Office Cystoscopy And Transrectal Ultrasound-guided Prostate Biopsies Pose Minimal Risk: Prospective Evaluation Of 921 Procedures
UroToday.com - The Institute of Medicine has drawn professional and public attention to the safety of patients in our health care system through two prominent publications. The Joint Commission has responded by developing a series of National Patient Safety Goals that must be followed to achieve accreditation. For patients undergoing surgery and procedures, the JCAHO developed the Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery TM which outlines a number of essential practices designed to ensure patient safety, including the designation of "minimal risk" and "more than minimal risk" procedures. As a result, without data to show the contrary, many institutions and practices may judge the 2 most commonly performed office procedures, cystoscopy and transrectal ultrasound guided biopsies (TRUS-BX), to represent more than minimal risk procedures, and thus be subjected to the same requirements as a major surgical procedure.
Prostate cancer remains one of the most commonly diagnosed cancers in the United States. In fact, one in six men will develop prostate cancer.(1) It is also the second-leading cause of cancer death in the United States.(1) But a recent survey suggests that many men at risk for the cancer still aren't aware of all available treatment options. The survey, conducted late last year, reveals that nearly 50% of men aged 40 and older are not aware of the most common approach to surgery for prostate cancer -- robotic-assisted surgery to remove the prostate.(2) "I had to do my own research and then self-admit myself to the [hospital], " says surgery patient Tim Propheter.
UroToday.com - Results from this systematic review demonstrate evidence for a higher stone expulsion rate and a reduced time to stone expulsion using alpha-blocker or calcium channel blockers compared to a standard therapy or placebo control group. Of nine alpha-blocker trials investigating stone expulsion with mean stone sizes <5 mm, only four studies demonstrated a significantly higher expulsion rate in the treatment group. In contrast, regarding alpha-blocker trials with stone sizes â 5 mm, 19 of 20 studies demonstrated a significant benefit in stone expulsion rates mirrored by an increase of the ARR from 0.15 to 0.31. Results might indicate that with decreasing stone size, an additional benefit for medical expulsive therapy is less likely because of the high spontaneous expulsion rate.
UroToday.com - Two Mid-Western studies on the emergency department (ED) management of patients with renal colic suggest that our ED colleagues would benefit from an educational update on this clinical problem. While the majority of patients are assessed with noncontrast CT imaging in the ED, there was a wide discrepancy in the understanding of the spontaneous stone passage rate for different stone sizes by ED physicians. Surprisingly, only 15% of ED actually have guidelines for the management of renal colic and only 58% of these guidelines include the use of alpha blockers. The ED physicians with <5 years of practice are more likely to use alpha blockers for these patients suggesting that they have had more up-to-date education.
UroToday.com - Contrary to traditional dictum, ureteral stones most commonly obstruct and present emergently at the ureterovesical junction (61%) and the proximal ureter between the UPJ and iliac vessels (23%). The remaining 16% of the ureteral stones causing renal colic are located at the UPJ (11%), between the iliac vessels and the ureterovesical junction (4.3%), and where the ureter crosses the iliac vessels (1.1%). This was determined by the UC San Francisco group in a retrospective review of 94 consecutive patients presenting to the ED with unilateral ureteral calculus. Not surprisingly, as previously observed, proximal ureteral calculi were greater in axial (6 vs.
UroToday.com - One of the main interests of our research group is the investigation of molecular markers for non-invasive early diagnosis of human tumors, among which bladder cancer occupies an important position. In particular, telomerase, an enzyme which is active in almost all human tumors, is a potentially useful marker for the early detection of bladder cancer. In recent years we have followed this line of research with the final aim of developing a simple, accurate, non-invasive, and inexpensive test for measuring telomerase activity in voided urine to use in large-scale screening programs. The results obtained by our group following international guidelines for the validation of diagnostic markers for clinical use have been published over a number of years.