No abstract

predictive index (PI). The algebraic sum of the regression coefficients of the factors with independent and significant association with disease-free survival for each case represented a proportional hazard score (PHS). The PI was validated in another series of 156 patients (validation series) in whom the same regression coefficients for the same significant factors as the test series were used to categorize it into three risk groups. KaplanMeier survival curves were plotted to compare the different risk categories in both test and validation series. RESULTSThe mean ( SD , range) follow-up in the test and validation series were 58 (19, and 28.3 (14.9, 2-94) months, respectively. In the test series, tumour stage, DNA ploidy, multiplicity, history of recurrence, tumour configuration, cystoscopy result and the type of adjuvant therapy had independent significance for recurrence on multivariate analysis. For progression, the cystoscopy result, DNA ploidy and grade were the only independent and significant predictors. The ranges of PHS for the factors affecting recurrence-free and progression-free survival were 0.0-7.14 and 0.0-5.84, respectively, which were divided equally into three risk categories with significant differences on Kaplan-Meier curves and a log-rank test ( P < 0.001). The three categories in the validation series were significantly different from each other and each was comparable with that in the test series. CONCLUSIONSTumour stage, DNA ploidy, multiplicity, history of recurrence, tumour configuration and type of adjuvant therapy affected independently the rate of recurrence after resecting superficial bladder tumour. Recurrence at the 3-month cystoscopy, histological grade and DNA ploidy were the only predictors of progression to muscleinvasion. The PI dividing the patients into three risk groups with different treatment and follow-up strategies for recurrence and progression was reproducible in a validation series. KEYWORDSsuperficial bladder tumour, recurrence, progression, multivariate analysis, predictive index OBJECTIVESTo assess the prognostic factors that could be used to predict tumour recurrence and progression, and to construct and validate a predictive index.

Compared to holmium laser enucleation of prostate, GreenLight XPS laser photoselective vapo-enucleation of the prostate is safe, noninferior and effective in treatment of benign prostatic hyperplasia.

ObjectiveTo assess the outcome of the drainage procedure used for treating a prostatic abscess, and to propose a treatment algorithm to reduce the morbidity and the need for re-treatment.Patients and methodsWe retrospectively reviewed patients who were admitted and received an interventional treatment for a prostatic abscess. All baseline relevant variables were reviewed. Details of the intervention, laboratory data, duration of hospital stay, follow-up data and re-admissions were recorded.ResultsA prostatic abscess was diagnosed in 42 patients; 30 were treated by transurethral deroofing and 12 by transrectal needle aspiration. The median (range) size of the abscess was 4.5 (2–23) mL and 2.7 (1.5–7.1) mL in the deroofing and aspiration groups, respectively (P = 0.2). In half of the cases multiple abscesses were evident on imaging before the intervention. The median (range) hospital stay after deroofing and aspiration was 2 (1–11) and 1 (1–19) days, respectively (P = 0.04). Perioperative complications occurred only in the deroofing group, in which two patients developed septic shock requiring intensive care (Clavien 4) and one developed epididymo-orchitis (Clavien 2). There were two late complications in the deroofing group, in which one patient developed a urethral stricture that required endoscopic urethrotomy (Clavien 3a) and one developed a urethral diverticulum and urinary incontinence that required diverticulectomy and a bulbo-urethral sling procedure (Clavien 3b). A urethro-rectal fistula developed after aspiration in one patient. Re-treatment for the abscess was indicated in two (7%) patients in the deroofing group, which was treated by aspiration.ConclusionTransrectal needle aspiration for a prostatic abscess, when done for properly selected cases, could minimise the morbidity of the drainage procedure.

Twenty-eight patients with 30 symptomatic simple renal cysts were treated by percutaneous aspiration of the cyst and injection of 95% ethanol. All patients were available for follow-up during mean period of 19 (range 14-40) months. In all patients, successful resolution of the cyst with disappearance of the symptoms was observed within 1 month after treatment. During the whole period of follow-up, no patient experienced recurrence of symptoms or required repeat therapy. Of all renal cysts treated, resolution was complete in 25 (83%) and partial (recurrence of < 50% of original cyst volume with no symptoms) in 5 (17%). The degree of response to sclerotherapy (whether complete or partial) correlated significantly with cyst size (P > 0.0008). Major complications were not encountered, while microscopic hematuria was seen in two patients, and low-grade fever was observed in another two. Ethanol sclerotherapy is simple, noninvasive, and highly cost-effective and should be recommended for the treatment of symptomatic simple renal cysts.

Objective To compare single-dose and multiple instilthe patients treated with epirubicin than in the control group (24, 25 and 52%, respectively; P<0.001). In lations of epirubicin in the chemoprophylaxis of superficial bladder tumours.those receiving epirubicin, the rates of recurrence were statistically comparable (P=0.9). Patients who had a Patients and methods In a prospective randomized and controlled study, 168 evaluable patients were large tumour burden showed slightly lower recurrence rates with single-dose epirubicin than with delayed assigned to three groups after transurethral resection of bladder tumour (TURBT) and histological confirmaintenance therapy but the diÂerence was statistically insignificant. Patients with a history of bladder mation of its superficial nature (pTa and pT1). The groups were comparable for tumour stage, grade and tumours before treatment had lower recurrence rates with maintenance treatment than with a single dose other tumour characteristics. In group 1, patients received a single dose of 50 mg epirubicin in 50 mL (34.6 and 22.6% in groups 1 and 2, respectively); again this diÂerence was statistically insignificant. normal saline immediately after TURBT; group 2 received 50 mg epirubicin in 50 mL normal saline Patients with grade 3 tumours showed a marginal diÂerence in favour of maintenance therapy. The rates 1-2 weeks after TURBT and the instillations were repeated for 8 weeks and thereafter monthly to of progression amongst the three groups were 5.5, 3.4 and 9.3%, respectively, with no significant diÂer-complete one year of treatment; group 3 (control group) received no adjuvant therapy after TURBT.ences. The overall toxicity rates were comparable in the two treated groups (22 and 25%). The patients were assessed by cysto-urethroscopy, urine cytology and DNA flow cytometry 8 weeks Conclusion With the possible exception of grade 3 tumours, single-dose immediate epirubicin is as eÂec-after resection and then every 3 months during the first 2 years and 6 monthly thereafter during the tive as delayed maintenance therapy, with the advantage of being more cost-eÂective. next 2 years. Intravenous urography was performed annually and when otherwise indicated.

Sequential BCG and epirubicin are comparable to BCG alone in efficacy and superior in terms of toxicity.

Rectus fascia sling and TVT seem to be equally effective regarding primary outcome measure (ie cure of stress incontinence). Symptom score related to incontinence surgery as well as simultaneous correction of cystocele are comparable in the 2 groups. Fascial sling is a longer treatment process yet it is more economical. Longer followup is vital before rigorous conclusions can be drawn.