Raman spectroscopy (RS) is an optical technique that provides an objective method of pathological diagnosis based on the molecular composition of tissue. Studies have shown that the technique can accurately identify and grade prostatic adenocarcinoma (CaP) in vitro. This study aimed to determine whether RS was able to differentiate between CaP cell lines of varying degrees of biological aggressiveness. Raman spectra were measured from two well-differentiated, androgen-sensitive cell lines (LNCaP and PCa 2b) and two poorly differentiated, androgen-insensitive cell lines (DU145 and PC 3). Principal component analysis was used to study the molecular differences that exist between cell lines and, in conjunction with linear discriminant analysis, was applied to 200 spectra to construct a diagnostic algorithm capable of differentiating between the different cell lines. The algorithm was able to identify the cell line of each individual cell with an overall sensitivity of 98% and a specificity of 99%. The results further demonstrate the ability of RS to differentiate between CaP samples of varying biological aggressiveness. RS shows promise for application in the diagnosis and grading of CaP in clinical practise as well as providing molecular information on CaP samples in a research setting.

Introduction: Nutritional support has been demonstrated to improve recovery from radical cystectomy, but is expensive and when used inappropriately may actually increase the costs and morbidity of surgery. We sought to establish national patterns of practice with regard to feeding following cystectomy in the UK. Aims and Methods: Following consultation with the specialist nutrition team, a questionnaire was designed to investigate the feeding strategy after cystectomy and dispatched by post to all UK urologists. Results: The majority (60%) of respondents employed a traditional strategy of resting the bowel and feeding orally after bowel recovery. A minority used either early total parenteral nutrition (TPN; 18.5%) or enteral nutrition (6.5%), but a larger proportion (29%) felt enteral nutrition was the ‘optimal’ feeding regime. Only 30% used guidelines and 52% felt trials would help to establish a nutrition strategy following cystectomy. Conclusion: There is little evidence that TPN improves the outcome of cystectomy and it may actually increase morbidity and costs, whereas enteral nutrition may improve recovery. Despite this evidence TPN is widely used by urologists whereas enteral nutrition is used infrequently. Implementation of an evidence-based feeding regime after cystectomy is likely to reduce the morbidity and financial costs of cystectomy.

Objective The objective of this article is to determine retrospectively if a one-stop clinic for all new urology referrals improved the efficiency and quality of our outpatient pathway. We considered any improvement in productivity (e.g. waiting times) to indicate improved efficiency as resources were not increased. We considered any improvement in the level and continuity of specialist care to indicate improved quality as these factors have both been associated with measures of quality such as patient satisfaction. Patients and methods Quality and efficiency markers were recorded and compared for 100 consecutive urology referrals from 1 October before (2010) and after (2011) introduction of the clinic. Efficiency markers recorded were waiting times, discharge rate, number of dictated letters and clinic attendance. Quality markers recorded were grade and continuity of specialist care. Results The new appointment wait dropped from seven to two weeks. The commonest tests (flexible cystoscopy and ultrasound) were virtually all completed at first attendance. Median hospital visits before diagnosis dropped from two to one (p < 0.001). The discharge rate rose from 5/100 to 19/100 (p < 0.001). More patients (72/100 versus 42/100) were seen by a consultant and more cystoscopies (23/25 (92%) versus 1/28 (3.3%)) were performed by the urologist requesting them (p < 0.0001). The median number of dictated letters per diagnosis dropped from three to two in the one-stop clinic (p = 0.002). Conclusion The one-stop clinic significantly improved efficiency and quality markers for all new referrals, thereby improving access and reducing inequality. The clinic was inexpensive to introduce, and wider adoption of similar clinics could improve access to urological care.

Abbreviations: 5ARIs , 5 α -reductase inhibitors; BPE , benign prostatic enlargement; MVD , microvascular density.