Despite similar access difficulty between groups, access related complications were less and stone-free rates were improved during urologist acquired percutaneous access. Urologists instructed in percutaneous access may be able to provide improved stone-free rates during percutaneous nephrolithotomy while minimizing access related complications.

The availability of several treatment options for prostate cancer creates a situation where patients may need to come to a shared decision with their health-care team regarding their care. Shared decision-making (SDM) is the concept of a patient and a health-care professional collaborating to make decisions about the patient’s treatment course. Nurse navigators (NNs) are health-care professionals often involved in the SDM process. The current project sought to evaluate the way in which patients with prostate cancer make decisions regarding their care and to determine patients’ perspectives of the role of the NN in the SDM process. Eleven participants were recruited from the Prostate Assessment Centre by a NN. They were interviewed via telephone and their responses were analyzed using thematic analysis. Five interacting factors were determined to influence the way participants made decisions including level of anxiety, desire to maintain normalcy, support system quality, exposure to cancer narratives, and extent of practical concerns. NNs were found to increase knowledge, decrease indecision, and provide reassurance for participants. Based on the beneficial aspects of NN interaction reported in this study, the use of NNs in SDM programs should be encouraged. The results of the study demonstrate the complexity of the decision-making process when it comes to prostate cancer treatment. The factors elucidated in the study should be considered during the development and implementation of prostate cancer SDM programs.

Most giant pheochromocytomas do not present with classic symptoms, as documented by published case reports. Given this, clinicians have to consider a wide differential diagnosis for any retroperitoneal mass and perform screening tests to rule out a pheochromocytoma. We describe the largest pheochromocytoma reported in Canada, where the patient presented with a palpable abdominal mass and dyspnea. The 19 × 18 × 12-cm right retroperitoneal mass was biochemically active and was radiologically and pathologically consistent with a giant pheochromocytoma. We present this case and review the relevant current literature.

The implementation of an ERAS protocol for radical cystectomy reduces length of stay, with no effect on early complication rates or 30-day readmission rates. This indicates that the protocol is safe for patients when compared to previous practices and is an effective means of reducing length of stay.

BackgroundMen with localized prostate cancer often have unrealistic expectations. Practitioners are poor judges of men’s preferences, contributing to preference misdiagnosis and unwarranted practice variation. Patient decision aids (PtDAs) can support men with decisions about localized prostate cancer. This is a comparative case study of two strategies for implementing PtDAs in clinical pathways for men with localized prostate cancer, evaluating (a) PtDA use; (b) impact on men, practitioners, and health system outcomes; and (c) factors influencing sustained use.Methods/designGuided by the Knowledge to Action Framework, this comparative case study will be conducted using administrative data, interviews, and surveys. Cases will be bound by geographic location (one hospital in Ontario; province of Saskatchewan) and time. Eligible participants will be all men newly diagnosed with localized prostate cancer, with outcomes assessed using administrative data and interviews. Nurses, urologists, radiation oncologists, and managers will be surveyed and a smaller sample interviewed. Cases will be established for each setting with findings compared across cases. Changes in the proportions of men given the PtDA over 2 years will be determined from administrative data. Factors associated with receiving the PtDA will be explored using multivariable logistic regression analysis. To assess the impact of the PtDA, outcomes will be described using mean and standard deviation (men’s decisional conflict) and frequency and proportions (practitioners consulted, uptake of treatment). To estimate the effect of the PtDA on these outcomes, adjusted mean differences and odds ratios will be calculated using exploratory multivariable general linear regression and binary or multinomial logistic regression. Factors influencing sustained PtDA use will be assessed using descriptive analysis of survey findings and thematic analysis of interview transcripts.DiscussionDetermining how to embed PtDAs effectively within clinical pathways for men with localized prostate cancer is essential. PtDAs have the potential to strengthen men’s active role in making prostate cancer decisions, enhance uptake of shared decision-making by practitioners, and reduce practice variation. Our team of researchers and knowledge users will use findings to improve current PtDA use and consider scaling-up implementation.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0451-1) contains supplementary material, which is available to authorized users.

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes Review

Introduction: Small renal masses (SRMs) are managed with active surveillance (AS), thermal ablation (TA), irreversible electroporation (IRE), or surgery, depending on patient and tumor factors. A novel SRM multidisciplinary clinic (SRMC), involving urologists and interventional radiologists, was established to provide patients with information on treatments options. The objective of this study was to evaluate the impact of the SRMC on treatment decision-making Methods: Demographics, tumor characteristics, and treatment decisions were prospectively collected on patients (n=216) attending the SRMC between 2016 and 2019. A retrospective historic cohort (n=238) seen by urologists was used as a control group. Key variables were analyzed and compared. Patient satisfaction (n=27) was surveyed and responses were summarized and explored. Results: Mean age, tumor size, and pathology was similar between groups; however, the SRMC cohort had more male patients (65.7% vs. 53.8%, p=0.009). Chosen treatment modality differed significantly between cohorts (p<0.0001). Patients in the historic cohort were treated by AS (41.5%), surgery (37.9%), TA (11.9%), watchful waiting (7.9%), and IRE (0.8%). SRMC patients were treated by TA (42.2%), AS (26.7%), surgery (21.3%), IRE (7.6%), and watchful waiting (2.2%). Post-hoc analysis revealed statistically significant differences in proportions of AS, TA, IRE, and surgery between cohorts. Patients reported high satisfaction with the collaborative approach. Conclusions: A multidisciplinary approach may have an impact on patient treatment decision-making for SRMs. Consultations involving a urologist and an interventional radiologist resulted in more TA and IRE and less AS and surgery. Future studies should evaluate if these findings occur in other centers.

Introduction: The Saskatoon Prostate Assessment Pathway (SPAP) was developed in 2013 in part to decrease the wait times between physician referral and biopsy for patients with suspected prostate cancer. Using an algorithm carefully designed to optimize appropriate prostate biopsy rates, physicians can directly refer patients for biopsy through the SPAP without seeing a urologist. All other patients are referred to the Saskatoon Urology Associates (SUA). The present study evaluates the performance of the algorithm. Methods: 971 patients seen at the SUA and 302 patients seen through the SPAP were identified. Information on age, biopsy status and outcome, risk stratification, and time between referral and biopsy was collected. Biopsy wait time data was analyzed using gamma distribution. Association between referral method and biopsy rate, and between referral method and risk stratification, was analyzed using Z-test. Results: The expected wait time from referral to biopsy for patients seen through SUA was 2.63 times longer than those seen through SPAP (34 vs. 91 days). The biopsy rate of patients seen in the SPAP was significantly higher than those by SUA (88% vs. 69%, 95% confidence interval [CI] 0.14-0.26; p<0.00001). There was no significant difference in positive biopsy rates for patients seen through the SPAP vs. SUA (81% vs. 74%, 95% CI -0.011,0.14; p=0.095), for detection of low-risk cancer, (12% vs. 10%, 95% CI -0.034,0.080; p=0.44), or for clinically relevant cancer, i.e., for SPAP vs. SUA (56.54% vs. 56.68%,0.089; p=0.49). Conclusions:The algorithm used in the SPAP is effective in decreasing wait time to prostate biopsy and has the same cancer/pre-cancer detection rate, but at the cost of a higher biopsy rate. Both referral mechanisms result in few low-risk cancer detection biopsies, finding primarily cases of high-or intermediate-risk cancer.