Additional post-operative NP measurement enhanced risk stratification for the composite outcomes of death or nonfatal myocardial infarction at 30 days and ≥180 days after noncardiac surgery compared with a pre-operative NP measurement alone.

Increased postoperative BNPs are independently associated with adverse cardiac events after noncardiac surgery.

Ann R Coll Surg Engl 2009; 91: 565-569 565Over the last century, there has been an evolution of methods for lower urinary tract reconstruction following cystectomy, from being simple means of diverting urine to techniques allowing normal voiding pattern through the intact native urethra. Various methods for continent urinary diversion have been developed to provide such realistic options from simply diverting urine through a conduit to orthotopic reconstruction. [1][2][3][4][5] These innovations in urinary diversions should allow patients to lead a near-normal lifestyle, eliminating the need for a urostomy. However, orthotopic bladder substitution (OBS) is not offered to a majority of patients undergoing cystectomy as the benefits of OBS over ileal conduit diversion (ICD) on quality-of-life parameters remain indeterminate.Health-related quality of life (HRQoL) is a multifaceted and subjective concept taking into consideration the patient's physical and emotional status, general health, social interaction and mental health. Comparison of QoL parameters in patients who have had cystectomy has been difficult with variable results. [6][7][8][9] This could be explained by the use of different questionnaires comparing a multitude of techniques. We compared HRQoL between patients who underwent OBS or ICD following cystectomy using a bladder cancer specific functional index questionnaire. Patients and MethodsOver a 6.5 year period, 57 consecutive patients who underwent Evolution of pathological guidelines has empowered centres to offer orthotopic substitution (OBS) to patients undergoing radical cystectomy. We compared health-related quality of life (HRQoL) between patients who underwent OBS or ileal conduit urinary diversion (ICD) following radical cystectomy. PATIENTS AND METHODS A total of 57 patients who underwent cystectomy were assessed pre-operatively using Karnofsky performance scale (KPS). Of these, 52 patients (28 OBS and 24 ICD) who responded to a postal questionnaire consisting of SF-36 and a functional index questionnaire were included. RESULTS Median age of patients was 70 years. Pre-operative KPS scores were similar. All eight HRQoL scales were favourable in both groups. OBS patients had significantly better physical functioning. In the cohort, 42% of men with OBS and 25% of diversions could maintain an erection to varying degrees. Of the OBS patients, 85% were continent with two patients reporting reduced QoL with pad usage. Of ICD patients, 63% felt less complete and 42% were embarrassed due to the stoma, with 58% apprehensive of stomal leakage. Of OBS patients, 96% had significant relationships and a more active life-style. CONCLUSIONS In a similar age-group population, there was no significant difference in most QoL indices but body image issues persist in ICD patients. OBS patients had significantly better physical function, continuing to have a more active lifestyle. They attained urethral voiding with good continence. A detailed discussion of long-term functional outcome would engender a realistic ...

RESULTSWe received 270 (66%) replies, of which six were excluded because they were from subspeciality interests (e.g. paediatric urology) or had ambiguous answers; 264 (64%) were therefore available for analysis. Urethral catheterization was the initial management of choice (98%), failing which a suprapubic catheter was inserted. Two-thirds (65.5%) admitted the patient after catheterization. Most consultants initiated a -blockers (70.5%), with 64% (118) of these using a TWOC 2 days after starting them. One failed TWOC was an indication for transurethral resection of the prostate for 192 (72.8%), with 136 (49.8%) re-admitting the patient for surgery later. Routine follow-up after a successful TWOC was advocated by 77.3%. Just over half the respondents (52.6%) felt that there was no need for uniform guidelines in the management of AUR secondary to BPH. CONCLUSIONThis survey identified a reasonable national uniformity in managing AUR secondary to BPH in the UK, but significant aspects of current practice are not evidence-based. KEYWORDSacute urinary retention, management, a -blocker, trial without catheter, BPH, surgery OBJECTIVETo analyse current practice in the management of acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH) in the UK, and to assess how much of this is evidence-based. METHODSIn all, 410 consultant urologists practising in UK hospitals were sent a questionnaire about the management of AUR secondary to BPH. Data were collected on practice relating to initial management, trial without catheter (TWOC), the use of a -blockers and the followup. The need for a uniform guideline in the management of AUR secondary to BPH was also assessed. INTRODUCTIONAcute urinary retention (AUR) remains the most common urological emergency and is usually caused by BPH [1]. We sought to assess the current practice in the management of AUR secondary to BPH in the UK, and to what degree this was evidence-based. METHODSWithin the UK, 410 consultant urologists were sent a questionnaire about the management of AUR specifically secondary to BPH. We received 270 (65.9%) responses, of which six were excluded from the analysis because of their speciality interests (paediatric urology) or ambiguity in the answers. The remaining 264 were evaluated. RESULTSMost urologists preferred urethral catheterization as the initial management, failing which a suprapubic catheter was inserted (98%). Apart from routine blood investigations, ultrasonography (26.5%), a plain film of the abdomen (15.5%) and PSA assay (24.6%) were part of the routine assessment by some. Nearly 71% (186) started their patients on a -blockers, with 64% (118) using a trial without catheter (TWOC) 2 days after starting them; 39% (103) used a TWOC only if the residual urine volume was <1 L at the time of initial catheterization, and 77% followed patients who had had a successful TWOC. One failed TWOC was an indication for TURP for 72.8% (192) of the respondents, with 49.8% (136/233) undertaking TURP at a separate admission. A second TWOC was ad...

Inhalation of Entonox or periprostatic infiltration with 1% lidocaine can be used for analgesia during TRUS guided biopsy of the prostate since each provides significant and similar pain relief.

No abstract

Objective:We have looked into the clinical and financial benefits of using intra-operative cell salvage (ICS) as a method to reduce the amount of autologous blood transfusion (ABT) requirement for our radical cystectomy (RC) patients.Materials and Methods:Fifteen consecutive patients undergoing radical cystectomy received cell salvaged blood (ICS), while 15 did not (NCS). The cost of using the cell saver, number of homologous transfusions, survival, and recurrences were recorded and compared using paired t-test and chi-square test between the two groups. A Dideco Electa® (Sorin Group, Electa, Italy) cell saver machine was used for all the patients in the ICS group and leukocyte filters were used on the salvaged blood before the autologous transfusion.Results:The mean age was 63 years (53–72 years), 66 years (46–79 years) in ICS and NCS groups, respectively (P = 0.368). All 15 (100%) patients in the NCS group required an allogenic transfusion compared to 9/15 (60%) in the ICS group (P = 0.08). There was a significant reduction in the mean volume of allogenic blood transfused with the use of cell saver. Median follow-up was 23 and 21 months in the ICS and NCS group with 10 and 4 patients alive at last follow-up, respectively. There was a saving of 355 pounds per patient in the ICS group compared to the NCS group.Conclusion:Our initial study shows that cell savage is feasible and safe in patients undergoing radical cystectomy. It does not adversely affect the medium term outcome of patients undergoing RC and is also cost effective.

Testicular metastasis from carcinoma of the prostate is rare. We report a case of carcinoma of the prostate with bilateral testicular metastases 7 years after the initial diagnosis. The exact prognosis is not known but it usually indicates advanced disease. Although testicular metastasis is uncommon, it should be considered when a patient presents with a lump in the testis, particularly in a patient known to have another primary malignancy.