The results of this study suggest that positive stone C&S and pelvic urine C&S are better predictors of potential urosepsis than bladder urine. Therefore, routine collection of these specimens is recommended.
In conclusion, the UK urological community has embraced the need for laparoscopic urology, and looks forward to a proper training programme for its junior colleagues. We look to those charged with providing it to do so with haste. REFERENCES 1 Clayman RV, Kavoussi LR, Soper NJ et al.
What's known on the subject? and What does the study add?
There is very little contemporary data regarding stone management in Australia.
This study assesses the impact of technological advances on stone management practises, and raises questions as to why there is an increasing rate of intervention for stone disease in Australia. Knowledge of management trends as demonstrated in this paper give individual surgeons a guideline for contemporary practise in this country.
OBJECTIVE
To examine trends in the operative management of upper urinary tract stone disease in Australia over the past 15 years.
MATERIALS AND METHODS
The Medicare Australia and Australian Institute of Health and Welfare databases were used to determine the annual number of renal colic presentations and procedural interventions undertaken for stone disease.
RESULTS
In Australia over the past 15 years, the annual number of procedural interventions for upper urinary tract stones has increased, primarily due to the rising number of endoscopic procedures performed.
During this period, shock wave lithotripsy numbers have remained steady whilst open and percutaneous procedures have been in decline.
CONCLUSION
The introduction of and subsequent preference for less invasive techniques has changed the management pathway of patients presenting with stone disease in Australia.
Further studies are necessary to determine whether this escalation in endoscopic procedures is due to an increase in the incidence of stone disease, earlier detection, a lower intervention threshold or a higher retreatment rate.
obtained from the hospital database and case-note review.
RESULTSIn all, 164 patients with upper urinary tract TCC and 2197 with bladder TCC were identified. There was a correlation between grade and stage of both upper urinary tract and bladder TCCs. 35% of the upper tract TCCs were classified as grade 2 and 44% as grade 3, while for bladder TCCs, 31% of lesions were classified as grade 2 and 35% as grade 3 ( P = 0.003). Of the upper urinary tract lesions 33% were stage pT2-T4, compared with only 20% of bladder TCCs ( P = 0.001).
CONCLUSIONSUpper urinary tract TCC is a higher grade and stage disease than bladder cancer, a finding that emphasizes the need for aggressive treatment of upper urinary tract TCC. If endourological management of upper urinary tract TCC is considered, histopathological determination of tumour grade before treatment is essential.
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