Scandinavian journal of urology
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The aim of this study was to assess the effect of introducing an enhanced recovery programme (ERP) to an established robot-assisted radical cystectomy (RARC) service. ⋯ Patient demographics changed as the RARC service evolved from selected patients to a general service. Despite worsening demographics, LOS decreased following ERP implementation. This evidence-based ERP safely standardized perioperative care, resulting in decreased LOS and decreased variability in LOS.
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Observational Study
Mobile kidney pain provocation ultrasonography before surgery for symptomatic mobile kidney: A prospective study of 43 consecutive patients.
The aim of this study was to evaluate whether mobile kidney pain provocation ultrasonography together with intravenous pyelography in supine and standing positions and a full medical history can confirm the diagnosis of the clinical condition of symptomatic mobile kidney and aid the selection of patients for surgical treatment. ⋯ The results indicate that mobile kidney pain provocation ultrasonography and intravenous pyelography in supine and standing positions can verify the diagnosis of symptomatic mobile kidney and aid the selection of patients who will benefit from nephropexy.
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Patients with spinal cord injury (SCI) commonly suffer from neurogenic lower urinary tract dysfunction (NLUTD). Sacral neuromodulation (SNM) offers an alternative in the treatment of detrusor overactivity in patients with NLUTD. We report the cases of three patients with NLUTD due to SCI who received SNM. ⋯ Reprogramming or replacement of the IPG or the electrodes resulted in restoration of SNM function. Trauma due to skiing is a potential risk factor for the integrity of SNM. Patients with SNM should be informed about the potential risk of SNM damage by falls and accidents.
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The aim of this study was to review the impact of salvage external beam radiotherapy (EBRT) of postprostatectomy patients with long-term follow-up on biochemical-free recurrence (BFR) and metastatic-free survival, and to describe pathological and clinical predictors of outcome. ⋯ Salvage EBRT provides effective long-term BFR and metastatic-free survival in a selected group of patients with detectable, rising prostate-specific antigen values following radical prostatectomy. SVI and PSADT are prognostic variables for a non-durable response to salvage EBRT and thus predictors of high-risk prostate cancer in patients in whom neoadjuvant and adjuvant androgen deprivation therapy should be considered.
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The aim of this study was to assess treatment-related changes in prostate-specific antigen (PSA), total and bone alkaline phosphatase (total ALP, bone ALP), and changes on conventional bone scans in patients with metastatic castration-resistant prostate cancer (mCRPC) with bone metastases who received six cycles of radium-223 (Ra-223). ⋯ These observations support the notion that Ra-223 kills tumour cells in metastases surrounded by highly proliferating osteoblasts, consistent with the reported survival benefit. The radiation effect in small tumour deposits not surrounded by increased osteoblast activity seems, however, insufficient, thus allowing continuous tumour growth. Long-lasting PSA reductions are the exception rather than the rule during Ra-223 treatment, whereas alkaline phosphatases decrease more frequently. To improve the overall anticancer effect, Ra-223 might be a valuable component of combination treatment.