Clinical and Patient-reported Outcome Measures in Men Referred for Consideration of Surgery to Treat Lower Urinary Tract Symptoms: Baseline Results and Diagnostic Findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM).

BACKGROUND: Clinical evaluation of male lower urinary tract symptoms (MLUTS) in secondary care uses a range of assessments. It is unknown how MLUTS evaluation influences outcome of therapy recommendations and choice, notably urodynamics (UDS; filling cystometry and pressure flow studies). OBJECTIVE: To report participants' sociodemographic and clinical characteristics, and initial diagnostic findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM). UPSTREAM is a randomised controlled trial evaluating whether symptoms are noninferior and surgery rates are lower if UDS is included. DESIGN, SETTING, AND PARTICIPANTS: A total of 820 men (≥18 yr of age) seeking treatment for bothersome LUTS were recruited from 26 National Health Service hospital urology departments. INTERVENTION: Care pathway based on routine, noninvasive tests (control) or routine care plus UDS (intervention arm). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome is International Prostate Symptom Score (IPSS) and the key secondary outcome is surgery rates 18 mo after randomisation. International Consultation on Incontinence Questionnaires were captured for MLUTS, sexual function, and UDS satisfaction. Baseline clinical and patient-reported outcome measures (PROMs), and UDS findings were informally compared between arms. Trends across age groups for urinary and sexual PROMs were evaluated with a Cuzick's test, and questionnaire items were compared using Pearson's correlation coefficient. RESULTS AND LIMITATIONS: Storage LUTS, notably nocturia, and impaired sexual function are prominent in men being assessed for surgery. Sociodemographic and clinical evaluations were similar between arms. Overall mean IPSS and quality of life scores were 18.94 and 4.13, respectively. Trends were found across age groups, with older men suffering from higher rates of incontinence, nocturia, and erectile dysfunction, and younger men suffering from increased daytime frequency and voiding symptoms. Men undergoing UDS testing expressed high satisfaction with the procedure. CONCLUSIONS: Men being considered for surgery have additional clinical features that may affect treatment decision making and outcomes, notably storage LUTS and impaired sexual function. PATIENT SUMMARY: We describe initial assessment findings from a large clinical study of the treatment pathway for men suffering with bothersome urinary symptoms who were referred to hospital for further treatment, potentially including surgery. We report the patient characteristics and diagnostic test results, including symptom questionnaires, bladder diaries, flow rate tests, and urodynamics.

DEDICATED BREAST CANCER MANAGEMENT CENTRES WITH. FACILITIES FOR FULL IMAGE-GUIDED ASSESSMENT AND IMAGE-GUIDED SURGERY IN THE DEVELOPING AREAS OF PAKISTAN--A LONG OVERDUE NECESSITY.

BACKGROUND: Dedicated centres to manage breast cancers are important to combat this menace. An example of practice in the U.K. Hospitals is given with an attempt to explain reasons for an urgent need of dedicated breast cancer centres in developing areas of Pakistan. METHODS: The rates of breast conservation, mastectomy, and immediate breast reconstruction are compared between a centre in the U.K. and a secondary radiotherapy facility in developing areas in Pakistan for 2011. RESULTS: At Kettering General Hospital, 152 patients (71%) had breast conservation therapy including image-guided surgery, 45 (29%) had mastectomy and 15 (33.3%) had immediate breast reconstruction. All the 263 patients who had adjuvant therapy with surgery, has had mastectomy at the institute of radiotherapy and nuclear medicine (IRNUM) in Peshawar, and no patient had immediate reconstruction. CONCLUSION: The availability of mammogram in individual clinics in Peshawar, without the back up of dedicated breast cancer centre fails to materialize the dream of provision of whole spectrum of breast cancer care. Government and international donor organisations may need to be approached for. investment in technology and training of personnel.