Active Surveillance for Localized Prostate Cancer: Nationwide Observational Study.

PURPOSE: The objective of this study was to investigate nationwide survival outcomes in men with localized prostate cancer managed on active surveillance. MATERIALS AND METHODS: A total of 936 men with localized prostate cancer were initiated on active surveillance in Denmark in 2002 to 2012. Kaplan-Meier estimated curative treatment-free, hormonal therapy-free, castration resistant prostate cancer-free and cause specific survival was calculated. RESULTS: Prostate cancer was classified as very low risk in 223 men, low risk in 436, intermediate risk in 259 (87% were at favorable intermediate risk) and high risk in 18. Median followup was 7.5 years (IQR 6.1-9.1). Kaplan-Meier estimated 10-year curative treatment-free survival was 62.8% (95% CI 59.1-66.3), 10-year hormonal therapy-free survival was 92.2% (95% CI 89.2-94.4), 10-year castration resistant prostate cancer-free survival was 97.2% (95% CI 95.3-98.4) and 10-year cause specific survival was 99.6% (95% CI 98.6-99.9). Compared to men with low risk prostate cancer, those with intermediate risk prostate cancer had higher curative treatment-free survival (69% vs 56%, p = 0.008), lower hormonal therapy-free survival (88% vs 95%, p = 0.005) and similar castration resistant prostate cancer-free survival (95% vs 99%, p = 0.17). CONCLUSIONS: In this nationwide cohort 10-year cause specific survival was similar to that in prospective active surveillance cohorts. Our study supports the use of active surveillance in men with localized prostate cancer, including men with favorable intermediate risk characteristics.

Pushing the Envelope: Laparoscopic Nephrectomy as Outpatient Surgery.

PURPOSE OF REVIEW: The purposes of this review were to identify the possible limiting factors prohibiting laparoscopic nephrectomy being performed as an outpatient surgery and optimize these limiting factors. RECENT FINDINGS: Laparoscopic nephrectomy for patients who have kidney cancer can be performed as an outpatient surgery in well-selected, well-educated, and well-informed patients in a well-prepared hospital culture. Patient confidence, pain, and hospital culture are the most important limiting factors to the performance of laparoscopic nephrectomy as an outpatient procedure. Controlling these factors leads to a high success rate for the outpatient procedure.

Laparoscopic Nephrectomy as Outpatient Surgery.

PURPOSE: We tested the feasibility and safety of performing laparoscopic nephrectomy as outpatient surgery in patients with renal cancer. MATERIALS AND METHODS: We performed a prospective, multicenter, descriptive study between April 2014 and February 2015 with postoperative followup at 30 days. A total of 140 patients were diagnosed with renal cancer during this period, of whom 50 met study inclusion criteria and agreed to participate. Reasons for exclusion from analysis included planned partial nephrectomy in 35 patients, lived alone without adequate home support in 17, advanced age or significant comorbid conditions in 33 and refusal to participate in 5. Pain, nausea, fatigue, operative time, bleeding, postoperative care unit stay and hospital stay were assessed. Continuous variables were compared by the paired t-test and categorical variables were compared by the Fisher exact test. RESULTS: Mean age of the 35 males (70%) and 15 females (30%) treated with planned outpatient surgery was 59.8 years. Of the patients 46 (92%) were discharged home within the first 6 hours after surgery. Four patients (8%) could not be discharged due to wrong medication in 2, fatigue in 1 and intestinal injury in 1. None of the 46 patients discharged early were readmitted to the hospital. In 2 patients with wound infection oral antibiotic treatment achieved good results without rehospitalization. CONCLUSIONS: Laparoscopic nephrectomy may be performed as outpatient surgery in carefully selected patients who meet inclusion criteria, representing greater than 40% of candidates for the surgery. Our study demonstrates that outpatient nephrectomy may be done safely and does not require hospital readmission.

Surgical experience is predictive for bladder tumour resection quality.

OBJECTIVES: To assess the resection quality of transurethral bladder tumour resection (TURBT) and the association to surgeon experience depending on the presence of detrusor muscle. METHODS: A retrospective study on 640 TURBT procedures performed at Zealand University Hospital, Denmark, from 1 January 2015 - 31 December 2016. Data included patient characteristics, procedure type, surgeon category, supervisor presence, surgical report data, pathological data, complications data and recurrence data. Analysis was performed using simple and multiple logistic regression on the association between surgeon experience and the presence of detrusor muscle in resected tissue from TURBT. RESULTS: Supervised junior residents had significant lower detrusor muscle presence (73%) compared with consultants (83%) (OR = 0.4, 95% CI = 0.21-0.83). Limitations were the retrospective design and the diversity of included TURBT. CONCLUSIONS: It was found that surgical experience predicts detrusor muscle presence and supervised junior residents performing TURBT on patients resulted in less detrusor muscle than consultants.

National Implementation of Simulator Training Improves Transurethral Resection of Bladder Tumours in Patients.

Background: Transurethral resection of bladder tumours (TURBT) is the initial diagnostic treatment for patients with bladder cancer. TURBT is not an easy procedure to master and simulator training may play a role in improving the learning curve. Objective: To implement a national training programme for simulation-based mastery learning in TURBT and explore operating theatre performance after training. Design setting and participants: From June 2019 to March 2021, 31 doctors at urology departments in Denmark performed two pretraining TURBT procedures on patients, followed by proficiency-based mastery learning on a virtual reality simulator and then two post-training TURBTs on patients. Outcome measurements and statistical analyses: Operating theatre performances were video-recorded and assessed by two independent, blinded raters using the Objective Structured Assessment for Transurethral Resection of Bladder Tumours Skills (OSATURBS) assessment tool. Paired-sample t tests were used to compare pretraining and post-training analyses and independent t tests for between-group comparisons. This trial is registered at ClinicalTrials.gov as NCT03864302. Results and limitations: Before training, novices had significantly lower performance scores in comparison to those with intermediate experience (p = 0.017) and experienced doctors (p < 0.001). After training, novices significantly improved their clinical performance score (from 11.4 to 17.1; p = 0.049, n = 10). Those with intermediate experience and experienced doctors did not benefit significantly from simulator training (p = 0.9 and p = 0.8, respectively). Conclusions: Novices improved their TURBT performance in the operating theatre after completing a proficiency-based training programme on a virtual reality simulator. Patient summary: We trained surgeons in an operation to remove bladder tumours using a virtual reality simulator. Novice doctors improved their performance significantly after the training, but the training effects for more experienced doctors were minimal. Therefore, we suggest the introduction of mandatory simulator training in the residency programme for urologists.

Validation of a Novel Assessment Tool Identifying Proficiency in Transurethral Bladder Tumor Resection: The OSATURBS Assessment Tool.

Background: Competence in transurethral resection of bladder tumors (TURB) is critical in bladder cancer management and should be ensured before independent practice. Objective: To develop an assessment tool for TURB and explore validity evidence in a clinical context. Design, Setting, and Participants: From July 2019 to March 2021, a total of 33 volunteer doctors from three hospitals were included after exemption from the regional ethics committee (REG-008-2018). Participants performed two TURB procedures on patients with bladder tumors. A newly developed assessment tool (Objective Structured Assessment for Transurethral Resection of Bladder Tumors Skills, OSATURBS) was used for direct observation assessment (DOA), self-assessment (SA), and blinded video assessment (VA). Outcome Measurements and Statistical Analysis: Cronbach's alpha and Pearson's r were calculated for across items internal consistency reliability, inter-rater reliability, and test-retest reliability. Correlation between OSATURBS scores and the operative experience was calculated with Pearson's r and a pass/fail score was established. Differences in assessment scores were explored with paired t-test and independent samples t-test. Results and Limitations: The internal consistency reliability across items Cronbach's alpha was 0.94 (n = 260, p < 0.001). Inter-rater reliability was 0.80 (n = 64, p < 0.001). Test-retest correlation was high, r = 0.71 (n = 32, p < 0.001). Relationship with TURB experience was high, r = 0.71 (n = 32, p < 0.001). Pass/fail score was 19 points. DOAs were strongly correlated with video ratings (r = 0.85, p < 0.001) but with a significant social bias with lower scores for inexperienced and higher scores for experienced participants. Participants tended to overestimate their own performances. Conclusions: OSATURBS tool for TURB can be used for assessment of surgical proficiency in the clinical setting. DOA and SA are biased, and blinded VA of TURB performances is advised. Clinical Trials NCT03864302.

Market Readiness for Single-Use Cystoscopes According to Urologists and Procurement Managers Worldwide.

PURPOSE: Single-use endoscopes have been subjected to increase awareness in recent years, and several new single-use cystoscopes (eg Ambu® aScope 4 Cysto) have entered the market. However, the market readiness for such single-use cystoscopes remains unknown. This study investigates the worldwide market readiness for single-use cystoscopes among urologists and procurement managers (PMs) from Europe, Japan, and the US. MATERIALS AND METHOD: An online survey using QuestionPro® was distributed to urologists and PMs in France, Germany, Italy, Japan, Spain, the UK, and the US between March 10, 2020 and July 14, 2020. All surveys were translated into the respective local language. Statistical analyses were performed using the software package Stata/SE version 16.1, StataCorp. Fisher's exact test was used to analyze categorical variables and simple linear regression was applied to continuous variables. RESULTS: A total of 415 urologists and PMs completed the survey (343 [82.7%] urologists and 72 [17.3%] PMs). Seventy (16.9%) were from Japan, 100 (24.1%) were from the US, and 245 (59.0%) were evenly distributed across the following European countries: France, Germany, Italy, Spain, and the UK. On average, respondents indicated that they would consider converting to single-use in 44.5% of their cystoscopy procedures. Respondents anticipated significantly higher conversion (p<0.05) when they (1) used single-use ureteroscopes in their department, (2) were concerned about cystoscopy-related infection as a result of contaminated cystoscopes, (3) were members of their institution's value committee, or (4) considered cost-transparency to be important when purchasing cystoscopes. CONCLUSION: This study investigated the marked readiness for single-use cystoscopes according to urologists and PMs worldwide. Respondents indicated a willingness to convert to single-use cystoscopes in nearly half (44.5%) of their cystoscopy procedures. Respondents that were concerned about cystoscopy-related infections as a result of contaminated cystoscopes indicated a significantly higher anticipated conversion rate (p<0.05).

Oncological outcomes of radical nephroureterectomy for upper urinary tract urothelial neoplasia in Denmark.

Objective: To report the oncological outcomes of radical nephroureterectomy for upper urinary tract urothelial neoplasia in a large study sample.Materials and methods: This was a nationwide multicenter registry-based cohort study of all patients with upper urinary tract urothelial neoplasia in Denmark found to be eligible for nephroureterectomy between April 2004 and April 2017 (N = 1384). Primary endpoints were intravesical recurrence-free survival and overall survival. Survival probabilities were estimated with Kaplan-Meier and the log-rank test to compare survival curves. Association with clinical outcomes was studied using univariate and multivariate Cox proportional hazards.Results: Intravesical recurrence-free survival was 72% [95% confidence interval (CI) 69-75%] at 5 years and 70% (95% CI 67-73%) at 10 years. Patients with muscle-invasive disease had a significantly lower rate of intravesical recurrence [hazard ratio (HR) = 0.46, p < 0.0001] and patients with high-grade tumors had a significantly higher rate of incident intravesical recurrence compared to low-grade tumors (HR = 1.65, p = 0.001). The overall survival was 76% (95% CI 74-79%) at 5 years and 64% (95% CI 60-70%) at 10 years. Patients with higher age (p = 0.008) and muscle-invasive disease (p < 0.0001) had worse overall survival. When comparing surgical approaches, laparoscopic nephroureterectomy versus open nephroureterectomy did not differ in intravesical recurrence-free survival but was associated with shorter postoperative hospital stay (p < 0.0001) and better overall survival (p = 0.02).Conclusions: We report the oncological outcomes of radical nephroureterectomy for upper urinary tract urothelial neoplasia in a large sample and give insights into predictive factors with significant impact.

Incidence and Associated Risk Factors of Venous Thromboembolism After Open and Laparoscopic Nephrectomy in Patients Administered Short-period Thromboprophylaxis: A Danish Nationwide Population-based Cohort Study.

OBJECTIVE: To report the incidence of venous thromboembolism (VTE) after nephrectomy in Denmark and explore associated risk factors. MATERIALS AND METHODS: A nationwide population-based retrospective cohort study was performed. All nephrectomies from January 2010 to August 2018 were assessed for postoperative VTE events. Univariable and multivariable analyses were used to evaluate the odds ratio (OR) of clinical variables' effect on postoperative VTEs, within 4 weeks and 4 months after nephrectomy. RESULTS: In 5213 nephrectomized patients, postoperative VTE incidence was 1% and 2% within 4 weeks and 4 months, respectively. Multivariable analyses revealed that predictors of postoperative VTE within 4 months were: open nephrectomy (OR 2.5, P = .001), history of VTE (OR 13.3, P <.001), length of hospital stay (OR 0.98, P = .02), and lymph node dissection (OR 2.0, P = .04). Limitations included the retrospective and registry-based study design and absence of individual patient data on patient body mass index and length of surgery. CONCLUSION: For nephrectomy, postoperative VTE is rare. Open nephrectomy, history of VTE, length of hospital stay, and lymph node dissection are important risk factors which should be evaluated when tailoring VTE prophylaxis regimens.

Development and validation of a simulator-based test in transurethral resection of bladder tumours (TURBEST).

Objectives: A prospective observational trial to develop and gather validity evidence using Messick's framework for a simulator-based test in TURB. Methods: Forty-nine doctors were recruited from urology departments (Herlev/Gentofte University Hospital, Rigshospitalet Copenhagen University Hospital and Zealand University Hospital Roskilde) and enrolled from April to September 2018. The TURB Mentor™ virtual reality (VR) simulator was assessed at an expert meeting selecting clinically relevant cases and metrics. Test sessions were done on identical simulators at two university hospitals in Denmark. All participants performed three TURB procedures on the VR simulator. Simulator metrics were analysed with analysis of variance (ANOVA) and metrics with the ability to discriminate between groups were combined in a total simulator score. Finally, a pass/fail score was identified using the contrasting groups' method.Results: Eleven simulator metrics were found eligible and four had significant discrimination ability between competency levels: resected pathology (%) (p = 0.008); cutting in bladder wall (n) (p = 0.004); time (s) (p = 0.034); and inspection of the bladder wall (%) (p = 0.002). The internal structure of the total simulator score [(resected pathology*inspection of the bladder wall)/time] was high with the intraclass correlation coefficient, Cronbach's alpha = 0.85. The mean total simulator score was significantly lower in the novice group than in the intermediate, 15.9 and 25.6, respectively (mean difference = 9.7, p = 0.011) and experienced group, 30.6 (mean difference = 14.7, p < 0.001). A pass/fail score of 22 was identified.Conclusion: We found validity evidence for a newly developed VR simulator-based test and establised a pass/fail score identifying surgical skills in TURB. The TURBEST test can be used in a proficiency-based TURB simulator training programme for accreditation prior to supervised procedures on patients.

Burden of renal cancer in Nordic countries.

Aim: To report the current incidence and estimate the future burden of renal cancer in Nordic countries until the year 2040.Methods: Most recent incidence and prevalence data for renal cancer were retrieved using the NORDCAN database (years 2011-2015). Publicly available population counts (years 2011-2015) and estimates (years 2019-2040) provided from the official statistics bureaus of the Nordic countries were used. Averaged country-specific age- and gender-stratified estimates were calculated using data from years 2011-2015 and projected into 2019 (current estimates) and for every year until 2040 (future estimates). Sensitivity analyses were made to evaluate the consequences of increases or decreases in changes in incident rates.Results: Incidence and prevalence of renal cancer increased with age and were higher among males. This study estimates incidence and prevalence in 2019 to, respectively, 910 and 5,747 for Denmark, 1,039 and 8,043 for Finland, 67 and 549 for Iceland, 914 and 6,481 for Norway, and 1,255 and 10,695 for Sweden. In all Nordic countries, the incidence and prevalence is expected to increase due to an aging population. An increasing proportion of patients will be 70 years or above.Conclusions: In Nordic countries, the burden of renal cancer will increase during the next years and a larger proportion of patients will be elderly. These demographic changes highlight the need for cancer prevention, innovation in minimally invasive approaches and focus on active surveillance strategies.

Novel technique: direct access partial nephrectomy approach through a transperitoneal working space (Roskilde technique).

Objectives: To describe a direct access partial nephrectomy technique through a transperitoneal working space (Roskilde technique).Materials and methods: Prospective single-center descriptive study between April 2015 and January 2017. The surgical outcomes are evaluated according to the Trifecta criteria (negative margins, warm ischemia time < 20 min and a Clavien-Dindo complication score < 3).Surgical procedure: The same access to the transperitoneal cavity as in a Standard transperitoneal Partial Nephrectomy was used. A direct access was established by incision of the peritoneum directly onto the renal fascia. The renal vessels and tumor were identified and the tumor removed with standard technique. The perinephric fat and peritoneum were then closed with a running suture.Results: In total, 122 patients underwent the Roskilde technique. The mean age was 62.2 years, the median Padua score was 12 (IQR = 9-12) and the median tumor size was 32 mm (IQR = 12-90). The median operative time was 101 min (IQR = 90-125). The trifecta achievement criteria goal was achieved in 116/122 (95%), with a median warm ischemia time of 8 min (IQR = 0-12).Conclusions: The Roskilde technique is safe and feasible. It can be performed on complex renal masses, and it seems to result in short operative times and high Trifecta achievement.Trial registration: None.

Active Surveillance Versus Radical Prostatectomy in Favorable-risk Localized Prostate Cancer.

BACKGROUND: Active surveillance (AS) and radical prostatectomy (RP) are both accepted treatments for men with favorable-risk localized prostate cancer (PCa) (ie, clinical tumor category 1-2b, Gleason Grade Group 1-2, and prostate-specific antigen < 20 ng/mL). However, head-to-head studies comparing oncologic outcomes and survival between these 2 treatment strategies are warranted. The objective of this study was to compare the use of prostate cancer treatments and PCa death in men managed on AS and men who underwent immediate RP. PATIENTS AND METHODS: This was an observational study including 647 men on AS and 647 men treated with RP propensity score matched. We examined the 10-year cumulative incidence of salvage radiotherapy, hormonal therapy, castration-resistant PCa, and PCa death. RESULTS: The 10-year curative treatment-free survival for men on AS was 61% (95% confidence interval [CI], 57%-65%). No differences in use of salvage radiotherapy (AS, 2.7%; 95% CI, 1.4%-4.1% vs. RP 5.4%; 95% CI, 3.4%-7.3%), hormonal therapy (AS, 6.9%; 95% CI, 4.4%-9.4% vs. RP, 4.1%; 95% CI, 2.5%-5.6%), developing castration-resistant PCa (AS, 1.7%; 95% CI, 0.5%-2.9% vs. RP, 2.0%; 95% CI, 0.7%-3.4%), or cumulative PCa mortality (AS, 0.4%; 95% CI, 0%-1.0% vs. RP, 0.5%; 95% CI, 0%-1.5%) were observed between the treatment strategies. The main limitation was the non-random allocation to treatment strategy. CONCLUSION: In this observational study on men with favorable-risk localized PCa, we found similar PCa mortality at 10 years between men on AS and men who underwent immediate RP. Moreover, there were no differences in the use of PCa therapies between the groups. Our study supports active surveillance as a treatment strategy for men with favorable-risk localized PCa.

Hand-assisted laparoscopic versus laparoscopic nephrectomy as outpatient procedures: a prospective randomized study.

OBJECTIVES: The aims of this study were to discuss the hand-assisted laparoscopic nephrectomy (HALNo) outpatient procedure and compare it to the transperitoneal laparoscopic nephrectomy (LNo) outpatient procedure. MATERIALS AND METHODS: A prospective, randomized study of 30 patients with renal tumor who were recruited between November 2014 and February 2016 was performed. The primary endpoint of the study was length of hospital stay (LOS). RESULTS: Fifteen patients received HALNo and 15 received LNo, with a male to female ratio of 2:1. The mean age was 60 years for HALNo and 64 years for LNo (p = 0.62). All patients were discharged within 6 h after the operation. The mean ± SD operation time was 65 ± 24 min [95% confidence limits (CL) 51-79] and 69 ± 24 min (95% CL 56-83) for HALNo and LNo, respectively (p = 0.95). The mean time for which patients stayed at the postoperative care unit was 85 ± 53 min (95% CL 44-126) and 91 ± 66 min (95% CL 54-127) for HALNo and LNo, respectively (p = 0.14). The mean LOS was 220 ± 96 min (95% CL 155-284) and 272 ± 80 min (95% CL 224-320) for HALNo and LNo, respectively (p = 0.53). CONCLUSION: HALNo, when performed as an outpatient procedure, is safe and feasible for a well-informed, well-educated and well-selected patient group, and is comparable to LNo regarding postoperative LOS.

Laparoscopic and robotic nephroureterectomy: does lymphadenectomy have an impact on the clinical outcome?

PURPOSE: To evaluate the effect of lymphadenectomy (LND) in conjunction with nephroureterectomy on cancer-specific mortality (CSM) and overall survival (OS) for patients with muscle-invasive UTUC. METHODS: A retrospective, multicenter study of patients with UTUC, clinical stage N0M0, who underwent nephroureterectomy between January 2008 and December 2014 was conducted. Outcome measures were OS and CSM. RESULTS: In total, 298 patients underwent robot-assisted or laparoscopic radical nephroureterectomy with a final histological diagnosis of UTUC. LND was performed in 46 (15.4%). One hundred and seventy-two patients (62%) had non-muscle-invasive disease (NMID); 105 patients (38%) had muscle-invasive disease (MID). Median time of follow-up was 43.5 months (95% CI 36.0-47.2). For patients with MID, the 5-year cumulative incidence of all-cause mortality and CSM was 73.5% (95% CI 60.4-86.6) and 52.4% (95% CI 38.9-65.9), respectively (p < 0.0001). There was no significant difference in OS between patients with N1 and patients with N0 disease (p = 0.53). The 5-year OS rates were 30.5% (95% CI 6.6-54.4) and 25.7% (95% CI 10.9-40.5), respectively. This study is limited by its retrospective nature. There may also have been bias in the selection of patients undergoing LND. CONCLUSIONS: Five-year OS and CSM are comparable between patients with N1 and N0 MID. This evidence may support the use of the LND procedure in patients with muscle-invasive UTUC.

En bloc ligation of renal vessels is safe and reduces duration of surgery.

INTRODUCTION: Conventionally, individual ligation of the renal vessels with clips is performed during laparoscopic nephrectomy (LN). Concomitant ligation of the vessels is not a standard procedure due to an expected risk of stapler dysfunction and the development of arteriovenous fistulas (AVF). Using the EndoGIA stapler 45/2.5 mm, we compared en bloc ligation with individual ligation during LN and nephroureterectomy (LNU) with a special focus on the development of AVF and technique safety. METHODS: This was a retrospective study of all patients undergoing LN or LNU at the Department of Urology, Roskilde Hospital, Denmark, between January 2010 and April 2014. The follow-up period was minimum six months. RESULTS: A total of 228 patients underwent LN and 56 patients underwent LNU. In the LN group, 77 patients underwent en bloc ligation. The mean surgical time was significantly reduced to 89 minutes in the en bloc group compared to 109 minutes in the conventional group (p = 0.0001). The difference remained significant with multivariate analysis. In the LNU group, seven patients underwent en bloc ligation. There was no significant difference between conventional ligation and en bloc ligation with respect to surgical time in either the univariate or the multivariate analyses. None of the patients needed blood transfusion. With a mean follow-up of 13.5 months, no AVF were found. CONCLUSIONS: En bloc ligation appears to be safe and can reduce the surgical time during LN without increased risk of blood transfusion and without development of AVF. Further studies are needed to assess any advantages associated with use of the method during LNU. FUNDING: none. TRIAL REGISTRATION: not relevant.

Do the different types of renal surgery impact the quality of life in the postoperative period?

PURPOSE: Because more than 70 % of patients with localized tumors experience 10 years of cancer-specific survival, their quality of life (QoL) after surgery is important. The aim of this study was to explore the impact of the type of surgery (partial vs. total nephrectomy) and the postoperative outcome on the QoL of patients with renal cancer. METHODS: A total of 205 patients underwent partial or total nephrectomy at the Department of Urology, Roskilde Hospital, between February 2008 and June 2013 and survived until the time of the survey. The European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30) was sent to this cohort in January 2014. RESULTS: The response rate was 74.1 % for complete answers. The overall global health status (QoL) was low (69.12 %) for all patient groups, regardless of the operation technique and the underlying medical status. Total nephrectomy was a negative predictor of QoL, physical functioning, role functioning, and fatigue. Patients who experienced recurrence reported significant deterioration in 11 of the 15 EORTC QLQ-C30 domains. Additionally, thinking about cancer only during the follow-up visit was associated with a significant decrease in emotional functioning and role functioning compared with never thinking about one's cancer. CONCLUSION: Total nephrectomy was a negative predictor of overall global health status. There is a demand for a reasonable follow-up program with an individual control interval according to the risk of recurrence and the possibility of treatment as well as the patient's discretion.

[Emphysematous pyelonephritis in a non-diabetic patient with a kidney tumour]. / Emfysematisk pyelonefritis hos en patient med nyretumor og uden diabetes

Emphysematous pyelonephritis (EPN) is a potentially life-threatening infection, where gas produced by bacteria accumulates in the kidney and the surrounding tissue. Although EPN usually presents in diabetic women, it is also associated with urinary tract obstruction and kidney tumours in non-diabetic patients. We present a case of EPN in a non-diabetic patient with a known kidney tumour, successfully treated with double-J catheter, antibiotics and delayed nephrectomy.

[Urological training in the county of Roskilde]. / Den urologiske uddannelse i Roskilde Amt.

INTRODUCTION: Training in surgical skills and the importance of function-bearing units are the subject of much debate at the moment. An exposition is given of the quality of the urological training in the County of Roskilde, which corresponds to a function-bearing unit as to size. MATERIAL AND METHODS: The exposition is based on charts of specific oncological diagnoses during one year and the list of operations performed by phase III interns during a period of six months. RESULTS: The number of operations performed by phase III interns during the two periods in compared with the informal claims of The Danish Urological Society. DISCUSSION: As regards open surgery, the number of operations performed by phase III interns fully lives up to the informal requirements of the Danish Urological Society and the number of operations per intern exceeds what has previously been calculated at branch-specialized departments. The number of endoscopic operations was a little lower than expected and did not quite live up to the requirements. It is concluded that the urological training at a county urological department meets the requirements of the Danish Urological Society.

[Partial priapism].

Partial priapism, also called partial segmental thrombosis of the corpus cavernosum, is a rare urological condition. Factors such as bicycle riding, drug usage, penile trauma and haematological diseases have been associated with the condition. Medical treatment with low molecular weight heparin (LMWH) or acetylsalicylic acid is first choice treatment, and surgery is preserved for patients unresponsive to analgesics. In this report we describe the case of a 70-year-old man with partial priapism after blood transfusions treated successfully with LMWH.