Stage-matched survival was better for the endoscopically treated group compared to the open surgery group, with high negative margin resections obtained.

Objectives: Determine the incidence and factors influencing neck disease, at presentation and delayed, in patients with olfactory neuroblastoma. Methods: Patients with a histological diagnosis of olfactory neuroblastoma that were treated across 6 tertiary hospitals were included. Treatment modalities to primary site and neck included radiotherapy, surgery, and combinations. The status of cervical lymph node metastases at presentation and at last follow-up was defined. Disease-free survival (DFS) was calculated as time taken for patients to develop delayed neck disease following primary treatment of olfactory neuroblastoma. Pearson correlation, regression analysis, and Kaplan Meier plots were performed to identify risk factors for developing cervical neck metastases. Results: A total of 113 patients (46 females, 49.7 ± 13.2 years) with median follow-up of 41.5 months (interquartile range, 58.2 months) were identified. Of the patients, 7.1% presented with primary neck disease while 8.8% of patients presented with delayed neck disease. Neck disease, both primary and delayed, was present in patients with Hyams grade II (22.2%), III (55.6%), and IV (22.2%) lesions (χ2 2 5.66, P = .13). Histologic grade was higher in patients with primary neck disease (χ2 2 16.22, P = .001). Positive surgical margins were associated with a higher risk of delayed neck disease compared with clear surgical margin (17.9% vs 5%, P = .034). Five- and 10-year disease-free survival for regional neck disease was 92.4% (SE: 2.8%) and 79.6% (SE: 9.0%), respectively. Conclusions: Neck metastasis is an important clinical consideration for olfactory neuroblastoma both at presentation and in surveillance. Primary treatment of the neck could be considered in select patients.

ObjectivesTo determine if portable video media (PVM) improves patient's knowledge and satisfaction acquired during the consent process for cystoscopy and insertion of a ureteric stent compared to standard verbal communication (SVC), as informed consent is a crucial component of patient care and PVM is an emerging technology that may help improve the consent process. Patients and MethodsIn this multi-centre randomised controlled crossover trial, patients requiring cystoscopy and stent insertion were recruited from two major teaching hospitals in Australia over a 15-month period (July 2014-December 2015. Patient information delivery was via PVM and SVC. The PVM consisted of an audio-visual presentation with cartoon animation presented on an iPad. Patient satisfaction was assessed using the validated Client Satisfaction Questionnaire 8 (CSQ-8; maximum score 32) and knowledge was tested using a true/false questionnaire (maximum score 28). Questionnaires were completed after first intervention and after crossover. Scores were analysed using the independent samples t-test and Wilcoxon signed-rank test for the crossover analysis. ResultsIn all, 88 patients were recruited. A significant 3.1 point (15.5%) increase in understanding was demonstrable favouring the use of PVM (P < 0.001). There was no difference in patient satisfaction between the groups as judged by the CSQ-8. A significant 3.6 point (17.8%) increase in knowledge score was seen when the SVC group were crossed over to the PVM arm. A total of 80.7% of patients preferred PVM and 19.3% preferred SVC. Limitations include the lack of a validated questionnaire to test knowledge acquired from the interventions. ConclusionsThis study demonstrates patients' preference towards PVM in the urological consent process of cystoscopy and ureteric stent insertion. PVM improves patient's understanding compared with SVC and is a more effective means of content delivery to patients in terms of overall preference and knowledge gained during the consent process.

Objective To determine the diagnostic accuracy of ultra‐low‐dose computed tomography (ULDCT) compared with standard‐dose CT (SDCT) in the evaluation of patients with clinically suspected renal colic, in addition to secondary features (hydroureteronephrosis, perinephric stranding) and additional pathological entities (renal masses). Patients and methods A prospective, comparative cohort study was conducted amongst patients presenting to the emergency department with signs and symptoms suggestive of renal or ureteric colic. Patients underwent both SDCT and ULDCT. Single‐blinded review of the image sets was performed independently by three board‐certified radiologists. Results Among 21 patients, the effective radiation dose was lower for ULDCT [mean (SD) 1.02 (0.16) mSv] than SDCT [mean (SD) 4.97 (2.02) mSv]. Renal and/or ureteric calculi were detected in 57.1% (12/21) of patients. There were no significant differences in calculus detection and size estimation between ULDCT and SDCT. A higher concordance was observed for ureteric calculi (75%) than renal calculi (38%), mostly due to greater detection of calculi of <3 mm by SDCT. Clinically significant calculi (≥3 mm) were detected by ULDCT with high specificity (97.6%) and sensitivity (100%) compared to overall detection (specificity 91.2%, sensitivity 58.8%). ULDCT and SDCT were highly concordant for detection of secondary features, while ULDCT detected less renal cysts of <2 cm. Inter‐observer agreement for the ureteric calculi detection was 93.9% for SDCT and 87.8% for ULDCT. Conclusion ULDCT performed similarly to SDCT for calculus detection and size estimation with reduced radiation exposure. Based on this and other studies, ULDCT should be considered as the first‐line modality for evaluation of renal colic in routine practice.

Selected cases of small renal masses can be observed with low risk of metastases, but this does not equate to zero risk. Nephron sparing surgery such as laparoscopic partial nephrectomy or open partial nephrectomy offers optimal oncological outcomes, nephron preservation and improved general prognosis. While there are no 'gold standards' in the management of the small renal mass, laparoscopic partial nephrectomy has demonstrated improving outcomes and minimal complications in the hands of an experienced surgeon. The challenge will be to encourage adoption of this technique, to ensure proficiency, but also be cognisant of the potential risks for lower volume surgeons. The role of ablative procedures is limited to the poor surgical candidate, and as an alternative to the technically difficult laparoscopic procedure. Until long-term data is available, this position is unlikely to change.

).Differing outcomes on olfaction have been reported from transsphenoidal approaches. [1][2][3][4] In general, patients prefer the endoscopic approach, 5 and olfactory scores are better after the endoscopic route. 6 The nasoseptal flap, in particular, to reconstruct the skull base as part of the overall process has been implicated in smell dysfunction. However, much of the literature on the impact of the nasoseptal flap comes from extended skull base surgery. In our institution, utilizing a small modified nasoseptal flap during simple pituitary surgery has greatly improved our reconstructive options and access. However, controversy exists as to the additional morbidity of utilizing such an approach. The existing studies on patients with large skull base tumors are not an appropriate population to discuss the impact of surgery or

Determination of reliable bony landmarks is clinically useful in endoscopic surgery and can aid identification of the sphenopalatine foramen. The inferior turbinate concha and posterior fontanelle may be used as reliable computed tomography landmarks for endoscopic approaches to the sphenopalatine foramen.

Neck metastasis is an important clinical consideration for olfactory neuroblastoma at presentation and in surveillance. Primary treatment of the neck could be considered in select patients. Long-term surveillance of the neck and primary site is essential.