Objective• To evaluate the incidence of lower limb compartment syndrome (LLCS) in robot-assisted radical prostatectomy (RARP) and the prevalence of risk factors in patients with LLCS. Methods• Data were collected from 17 UK robotic surgery institutions for a multicentre analysis.• Data were used to calculate the incidence of LLCS and the prevalence of risk factors. Results• A total of 3110 RARPs were performed by 17 institutions between 2004 and 2011.• There were nine cases of LLCS, giving an incidence of 0.29%. Seven of these required fasciotomy.• The prevalence of risk factors was as follows: console time >4 h in 8/9 cases, early learning curve (<20 cases) in 3/9 cases; obesity (BMI >30 kg/m 2 ) in 5/9 cases; and peripheral vascular disease in 2/9 cases. One patient with LLCS was positioned incorrectly. Conclusions• The serious complication LLCS occurs in RARP but has a low incidence.• Long operating times, surgical inexperience, poor patient positioning, obesity and vascular disease appear to be risk factors.

Purpose: NRH:quinone oxidoreductase 2 (NQO2) is a homologue of NAD(P)H:quinone oxidoreductase 1 (NQO1). Despite 54% homology with human NQO1, NQO2 has little endogenous enzymatic activity. However, NQO2 has potential as a therapeutic target because the addition of the nonbiogenic electron donor dihydronicotinamide riboside (NRH) selectively potentiates the bioactivation of the alkylating agent tretazicar (CB 1954). The NQO activity of ovarian and bladder tumors was determined and the effect of NQO polymorphisms on NQO activity was investigated. Experimental Design: Intraperitoneal ovarian metastases and bladder tumor clinical samples were analyzed for NQO1and NQO2 activity, mRNA expression by semiquantitative reverse transcription-PCR, and genotype by RFLP analysis. Results: NQO1activity was higher in the bladder cohort than in the ovarian cohort (0-283 and 0-30 nmol/min/mg, respectively; P < 0.0001). In contrast, NQO2 activity was higher in the ovarian tissue than in the bladder samples (0.15-2.27 and 0-1.14 nmol/min/mg, respectively; P = 0.0004). In both cohorts, the NQO1C609T single-nucleotide polymorphism (SNP) was associated with f7-fold lower NQO1activity. The NQO2 exon 3 T14055C SNP was associated with lower NQO2 activity relative to wild-type [median values of 0.18 and 0.37 nmol/min/mg in the bladder samples (P = 0.007) and 0.82 and1.16 nmol/min/mgin the ovarian cohort (P = 0.034)]. Conclusion: This is the first observation reporting an apparent association between an NQO2 exon 3 SNP and lower enzymatic activity. The high NQO2 activity of intraperitoneal ovarian metastases relative to other tissues indicates a potential for tretazicar therapy in the treatment of this disease. In contrast, the low level of NQO1 activity and expression relative to other tissues suggests that NQO1-directed therapies would not be appropriate. NAD(P)H:quinone oxidoreductase 1 (NQO1, EC 1.6.5.2) is a quinone reductase implicated in protection against carcinogenesis and exploited in cancer chemotherapy (1). NRH:quinone oxidoreductase 2 (NQO2, EC 1.10.99.2) is a homologue of the more fully characterized NQO1 (2). Whereas the two proteins retain similar substrate specificities, structural differences result in differences in affinity for electron donating cofactors. NQO1 can use either NADH or NADPH. In contrast, NQO2 can use neither NADH nor NADPH efficiently and instead requires the nonbiogenic compound dihydronicotinamide riboside (NRH) or related molecules to reveal what can be considered a latent enzymatic activity (3). Both proteins have also been implicated in stabilization of p53 (4, 5) and, in the case of NQO1, this has been shown to result from a direct protein:protein interaction (6).Polymorphisms have been described for both NQO1 and NQO2. A well-characterized single-nucleotide polymorphism (SNP) in the NQO1 gene (C609T) results in a proline to serine substitution and ubiquitination with rapid degradation of the variant protein (7). Numerous polymorphisms have been reported in NQO2, mostly in the promoter reg...

ObjectivesTo evaluate the use of post-discharge venous thromboembolism (VTE) prophylaxis in UK pelvic cancer centres consistent with national guidelines. MethodsData was collected from healthcare professionals from 64 UK pelvic cancer centres. ResultsAfter radical cystectomy (RC), all cancer centres routinely use low-molecular-weight heparin (LMWH) in the perioperative period. After RC 67% of cancer centres use post-discharge LMWH routinely. After radical prostatectomy (RP), 98% of units use perioperative LMWH VTE prophylaxis routinely.After RP, 61% of hospitals always use post-discharge LMWH. In all, 27% of all UK cancer centres reported deaths or serious VTE complications from urological pelvic cancer surgery in the last 2 years. ConclusionsThe National Institute for Health and Care Excellence (NICE) issued explicit guidance of VTE prophylaxis after pelvic and abdominal cancer surgery. Conversion of national guidance into local policy is ≈60% for UK pelvic cancer centres. A lack of good quality evidence is cited as a reason for not adhering to NICE guidance.

Prostatic involvement is common in men with melioidosis. Indeed, some clinicians recommend radiological screening of all male patients as an undrained prostatic abscess may result in relapse of this potentially fatal disease. However, sophisticated medical imaging is frequently unavailable in the remote and resource-poor locations where patients are managed. In this retrospective study from Queensland, Australia, 22/144 (15%) men with melioidosis had a radiologically confirmed prostatic abscess. The absence of urinary symptoms had a negative predictive value (NPV) (95% confidence interval [CI]) for prostatic abscess of 96% (90-99%), whereas a urinary leukocyte count of < 50 × 10/L had an NPV (95% CI) of 100% (94-100%). A simple clinical history and basic laboratory investigations appear to exclude significant prostatic involvement relatively reliably and might be used to identify patients in whom radiological evaluation of the prostate is unnecessary. This may be particularly helpful in locations where radiological support is limited.