e15100 Background: To establish the response rate of 5-flurouracil (5-FU) and imiquimod (IQ) in the treatment of penile CIS in a large contemporary series in a supra-network center. The use of topical agents in the treatment of CIS of the penis has been well described in the literature. Previous studies have been limited by small sample size and imprecise end-points. Methods: Retrospective review of all primary and recurrent cases of penile CIS treated with 5-FU and IQ identified from a prospective database over a 10- year period. Therapy was standardised in all cases with application to the lesion for 12 hours every 48 hours for 28 days. 5-FU was the first line therapy and IQ used as second line topical agent. The primary end-point was defined as complete response (CR = resolution of lesion), partial response (PR = lesion reduced in size and or visibility) or no response (NR = no improvement in lesion size and or visibility). The secondary end-points included local toxicity and adverse events. Results: A total of 86 patients were diagnosed with CIS of the penis over the 10-year period. 44/86 (51%) received topical chemotherapy. Mean follow-up was 34 months. The response rates, local toxicity and adverse events were analysed. The overall complete response rate for topical agents was 57% (Table). Conclusions: Topical chemotherapy agents are moderately effective first line therapy in the treatment of penile CIS. Toxicity and adverse events were low with our treatment protocol. The issue of long-term surveillance and assessment of partial responders remains a challenge. Topical chemotherapy should remain a first line treatment option for penile CIS. [Table: see text]
TUS insertion is a technically efficient and effective procedure in the management of MUO, with the majority of patients treated dying of the underlying condition with functioning stents in situ.
IntroductionHematuria has been described following bladder drainage in 2% to 16% of high-pressure chronic urinary retention treatments by decompression and is generally self-limiting. We describe a case of significant bilateral upper urinary tract hematuria following drainage of high-pressure chronic retention. To the best of our knowledge, the only similar case reported in the literature was in 1944.Case presentationAn 82-year-old Caucasian man was referred to our department with nocturnal enuresis and a palpable bladder. He was catheterized, produced a residual volume of 2900mL, and ended up becoming oliguric. Following investigations, he had bilateral nephrostomies. He was discharged 18 days after presentation.ConclusionsClinicians should keep in mind the presentation discussed in this case report to be able to swiftly manage this extremely rare complication of decompression in patients with high-pressure chronic retention.
Objectives
To define reference levels for intraoperative radiation during stent insertion, ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL); to identify variation in radiation exposure between individual hospitals across the UK, between low‐ and high‐volume PCNL centres, and between grade of lead surgeon.
Patients/Subjects and Methods
In all, 3651 patients were identified retrospectively across 12 UK hospitals over a 1‐year period.
Radiation exposure was defined in terms of total fluoroscopy time (FT) and dose area product (DAP). The 75th percentiles of median values for each hospital were used to define reference levels for each procedure.
Results
Reference levels: ureteric stent insertion/replacement (DAP, 2.3 Gy/cm2; FT, 49 s); URS (DAP, 2.8 Gy/cm2; FT, 57 s); PCNL (DAP, 24.1 Gy/cm2; FT, 431 s).
Significant variations in the median DAP and FT were identified between individual centres for all procedures (P < 0.001).
For PCNL, there was a statistically significant difference between DAP for low‐ (<50 cases/annum) and high‐volume centres (>50 cases/annum), at a median DAP of 15.0 Gy/cm2 vs 4.2 Gy/cm2 (P < 0.001).
For stent procedures, the median DAP and FT differed significantly between grade of lead surgeon: Consultant (DAP, 2.17 Gy/cm2; FT, 41 s) vs Registrar (DAP, 1.38 Gy/cm2; FT, 26 s; P < 0.001).
Conclusion
This multicentre study is the largest of its kind. It provides the first national reference level to guide fluoroscopy use in urological procedures, thereby adding a quantitative and objective value to complement the principles of keeping radiation exposure ‘as low as reasonably achievable’. This snapshot of real‐time data shows significant variation around the country, as well as significant differences between low‐ and high‐volume centres for PCNL, and grade of lead surgeon for stent procedures.
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