NSAIDs provide optimal analgesia in renal colic due to the reduction in glomerular filtration and renal pelvic pressure, ureteric peristalsis and ureteric oedema. Prevention of glomerular afferent arteriolar vasodilatation renders these patients at risk of renal impairment. NSAIDs have the additional benefit of reducing the number of new colic episodes and preventing subsequent readmission to hospital. Despite recent work promoting the use of pharmacological agents to improve stone passage rates, NSAIDs do not appear to reduce the time to stone passage or increase the likelihood of stone passage in renal colic.
Objective: To investigate and document the surgical, functional and oncological outcomes following surgery for high-risk prostate cancer patients. Patients and methods: Patients with pathological T3a, T3b and N1 disease were extracted from our prospectively updated institutional database. Data include demographics, preoperative cancer parameters, short and long-term complications and functional results. Details of biochemical recurrence, type and oncological outcome of salvage treatments, cancer-specific and overall survival were also obtained. Results: A total of 669 patients were included; 58.9% had T3a disease, 35.9% had pT3b and 11.4% N1 disease. With a median follow-up of 66 months (8–129), overall survival was 94.3%, cancer-specific survival was 98.7% and biochemical recurrence was 45.6%. Average inpatient stay was 1 day and the overall complication rate was 9.1%; 54.2% experienced a biochemical recurrence and 90.3% went on to have one or more salvage treatments, which were varied. Significant predictors of biochemical recurrence included pathological stage, any positive margin and patient age ( P<0.005). A total of 44.9% had an immediate biochemical recurrence, with 90% receiving subsequent treatment and 20.5% having a durable response. None of the patients receiving prostate bed radiotherapy alone had a durable response. 54% had a delayed biochemical recurrence, with 63.5% receiving subsequent treatment and 44% having a durable response. Conclusions: Surgery is associated with encouraging surgical and functional outcomes, cancer-specific survival and overall survival rates in these patients. Pathological stage is a significant predictor of biochemical recurrence. The present analysis shows that long-term observation for certain patients with biochemical recurrence is appropriate and questions the effectiveness of further local salvage treatments in patients with an immediate biochemical recurrence postoperatively. Level of evidence: II
Objective: To evaluate resection and re-resection practice in the South West region of England in patients with newly diagnosed T1 bladder cancer. Patients and methods: All patients diagnosed with T1 disease between 2005 and 2008 were identified. Patients with incomplete primary resections were excluded. Results: Of 344 patients identified, the primary resection specimen did not contain deep muscle in 110 (32%). In total, 76 patients (22%) underwent a planned re-resection within 8 weeks of their primary resection. In 225 patients, a routine check cystoscopy was performed at an interval of 3 months or greater. The remainder had no further cystoscopy. Residual disease was present in 38 (50%) patients undergoing early re-resection and 89 (40%) patients in the routine check cystoscopy group. Upstaging of tumours from T1 to T2 was demonstrated in 7% and 5% of patients within these respective groups. Grade of operating surgeon was not a predictor of adequacy of resection or tumour persistence/recurrence.
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