department of Urology and Nephrology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Jayasimha Abbaraju
- Department of Urology and Nephrology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Sanjeev Madaan
- Department of Urology and Nephrology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
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21
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Wani MM, Sriprasad S, Bhat T, Madaan S. Is Thulium laser enucleation of prostate an alternative to Holmium and TURP surgeries - A systematic review? Turk J Urol 2020; 46:419-426. [PMID: 33052829 PMCID: PMC7608540 DOI: 10.5152/tud.2020.20202] [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] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/01/2020] [Indexed: 09/25/2023]
Abstract
To assess efficacy and safety of Thulium laser enucleation of prostate (ThuLEP) for benign prostatic hyperplasia. It is a systemic review based on a comprehensive search of PubMed, Cochrane, and Google scholar databases from inception to 31 March 2020. All studies in English evaluating ThuLEP as well as those comparing it with Transurethral resection of prostate (TURP) and Holmium Laser enucleation of prostate (HoLEP) were enrolled. The primary outcome was to evaluate operative, postoperative, and functional outcomes (IPSS, QoL, Qmax, PVR) in patients undergoing ThuLEP. Secondary outcome was to compare operative, postoperative, and functional outcomes with TURP and HoLEP in comparative studies. Fourteen studies with a total of 2,562 patients were included in this review. 2,034 underwent ThuLEP, 349 underwent TURP, and remaining 139 had HoLEP. We found that ThuLEP is safe as well as efficacious in all age groups as well as across all prostate sizes and with all four functional outcomes (IPSS, QoL, Qmax, PVR) revealing marked improvement at 3, 6, 12, and 24 months. Compared to TURP and HoLEP, Thulep is non-inferior in terms of operative and functional outcomes and, in fact, is associated with lesser catheterization duration as well as shorter hospital stay. Further, Thulium fiber laser (TFL) has advantages of being light weight, having high frequency, less fiber degradation, and less energy consumption, making it cost effective for operational and maintenance purpose. ThuLEP is a safe, efficacious, and cost-effective procedure for BPE.
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Affiliation(s)
- Mudassir M. Wani
- Canterburry University, Working as Specialty Registrar at Medway Maritime Hospital, Kent, UK
| | - Seshadri Sriprasad
- Consultant Urological Surgeon & Lead Clinician, Darent Valley Hospital, Dartford Professor, Canterbury Christ Church University, UK
| | - Tahir Bhat
- Consultant Urological Surgeon, Medway Maritime Hospital, Kent UK
| | - Sanjeev Madaan
- Consultant Urological Surgeon & Lead Cancer Clinician, Darent Valley Hospital, Dartford Visiting Professor, Canterbury Christ Church University, UK
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22
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Whiting D, Fowler S, Challacombe B, Napier-Hemy R, Madaan S, Sriprasad S. Partial versus radical nephrectomy for T1 renal tumours in octogenarians: Analysis from the British Association of Urological Surgeons Nephrectomy Audit. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32645-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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23
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Whiting D, Rudd I, Goel A, Sriprasad S, Madaan S. Spontaneous haemorrhage of an adrenal angiomyolipoma: case report. Afr J Urol 2019. [DOI: 10.1186/s12301-019-0006-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Angiomyolipomas are rare mesenchymal tumours arising from the perivascular epithelioid cells consisting of variable amounts of adipose, thick-walled blood vessels and smooth muscle cells. These benign tumours commonly occur in the kidney with only a few case reports of adrenal angiomyolipomas which have the potential to reach a large size and haemorrhage.
Case presentation
A 45-year-old lady presented with a 3-week history of right loin pain, nausea and vomiting. A CT scan revealed a right adrenal angiomyolipoma measuring 6.3 × 6.8 cm with associated haemorrhage. The lesion was successfully treated with right open adrenalectomy, and histology confirmed the diagnosis of adrenal angiomyolipoma. The patient remained well with no evidence of recurrence at the 36-month follow-up.
Conclusion
Adrenal angiomyolipomas are rare benign tumours that have the ability to reach a large size and potential to bleed. Here, we report the second case of spontaneous haemorrhage in an adrenal angiomyolipoma, which was successfully treated with open adrenalectomy.
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Kelly JD, Tan WS, Porta N, Mostafid H, Huddart R, Protheroe A, Bogle R, Blazeby J, Palmer A, Cresswell J, Johnson M, Brough R, Madaan S, Andrews S, Cruickshank C, Burnett S, Maynard L, Hall E. BOXIT-A Randomised Phase III Placebo-controlled Trial Evaluating the Addition of Celecoxib to Standard Treatment of Transitional Cell Carcinoma of the Bladder (CRUK/07/004). Eur Urol 2019; 75:593-601. [PMID: 30279015 DOI: 10.1016/j.eururo.2018.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/11/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Non-muscle-invasive bladder cancer (NMIBC) has a significant risk of recurrence despite adjuvant intravesical therapy. OBJECTIVE To determine whether celecoxib, a cyclo-oxygenase 2 inhibitor, reduces the risk of recurrence in NMIBC patients receiving standard treatment. DESIGN, SETTING, AND PARTICIPANTS BOXIT (CRUK/07/004, ISRCTN84681538) is a double-blinded, phase III, randomised controlled trial. Patients aged ≥18 yr with intermediate- or high-risk NMIBC were accrued across 51 UK centres between 1 November 2007 and 23 July 2012. INTERVENTION Patients were randomised (1:1) to celecoxib 200mg twice daily or placebo for 2 yr. Patients with intermediate-risk NMIBC were recommended to receive six weekly mitomycin C instillations; high-risk NMIBC cases received six weekly bacillus Calmette-Guérin and maintenance therapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was time to disease recurrence. Analysis was by intention to treat. RESULTS AND LIMITATIONS A total of 472 patients were randomised (236:236). With median follow-up of 44 mo (interquartile range: 36-57), 3-yr recurrence-free rate (95% confidence interval) was as follows: celecoxib 68% (61-74%) versus placebo 64% (57-70%; hazard ratio [HR] 0.82 [0.60-1.12], p=0.2). There was no difference in high-risk (HR 0.77 [0.52-1.15], p=0.2) or intermediate-risk (HR 0.90 [0.55-1.48], p=0.7) NMIBC. Subgroup analysis suggested that time to recurrence was longer in pT1 NMIBC patients treated with celecoxib compared with those receiving placebo (HR 0.53 [0.30-0.94], interaction test p=0.04). The 3-yr progression rates in high-risk patients were low: 10% (6.5-17%) and 9.7% (6.0-15%) in celecoxib and placebo arms, respectively. Incidence of serious cardiovascular events was higher in celecoxib (5.2%) than in placebo (1.7%) group (difference +3.4% [-0.3% to 7.2%], p=0.07). CONCLUSIONS BOXIT did not show that celecoxib reduces the risk of recurrence in intermediate- or high-risk NMIBC, although celecoxib was associated with delayed time to recurrence in pT1 NMIBC patients. The increased risk of cardiovascular events does not support the use of celecoxib. PATIENT SUMMARY Celecoxib was not shown to reduce the risk of recurrence in intermediate- or high-risk non-muscle-invasive bladder cancer (NMIBC), although celecoxib was associated with delayed time to recurrence in pT1 NMIBC patients. The increased risk of cardiovascular events does not support the use of celecoxib.
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Affiliation(s)
| | | | - Nuria Porta
- The Institute of Cancer Research, London, UK
| | - Hugh Mostafid
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Robert Huddart
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Richard Bogle
- Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK
| | | | | | - Jo Cresswell
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Mark Johnson
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | | | | | | | | | - Emma Hall
- The Institute of Cancer Research, London, UK
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Jayawardhana T, Alsayed H, Goel A, Madaan S. Non-muscle-invasive clear cell carcinoma of the urinary bladder: Is cystectomy necessary? BMJ Case Rep 2019; 12:e226928. [PMID: 30850563 PMCID: PMC6424185 DOI: 10.1136/bcr-2018-226928] [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] [Accepted: 02/12/2019] [Indexed: 11/03/2022] Open
Abstract
We report the clinical presentation, histological findings and management of a 49-year-old female patient with non-muscle-invasive clear cell carcinoma of the urinary bladder. In the literature, there are only seven such case reports. We feel that transurethral resection of the bladder tumour followed by close cystoscopy surveillance is a suitable management for non-muscle-invasive clear cell carcinoma of the urinary bladder.
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Affiliation(s)
| | - Hossam Alsayed
- Department of Urology & Nephrology, Darent Valley Hospital, Dartford, UK
| | - Amit Goel
- Department of Histopathology, Maidstone Hospital, Maidstone, UK
| | - Sanjeev Madaan
- Department of Urology & Nephrology, Darent Valley Hospital, Dartford, UK
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van Valenberg FJP, Kajtazovic A, Canepa G, Lüdecke G, Kilb JI, Aben KKH, Nativ O, Madaan S, Ayres B, Issa R, Witjes JA. Intravesical Radiofrequency-Induced Chemohyperthermia for Carcinoma in Situ of the Urinary Bladder: A Retrospective Multicentre Study. Bladder Cancer 2018; 4:365-376. [PMID: 30417047 PMCID: PMC6218119 DOI: 10.3233/blc-180187] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 12/22/2022]
Abstract
Objective: To examine the effect of intravesical radiofrequency-induced chemohyperthermia (RF-CHT) in carcinoma in-situ (CIS) patients overall and split according to previously received therapy. Methods: CIS patients that underwent an induction and maintenance phase of≥6 RF-CHT instillations, and had either pathology or cystoscopy plus cytology available at 6 months of follow-up were retrospectively included. Complete response (CR), recurrences, cystectomy-free rate, overall survival (OS), and adverse events were evaluated. Analysis was performed for overall, bacillus Calmette-Guérin (BCG)-unresponsive, other BCG-treated, and treatment naïve patients. Results: Patients (n = 150) had a mean of 17.5, 9.2, or 0 previous BCG instillations in the BCG-unresponsive (n = 50), other BCG-treated (n = 46, missing n = 4), and treatment naïve groups (n = 47, missing n = 3), respectively. After 6 months, a CR of 46.0%, 71.7%, and 83.0% was found (p < 0.001). Subsequent 2-year recurrence rates were 17.4%, 27.3%, and 12.8%, respectively. The overall cystectomy-free rate and OS at mean follow-up (35.8 months) were 78.5% and 78.0%, respectively. These were 71.4% vs. 84.1% vs. 86.7% (cystectomy-free rate, p = 0.006) and 76.0% vs. 69.6% vs. 87.2% (OS, p = 0.06) for BCG-unresponsive vs. other BCG-treated vs. treatment naïve patients. Progression to muscle-invasive disease was seen in 13.3% of patients. Patients stopped induction or maintenance RF-CHT instillations due to adverse events in respectively 13.4% and 17.8%. Conclusions: Intravesical RF-CHT showed good results in both treatment naïve and BCG-treated CIS patients, avoiding the need for cystectomy in 78.5% of cases for at least 3 years with a modest risk of progression. Thus, RF-CHT proves an alternative to cystectomy in selected high-risk patients.
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Affiliation(s)
| | - Amir Kajtazovic
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Gerson Lüdecke
- University Clinics Giessen and Marburg GmbH, Location Giessen, Justus-Liebig University Giessen, Germany
| | - Jill-Isabel Kilb
- University Clinics Giessen and Marburg GmbH, Location Giessen, Justus-Liebig University Giessen, Germany
| | - Katja K H Aben
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | | | | | | | | | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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Tan WS, Panchal A, Buckley L, Devall AJ, Loubière LS, Pope AM, Feneley MR, Cresswell J, Issa R, Mostafid H, Madaan S, Bhatt R, McGrath J, Sangar V, Griffiths TRL, Page T, Hodgson D, Datta SN, Billingham LJ, Kelly JD. Radiofrequency-induced Thermo-chemotherapy Effect Versus a Second Course of Bacillus Calmette-Guérin or Institutional Standard in Patients with Recurrence of Non-muscle-invasive Bladder Cancer Following Induction or Maintenance Bacillus Calmette-Guérin Therapy (HYMN): A Phase III, Open-label, Randomised Controlled Trial. Eur Urol 2018; 75:63-71. [PMID: 30274699 DOI: 10.1016/j.eururo.2018.09.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/04/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is no effective intravesical second-line therapy for non-muscle-invasive bladder cancer (NMIBC) when bacillus Calmette-Guérin (BCG) fails. OBJECTIVE To compare disease-free survival time (DFS) between radiofrequency-induced thermo-chemotherapy effect (RITE) and institutional standard second-line therapy (control) in NMIBC patients with recurrence following induction/maintenance BCG. DESIGN, SETTINGS, AND PARTICIPANTS Open-label, phase III randomised controlled trial accrued across 14 centres between May 2010 and July 2013 (HYMN [ClinicalTrials.gov: NCT01094964]). INTERVENTION Patients were randomly assigned (1:1) to RITE (60min, 40mg mitomycin-C, 42±2°C) or control following stratification for carcinoma in situ (CIS) status (present/absent), therapy history (failure of previous induction/maintenance BCG), and treatment centre. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary outcome measures were DFS and complete response (CR) at 3 mo for the CIS at randomisation subgroup. Analysis was based on intention-to-treat. RESULTS AND LIMITATIONS A total of 104 patients were randomised (48 RITE: 56 control). Median follow-up for the 31 patients without a DFS event was 36 mo. There was no significant difference in DFS between treatment arms (hazard ratio [HR] 1.33, 95% confidence interval [CI] 0.84-2.10, p=0.23) or in 3-mo CR rate in CIS patients (n=71; RITE: 30% vs control: 47%, p=0.15). There was no significant difference in DFS between treatment arms in non-CIS patients (n=33; RITE: 53% vs control: 24% at 24 mo, HR 0.50, 95% CI 0.22-1.17, p=0.11). DFS was significantly lower in RITE than in control in CIS with/without papillary patients (n=71; HR 2.06, 95% CI 1.17-3.62, p=0.01; treatment-subgroup interaction p=0.007). Disease progression was observed in four patients in each treatment arm. Adverse events and health-related quality of life between treatment arms were comparable. CONCLUSIONS DFS was similar between RITE and control. RITE may be a second-line therapy for non-CIS recurrence following BCG failure; however, confirmatory trials are needed. RITE patients with CIS with/without papillary had lower DFS than control. HYMN highlights the importance of the control arm when evaluating novel therapies. PATIENT SUMMARY This study did not show a difference in bladder cancer outcomes between microwave-heated chemotherapy and standard of care treatment. Papillary bladder lesions may benefit from microwave-heated chemotherapy treatment; however, more research is needed. Both treatments are similarly well tolerated.
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Affiliation(s)
- Wei Shen Tan
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK
| | - Anesh Panchal
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Laura Buckley
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Adam J Devall
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Laurence S Loubière
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Ann M Pope
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Mark R Feneley
- Department of Urology, University College London Hospital, London, UK
| | - Jo Cresswell
- Department of Urology, James Cook University Hospital, Middlesbrough, UK
| | - Rami Issa
- Department of Urology, St George's Hospital, London, UK
| | - Hugh Mostafid
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | - Sanjeev Madaan
- Department of Urology, Darent Valley Hospital, Dartford, UK
| | - Rupesh Bhatt
- Department of Urology, Queen Elizabeth Hospital, Birmingham, UK
| | - John McGrath
- Department of Urology, Royal Devon and Exeter Hospital, Exeter, UK
| | - Vijay Sangar
- Department of Urology, Withington Hospital, Manchester, UK
| | | | - Toby Page
- Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Dominic Hodgson
- Department of Urology, Queen Alexandra Hospital, Portsmouth, UK
| | | | - Lucinda J Billingham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - John D Kelly
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK.
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Abstract
Renal artery pseudoaneurysm is a rare complication following renal interventional procedures or, although it may be spontaneous as described in this case. Clinicians should have a low threshold for early computer tomography (CT) imaging in cases of diagnostic uncertainty.
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Affiliation(s)
| | | | - Viktor Serafimov
- Department of Urology, Darent Valley Hospital, Dartford DA2 8DA, UK
| | - Sanjeev Madaan
- Department of Urology, Darent Valley Hospital, Dartford DA2 8DA, UK
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Reekhaye A, Sriprasad S, Madaan S. A review of the contemporary management of upper urinary tract urothelial carcinoma. Journal of Clinical Urology 2018. [DOI: 10.1177/2051415817717906] [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: 11/16/2022]
Abstract
Upper tract urothelial carcinoma (UTUC) is relatively rare and accounts for approximately 5% of all urothelial carcinomas. The estimated annual incidence of UTUC in Western countries is about two new cases per 100,000 inhabitants. The management of patients with upper tract urothelial carcinomas has changed significantly over the last decade with improved diagnostic techniques and treatment options. The gold-standard treatment used to be open radical nephroureterectomy with removal of the ipsilateral bladder cuff. The use of minimally invasive techniques for the diagnosis and management of upper urinary tract urothelial carcinoma is however expanding and has led to a paradigm shift in treatment strategies of upper tract urothelial carcinomas. In this article, we review the current diagnostic modalities and various endoscopic techniques being currently used in the management of this relatively rare tumour.
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Affiliation(s)
| | | | - Sanjeev Madaan
- Department of Urology and Nephrology, Darent Valley Hospital, UK
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Affiliation(s)
| | - Amit Kumar
- White Horse Surgery, Northfleet, Gravesend DA11 8BZ, UK
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Tan WS, Buckley L, Devall A, Loubiére L, Pope A, Feneley M, Cresswell J, Issa R, Mostafid H, Madaan S, Bhatt R, McGrath J, Sangar V, Griffiths L, Page T, Hodgson D, Datta S, Billingham L, Kelly J. PD19-08 RADIOFREQUENCY-INDUCED THERMO-CHEMOTHERAPY EFFECT (RITE) PLUS MITOMYCIN VERSUS A SECOND COURSE OF BACILLUS CALMETTE-GUÉRIN (BCG) OR INSTITUTIONAL STANDARD IN PATIENTS WITH RECURRENCE OF NON-MUSCLE INVASIVE BLADDER CANCER FOLLOWING INDUCTION OR MAINTENANCE BCG THERAPY (HYMN): A OPEN-LABEL, MULTICENTRE, PHASE III RANDOMISED CONTROLLED TRIAL. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.881] [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: 10/19/2022]
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Rees T, Raison N, Sheikh MI, Jaffry Z, Madaan S, Challacombe B, Ahmed K, Dasgupta P. Is extended pelvic lymph node dissection for prostate cancer the only recommended option? A systematic over-view of the literature. Turk J Urol 2016; 42:240-246. [PMID: 27909616 DOI: 10.5152/tud.2016.52893] [Citation(s) in RCA: 7] [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] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Pelvic lymph node dissection (PLND) is performed alongside radical prostatectomy as the most accurate method of staging prostate cancer. Yet the potential therapeutic benefits of lymphadenectomy are yet to be confirmed. MATERIAL AND METHODS A PubMed database search was performed to identify all papers comparing techniques for PLND or none. The primary outcome measure was long term oncological outcomes. Studies looking at men with clinically localized prostate cancer at the time of radical prostatectomy who received no adjuvant treatment were included. Previous reviews and single case reports were excluded. The subsequent available papers were then systematically reviewed. RESULTS Limited PLND provides no benefit in low risk prostate cancer and is unlikely to provide a therapeutic benefit in higher risk groups either when compared with no PLND. Extended PLND may provide some therapeutic benefit, particularly in patients with occult metastases; however, the evidence base for this is not particularly strong and may be down to statistical phenomena. CONCLUSION When performed in prostate cancer patients, PLND should be extended, as it is a more accurate staging tool and may provide therapeutic benefit to some patients. However, to properly assess this, randomised controlled studies need to be performed in this area.
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Affiliation(s)
- Thomas Rees
- King's College School of Medicine, King's College London, London, UK
| | - Nicholas Raison
- MRC Centre for Transplantation, Kings College London, London, UK
| | | | - Zahra Jaffry
- Department of Urology, Guy's and St Thomas' Hospital, London, UK
| | - Sanjeev Madaan
- Department of Urology, Darent Valley Hospital, Dartford, UK
| | - Ben Challacombe
- Department of Urology, Guy's and St Thomas' Hospital, London, UK
| | - Kamran Ahmed
- King's College School of Medicine, King's College London, London, UK
| | - Prokar Dasgupta
- King's College School of Medicine, King's College London, London, UK
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Gilbert DC, Duong T, Kynaston HG, Alhasso AA, Cafferty FH, Rosen SD, Kanaga-Sundaram S, Dixit S, Laniado M, Madaan S, Collins G, Pope A, Welland A, Nankivell M, Wassersug R, Parmar MKB, Langley RE, Abel PD. Quality-of-life outcomes from the Prostate Adenocarcinoma: TransCutaneous Hormones (PATCH) trial evaluating luteinising hormone-releasing hormone agonists versus transdermal oestradiol for androgen suppression in advanced prostate cancer. BJU Int 2016; 119:667-675. [PMID: 27753182 DOI: 10.1111/bju.13687] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare quality-of-life (QoL) outcomes at 6 months between men with advanced prostate cancer receiving either transdermal oestradiol (tE2) or luteinising hormone-releasing hormone agonists (LHRHa) for androgen-deprivation therapy (ADT). PATIENTS AND METHODS Men with locally advanced or metastatic prostate cancer participating in an ongoing randomised, multicentre UK trial comparing tE2 versus LHRHa for ADT were enrolled into a QoL sub-study. tE2 was delivered via three or four transcutaneous patches containing oestradiol 100 μg/24 h. LHRHa was administered as per local practice. Patients completed questionnaires based on the European Organisation for Research and Treatment of Cancer quality of life questionnaire 30-item core (EORTC QLQ-C30) with prostate-specific module QLQ PR25. The primary outcome measure was global QoL score at 6 months, compared between randomised arms. RESULTS In all, 727 men were enrolled between August 2007 and October 2015 (412 tE2, 315 LHRHa) with QoL questionnaires completed at both baseline and 6 months. Baseline clinical characteristics were similar between arms: median (interquartile range) age of 74 (68-79) years and PSA level of 44 (19-119) ng/mL, and 40% (294/727) had metastatic disease. At 6 months, patients on tE2 reported higher global QoL than those on LHRHa (mean difference +4.2, 95% confidence interval 1.2-7.1; P = 0.006), less fatigue, and improved physical function. Men in the tE2 arm were less likely to experience hot flushes (8% vs 46%), and report a lack of sexual interest (59% vs 74%) and sexual activity, but had higher rates of significant gynaecomastia (37% vs 5%). The higher incidence of hot flushes among LHRHa patients appear to account for both the reduced global QoL and increased fatigue in the LHRHa arm compared to the tE2 arm. CONCLUSION Patients receiving tE2 for ADT had better 6-month self-reported QoL outcomes compared to those on LHRHa, but increased likelihood of gynaecomastia. The ongoing trial will evaluate clinical efficacy and longer term QoL. These findings are also potentially relevant for short-term neoadjuvant ADT.
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Affiliation(s)
- Duncan C Gilbert
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Trinh Duong
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | | | | | - Fay H Cafferty
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Stuart D Rosen
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Sanjay Dixit
- Scunthorpe General Hospital, North Lincolnshire and Goole NHS Trust, Scunthorpe, UK
| | - Marc Laniado
- Frimley Health NHS Foundation Trust, Wexham Park Hospital, Slough, UK
| | - Sanjeev Madaan
- Dartford and Gravesham NHS Trust, Darent Valley Hospital, Dartford, UK
| | - Gerald Collins
- Stockport NHS Foundation Trust, Stepping Hill Hospital, Stockport, UK
| | - Alvan Pope
- The Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - Andrew Welland
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Matthew Nankivell
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | | | - Mahesh K B Parmar
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Ruth E Langley
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Paul D Abel
- Imperial College Healthcare NHS Trust, London, UK.,Imperial College London, London, UK
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Madaan S, Reekhaye A. NICE prostate cancer quality standards. Journal of Clinical Urology 2016. [DOI: 10.1177/2051415816642694] [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
Prostate cancer is the most common cancer in men in the United Kingdom. Over 42,000 men are diagnosed with prostate cancer every year. In June 2015, the National Institute for Health and Care Excellence (NICE) finally published five key statements regarding prostate cancer care. The quality standards are mostly derived from the NICE prostate cancer guidelines. In this article, we discuss the development process by the NICE Advisory Committee and highlight the five key priorities proposed by NICE to drive quality improvements in patient safety, patient experience and clinical effectiveness. We also discuss areas for potential improvement to improve the standard of care for men with prostate cancer.
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Affiliation(s)
- Sanjeev Madaan
- Department of Urology and Nephrology, Darent Valley Hospital, UK
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Madaan S, Reekhaye A, McFarlane J. Survivorship and prostate cancer: the TrueNTH Supported Self-Management programme. Trends Urology & Men Health 2016. [DOI: 10.1002/tre.502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sanjeev Madaan
- Department of Urology and Nephrology; Darent Valley Hospital; Dartford
| | - Abhishek Reekhaye
- Department of Urology and Nephrology; Darent Valley Hospital; Dartford
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Khan F, Srirangan S, El-Miedany Y, Madaan S. Widespread lytic lesions-A metastatic or vasculitic process? Int J Surg Case Rep 2015; 18:18-20. [PMID: 26684863 PMCID: PMC4701870 DOI: 10.1016/j.ijscr.2015.11.023] [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: 08/01/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION This case highlights the complexities in the initial diagnosis and investigations of widespread lytic lesions initially perceived to be a widespread metastatic process and the consideration of alternative diagnosis. PRESENTATION OF CASE A 57 year-old man with a background of psoriatic arthritis presented to the rheumatology department with lumbar back pain and sensory disturbance over L4/5. Magnetic resonance imaging (MRI) and bone scan identified lesions consistent with bony metastases at L5. The patient previously had a raised prostate specific antigen (PSA) of 10.8μg/L (normal<4) but prostate biopsy was benign. Multiple metastatic deposits in the liver and kidneys (confirmed necrotic tissue on biopsy) were identified through further investigations. The initial diagnosis of malignancy was challenged after a positron emission tomography (PET) scan showed lesions highly suggestive of polyarteritis nodosa (PAN) and subsequent magnetic resonance angiogram (MRA) revealed stenosis and aneurysm in the renal artery in keeping with PAN. Therefore what was initially thought to be a widespread metastatic disease process was in fact the manifestation of a systemic vasculitic disease. DISCUSSION PAN is a vasculitis that predominantly involves small to medium-sized vessels. The disease can affect any site in the body, but holds a predisposition for organs such as kidneys, heart and the gastrointestinal tract. Differential diagnosis of PAN should be considered in patients with widespread lytic lesions. CONCLUSION Due to the pathological nature of PAN and its variable clinical manifestations that add to the challenges of its diagnosis, one must hold a high clinical suspicion, even in urological conditions.
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Affiliation(s)
- Fahd Khan
- Department of Urology, Darenth Wood Road, Dartford, DA2 8DA, United Kingdom.
| | - Srinivasan Srirangan
- Department of Rheumatology, Darent Valley Hospital, Darenth Wood Road, Dartford, DA2 8DA, United Kingdom
| | - Yasser El-Miedany
- Department of Rheumatology, Darent Valley Hospital, Darenth Wood Road, Dartford, DA2 8DA, United Kingdom
| | - Sanjeev Madaan
- Department of Urology, Darenth Wood Road, Dartford, DA2 8DA, United Kingdom
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Hadjipavlou M, Mohamed A, Sriprasad S, Madaan S, Khan S, Rane A. PD44-08 ABNORMAL DIGITAL RECTAL EXAMINATION (DRE) OF THE PROSTATE INCREASES THE LIKELIHOOD OF FUTURE HIGH GRADE PROSTATE CANCER DIAGNOSIS IN PATIENTS WITH INITIAL BENIGN PROSTATE BIOPSY. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2554] [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: 10/23/2022]
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Tasleem AM, Varga B, Mahmalji W, Madaan S. A late presentation of isolated lymph node tuberculosis postintravesical BCG therapy for superficial bladder cancer: a novel case. BMJ Case Rep 2014; 2014:bcr-2014-204037. [PMID: 24792024 DOI: 10.1136/bcr-2014-204037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Intravesical BCG immunotherapy is commonly used in the treatment of superficial bladder cancer. We recount the case of an 82-year-old British man who completed a course of BCG immunotherapy in 2011 for superficial bladder cancer, and presented in January 2013 with a loss of appetite, loss of weight and severe back pain. CT scanning, followed by MRI displayed a 5.7 cm × 5 cm conglomerated necrotic, haemorrhagic mass of lymph nodes in the para-aortic region. A CT-guided biopsy revealed granulomatous inflammation, focal fibrosis and acid-fast bacilli consistent with Mycobacterium tuberculosis (TB). The patient was treated with combination antituberculous medication, and is recovering. To our knowledge, this is the only reported case of lymph node TB secondary to intravesical BCG immunotherapy. We suggest that in patients treated with postintravesical BCG with enlarged lymph nodes, a diagnosis of secondary TB should be considered.
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Khan F, Mukhtar S, Marsh H, Anjum F, Madaan S, Dickinson IK, Sriprasad S. Evaluation of the pressure leak test in increasing the lifespan of flexible ureteroscopes. Int J Clin Pract 2013; 67:1040-3. [PMID: 24073976 DOI: 10.1111/ijcp.12149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 02/05/2013] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Flexible ureteroscopes are expensive and delicate instruments that are integral in the offering of a minimally invasive technique of diagnosis and treatment of urolithiasis. Published literature has identified the importance of early damage recognition in preventing frequent use of the scope that would lead to further damage and high repair and replacement costs. Our study was designed to examine the outcome of the pressure leak test on the condition of flexible ureteroscopes after every use and analysing the damage and costs of maintenance. PATIENTS AND METHODS A prospective study was designed with two treatment groups. Group 1, 95 consecutive procedures (n = 95) of flexible ureterorenoscopy and laser fragmentation of renal calculi were performed with ACMI DUR 8, (a scope with no in-built leak test facility). This was compared against group 2, where 98 procedures of laser fragmentation of renal calculi (n = 98) were performed using Storz Flex X(2) Ureteroscopes (with a in-built leak test facility). All scopes in Group 2 were tested for pressure leak after every procedure and the outcome of the tests recorded. RESULTS Both groups were comparable for grade of surgeon; stone location, size & number; access sheath usage and duration of lasering. In Group 1, there were seven scope damages resulting in repairs/replacement amounting to costs $46264.40 (7.1% damage). In Group 2, three scopes revealed a positive pressure leak test, implying damage with repair costs of $9952.80 (3.1% damage) (p < 0.05). Significant cost savings and reduction in downtime were made in Group 2. CONCLUSIONS Pressure leak testing following flexible ureterorenoscopy helped to significantly control costs of maintenance and repair. Newer scopes should have a leak testing mechanism as it prevents further detrimental damage to the scope, build-up of repair costs are avoided and there is an increase in the longevity of these delicate instruments.
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Affiliation(s)
- F Khan
- The Stone Centre, Department of Urology, Darent Valley Hospital, Kent, UK
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Abstract
A 66-year-old Caucasian man with a background of prostate cancer presented with a progressive history of nausea, reduced appetite, shortness of breath and a distended abdomen. Radiological imaging revealed a left-sided renal mass and gross ascites suggestive of metastatic renal cell carcinoma (RCC). Subsequent histological examination and immunostaining of renal mass biopsy revealed features characteristic of metastatic moderately differentiated to a focally poorly differentiated, large duct type of prostatic adenocarcinoma.
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Affiliation(s)
- Fahd Khan
- Department of Urology, Darent Valley Hospital, Kent, Dartford, UK.
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Shah S, Marsh H, Khan MS, Shah A, Madaan S. Urological complications of inguinal hernia surgery. Scott Med J 2013; 58:119-23. [PMID: 23728759 DOI: 10.1177/0036933013482671] [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] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS A systematic review of the literature is presented with regard to urological complications resulting from inguinal hernia surgery. Considering the amount of inguinal hernia operations performed, the resulting complications, which may be urological in presentation, have potential late irreversible and medico-legal implications. METHODS AND RESULTS A Pubmed search of 'urological' 'complications' and 'inguinal hernia surgery' was carried out and clinical practice was also taken into consideration. DISCUSSION Approximately 75% of hernias occur in the groin; two-third of these are indirect and about one-third direct. Most of these repairs are carried out by the general surgeons and any complication, including urological, are often initially managed by the operating general surgeon. Often a urological opinion is sought late for conditions which may be reversible. We present potential urological complications, their presenting features and management. CONCLUSION Recognition, timely referral and appropriate treatment of urological complications after hernia surgery are necessary to avoid potential consequences and long-term morbidity.
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Affiliation(s)
- S Shah
- Department of Urology, Medway Maritime Hospital, Gillingham, Kent, UK.
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Khan F, Madaan S, Sriprasad S, Dickinson I. 1113 A TRIBUTE TO THE LIFE AND ACCOMPLISHMENTS OF MATHIEU JABOULAY. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.705] [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: 10/27/2022]
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Khan F, Mukhtar S, Anjum F, Tripathi B, Sriprasad S, Dickinson IK, Madaan S. Fournier's gangrene associated with intradermal injection of cocaine. J Sex Med 2013; 10:1184-6. [PMID: 23347293 DOI: 10.1111/jsm.12055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cocaine abuse is associated with a number of medical complications, most notably arrhythmias, myocardial infarction, and cerebral hemorrhages. The injection of cocaine in the penis has been predominantly recorded into the corpus cavernosae and is associated with priapism. AIM Here we describe the injection of subcutaneous cocaine within the penile shaft skin producing ischemic necrosis and Fournier's gangrene. MAIN OUTCOME MEASURES We sought to highlight the effects of cocaine use within the penis and emphasize the different effects that may ensue. METHODS We reviewed a recent clinical case and conducted a literature review on the use of cocaine within the penis. RESULTS The use of cocaine has been reported previously within the literature and is mainly limited to case reports. Cocaine use within the corpora and the subcutaneous tissues produces significantly different consequences ranging from priapism to Fournier's gangrene. CONCLUSIONS The case illustrates the growing use of cocaine and other illicit drugs and emphasizes the importance of this issue to all clinicians.
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Affiliation(s)
- Fahd Khan
- Department of Urology, Darent Valley Hospital, Dartford, Kent, UK
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Khan F, Madaan S, Dickinson I, Sriprasad S. 1041 UROLOGICAL INSTRUMENTS IN THE 10TH CENTURY- CONTRIBUTIONS OF ALBUCASIS, THE SHEIKH OF SURGERY. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1146] [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]
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Madaan S, Palit V, Gudgeon P, Biyani CS. Omental metastasis with malignant ascites: an unusual manifestation of prostatic adenocarcinoma. Can Urol Assoc J 2011; 1:288-90. [PMID: 18542809 DOI: 10.5489/cuaj.86] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Omental metastasis with malignant ascites from prostatic adenocarcinoma is rare. This case report is about a patient who presented with a 24-hour history of a swollen right leg. Clinical examination revealed a hard prostate and blood biochemistry demonstrated an elevated prostate specific antigen level. A Doppler ultrasound scan excluded deep venous thrombosis, but a CT scan of the abdomen revealed marked para-aortic lymphadenopathy and prostate gland biopsy confirmed prostatic adenocarcinoma. The patient was treated with goserelin. Three years later, he presented with ascites and an omental mass. Histology of the omental mass showed metastasis from the prostatic adenocarcinoma. He was treated with second-line hormonal therapy but died after 4 months. We discuss the clinical progression, with a review of the literature.
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Affiliation(s)
- Sanjeev Madaan
- Department of Urology, Pinderfields General Hospital, Wakefield, West Yorkshire, UK
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Sellaturay S, Madaan S, Dickinson I, Sriprasad S. 1051 THE ETYMOLOGY OF PROTEUS: AN EVOLUTION FROM MYTHOLOGY AND HISTORY TO PRESENT DAY. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.1087] [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: 10/18/2022]
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Chawla S, Goyal SC, Angrish R, Rani C, Arora V, Datta KS, Madaan S, Devi S. Acclimatory response to hydrogen peroxide and glutathione under salt-boron stress through their impact on mineral nutrition and antioxidant defense system in pigeonpea (Cajanus cajan L.). Physiol Mol Biol Plants 2010; 16:295-304. [PMID: 23572979 PMCID: PMC3550669 DOI: 10.1007/s12298-010-0032-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Investigations were carried out on a salt tolerant (Manak, H77-216) and a comparatively salt sensitive (ICPL 88039) genotypes of pigeonpea (Cajanus cajan L. Millsp.) under NaCl, B and NaCl + B stress to examine the acclimatory response to H2O2, glutathione and H2O2 + glutathione through their effect on mineral nutrition, morpho-physiological parameters and antioxidant defense system. Both B and NaCl alone and their combinations had deleterious effect on dry biomass of plumule, enhanced relative stress injury (RSI), lipid peroxidation with concomitant increase in Na, Cl and B contents. However it did not bear any correlation with osmotic potential of plumule and K contents. Antioxidative enzymes like superoxide dismutase (SOD), catalase (CAT), ascorbate peroxidase (APX), peroxidase (POX) and glutathione reductase (GR) also decreased with salt, B and salt + B treatments. However contents of H2O2 enhanced and that of ascorbate declined under aforementioned treatments. These injurious effects are partially alleviated by exogenous application of H2O2; glutathione (GSH) and H2O2 + GSH treatments. The role of H2O2 and GSH in the present study is suggestive of triggering multifunctional signal transduction in plant defense mechanisms to prevent cellular oxidation, membrane injury, lipid peroxidation and protein enzyme inactivation.
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Affiliation(s)
- S. Chawla
- Department of Botany and Plant Physiology, CCS Haryana Agricultural University, Hisar, 125004 Haryana India
| | - S. C. Goyal
- Department of Botany and Plant Physiology, CCS Haryana Agricultural University, Hisar, 125004 Haryana India
| | - Rajiv Angrish
- Department of Botany and Plant Physiology, CCS Haryana Agricultural University, Hisar, 125004 Haryana India
| | - C. Rani
- Department of Botany and Plant Physiology, CCS Haryana Agricultural University, Hisar, 125004 Haryana India
| | - V. Arora
- Department of Botany and Plant Physiology, CCS Haryana Agricultural University, Hisar, 125004 Haryana India
| | - K. S. Datta
- Department of Botany and Plant Physiology, CCS Haryana Agricultural University, Hisar, 125004 Haryana India
| | - S. Madaan
- Department of Botany and Plant Physiology, CCS Haryana Agricultural University, Hisar, 125004 Haryana India
| | - S. Devi
- Department of Botany and Plant Physiology, CCS Haryana Agricultural University, Hisar, 125004 Haryana India
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Madaan S, Bardapure M, Nagarajan M, Biyani CS. Submucosal ureteric calculus mimicking transitional cell carcinoma. Int J Clin Pract 2010; 64:131-3. [PMID: 20089036 DOI: 10.1111/j.1742-1241.2006.01070.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Madaan S, Joniau S, Klockaerts K, DeWever L, Lerut E, Oyen R, Van Poppel H. Segmental Testicular Infarction: Conservative Management is Feasible and Safe: Part 2. Eur Urol 2008; 53:656-8. [DOI: 10.1016/j.eururo.2007.03.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kotwal S, Madaan S, Prescott S, Chilka S, Whelan P. Unusual squamous cell carcinoma of the scrotum arising from a well healed, innocuous scar of an infertility procedure: a case report. Ann R Coll Surg Engl 2007; 89:W17-9. [PMID: 17688712 PMCID: PMC2048626 DOI: 10.1308/147870807x188498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A novel case of squamous cell carcinoma of scrotum that developed in a well-healed, uncomplicated scar following an infertility procedure.
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Affiliation(s)
- Sanjeev Kotwal
- Pyrah Department of Urology, St James's University Hospital, Leeds, UK.
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