BJU international
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Comparative Study
Cost-effectiveness of standard vs intensive antibiotic regimens for transrectal ultrasonography (TRUS)-guided prostate biopsy prophylaxis.
Multiple studies have shown an increase in the hospital admission rates due to infectious complications after transrectal ultrasonography (TRUS)-guided prostate biopsy (TRUSBx), mostly related to a rise in the prevalence of fluoroquinolone-resistant organisms. As a result, multiple series have advocated the use of more intensive prophylactic antibiotic regimens to augment the effect of the widely used fluoroquinolone prophylaxis for TRUSBx. The present study compares the cost-effectiveness fluoroquinolone prophylaxis to more intensive prophylactic antibiotic regimens, which is an important consideration for any antibiotic regimen used on a wide-scale for TRUSBx prophylaxis. ⋯ As the risk of admission for infectious complications due to TRUSBx increases, use of an intensive prophylactic antibiotic regimen becomes significantly more cost-effective than current standard antibiotic prophylaxis.
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Review
Current status of molecular markers for prognostication and outcome in invasive bladder cancer.
What's known on the subject? and What does the study add? Currently, prognostication of patients with invasive BC is hampered owing to the inadequacy of standard clinicopathological risk factors to predict accurately individual treatment outcomes. This review provides a comprehensive albeit brief overview on current studies elucidating the potential role of different molecular markers to close this gap of evidence. It focuses on biostatistical considerations in the interpretation of study results which are essential to provide meaningful clinical conclusions for an individual patient. ⋯ • Different molecular markers have the potential to improve prognostication of patients with invasive BC and provide improved evidence for targeted therapy in the neoadjuvant, adjuvant and metastatic setting. • However, in order to advocate their routine clinical use on a sound scientific basis prospective data are still necessary.
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Randomized Controlled Trial Comparative Study
Combined perianal-intrarectal (PI) lidocaine-prilocaine (LP) cream and lidocaine-ketorolac gel provide better pain relief than combined PI LP cream and periprostatic nerve block during transrectal prostate biopsy.
What's known on the subject? and What does the study add? Study Type - Harm Reduction RCT Level of Evidence 1b The combination of perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block effectively counteracts probe and sampling related pain during transrectal prostate biopsy, but not pain due to periprostatic infiltration. The novel combination of lidocaine-prilocaine cream and lidocaine-ketorolac gel, both administered perianal-intrarectally, provides the same probe and sampling-related pain relief than combined perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block and prevents the non-negligible pain due to periprostatic infiltration, thus leading to better overall patients' compliance to the procedure. ⋯ • The novel combination of PI LP cream and LK gel provided the same probe- and sampling- related pain relief as combined PI LP and PPNB; moreover, by preventing the non-negligible periprostatic infiltration pain, it provided significantly better overall patients' compliance to the procedure. • Being safe and easy to administer, this novel non-infiltrative regimen has the potential to replace infiltrative anaesthesia in relieving pain during TPB.
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Study Type - Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Only 30-35% of patients with positive surgical margins after radical prostatectomy develop recurrent disease. Adjuvant radiotherapy reduces the rate of biochemical relapse or metastasis and improves overall survival after radical prostatectomy. Various pathological factors, such as location and extent of positive margins, have been proposed as possible prognostic factors in men with margin-positive prostate cancer, however, the recent International Society of Urological Pathology consensus meeting in Boston noted that there is limited data on the significance of Gleason grade of the carcinoma at a positive margin. The present study shows that the presence of high grade prostate cancer, i.e. Gleason pattern 4 or 5, at a positive surgical margin is an independent predictor of biochemical recurrence after radical prostatectomy. Moreover, patients with lower grade carcinoma at the margin have a similar prognosis to men with negative margins. Hence, assessment of Gleason grade at the site of positive margin may aid optimal selection of patients for adjuvant radiotherapy. ⋯ • The Gleason grade at the site of a PSM identifies patients at increased risk of biochemical recurrence and should aid stratification of patients for adjuvant radiation therapy.
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Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Penetrating trauma to the scrotum often requires operative intervention, with testicular salvage only possible when enough testicular tissue can be re-approximated in the traumatic setting. The present report represents the largest series of gunshot wound trauma to the scrotum in the literature. Further, it validates recommendations of the European Association of Urology guidelines on urological trauma that advocate operative intervention due to minimal rates of patient morbidity and the inherent limitations of scrotal ultrasonography in discerning testicular compromise. ⋯ The present report confirms that any patient with a penetrating injury to the scrotum should undergo immediate scrotal exploration. A low clinical suspicion for performing additional studies to rule out associated urethral and/or penile injury is clinically warranted. Testicular loss occurs in ≈50% of injured testicles.