Composite health behaviour classifier as the basis for targeted interventions and global comparisons in men's health.

INTRODUCTION: Lifestyle-related diseases are the leading cause of death among North American men. We evaluated health behaviours and their predictors that contribute to morbidity and mortality among Canadian men as a means to making recommendations for targeted interventions. METHODS: A cross-sectional analysis of Canadian men drawn from 5362 visitors to our online survey page was conducted. The current study sample of 2000 men (inclusion: male and >18 years; exclusion: incomplete surveys) were stratified to the 2016 Canadian census. The primary outcome was the number of unhealthy men classified using our Canadian Composite Classification of Health Behaviour (CCCHB) score. Secondary outcomes included the number of men with unhealthy exercise, diet, smoking, sleep, and alcohol intake, as well as socioeconomic and demographic factors associated with unhealthy behaviours to be used for targeting future interventions. RESULTS: Only 118/2000 (5.9%) men demonstrated 5/5 healthy behaviours, and 829 (41.5%) had 3/5 unhealthy behaviours; 391 (19.6%) men currently smoked, 773 (38.7%) demonstrated alcohol overuse, 1077 (53.9%) did not get optimal sleep (<7 or >9 hours per night), 977 (48.9%) failed to exercise >150 minutes/week, and 1235 (61.8%) had an unhealthy diet. Multivariate analysis indicated that men with high school education were at increased risk of unhealthy behaviours (odds ratio [OR] 1.58; 95% confidence interval [CI] 1.15-2.18; p=0.005), as were men living with relatives (OR 2.10; 95% CI1.04-4.26; p=0.039), or with their partner and children (OR 1.34; 95% CI 1.02-1.76; p=0.034). CONCLUSIONS: An overwhelming 41.5% of Canadian men had 3/5 unhealthy behaviours, affirming the need for targeted lifestyle interventions. Significant health inequities within vulnerable subgroups of Canadian men were identified and may guide the content and delivery of future interventions.

Management of post-radiation therapy complications among prostate cancer patients: A case series.

INTRODUCTION: Treating prostate cancer with radiation therapy (RT) is a viable option, albeit with its own profile of complications. We describe a unique Canadian report of a single surgeon (RJB) experience in the management of complex post-prostate cancer RT complications. METHODS: We retrospectively analyzed patients who had previously received external beam radiation (XRT) or brachytherapy (BT) for prostate cancer referred to a single surgeon for persistent urologic related difficulties between 2005 and 2010. We used the Radiation Therapy Oncology Group (RTOG) morbidity grading system to assign each patient a 1 to 5 grade for their greatest complication. RESULTS: In total, 15 patients were identified with a total of 43 RT-related complications. Of these 43 complications, 19 presented with obstruction, 8 with radiation failure or new bladder cancer, 6 with hematuria, 5 with intractable incontinence, and 5 with urinary tract infections. These patients required several investigations prior to treatment. Treatment of these complications used surgical, local and medical approaches. In the end, 1 patient had total incontinence, 3 improved their incontinence, 3 had self-catheterization and dilation, 1 voided well, 3 underwent cystectomy with ileo-conduits, 2 had chronic hematuria, and 2 passed away. CONCLUSION: These patients are heavily investigated and require significant resources, including patient visits, diagnostics and treatment modalities to optimize their condition. Cure is not always possible, but the aim to improve quality of life should guide management.

Standardized follow-up program may reduce emergency room and urgent care visits for patients undergoing radical prostatectomy.

INTRODUCTION: The objective of the current study was to determine the impact of a standardized follow-up program on the morbidity and rates of hospital visits following radical prostatectomy (RP) in a tertiary, non-teaching urologic centre. METHODS: Patients who underwent a RP in 2008 were retrospectively evaluated in this study. Postoperative morbidity for the entire cohort was assessed using the Modified Clavien Scale (MCS). Those patients readmitted to hospital or who visited an urban or rural emergency department (ED) within 90 days of surgery were further evaluated to determine the reason for readmission. RESULTS: At our centre, 321 patients underwent RP in 2008 by 11 surgeons. Of the 321 patients, 77 (24.0%) visited an ED within 90 days, and 14 were readmitted to hospital, with an additional patient readmitted directly (with a total 15 readmissions, 4.7% overall). No patients died within the study period. In 2009 we launched a pilot study wherein 115 RP patients received scheduled and on-demand follow-up care by a dedicated nurse between May and November. We found that 90-day readmission rates among this cohort dropped to 5% and 2.6% for ED visits and hospital readmission, respectively. CONCLUSIONS: At our tertiary non-teaching centre, a significant number of patients presented back to hospital within 90 days following RP. Most of these patients (80.8%) were managed entirely through an outpatient ED, and many visits were for routine postoperative care. Only 18.2% (4.7% of the 321 prostatectomy patients) were readmitted to hospital. These data point to a need for enhanced postoperative support of patients to reduce costly and often unnecessary visits to acute care EDs. This conclusion is supported by our early experience. Limitations include retrospective design, and variability in practice of surgeons in this study.

Case report and literature review of a rare diagnosis of ossifying renal tumour of infancy.

One must entertain a broad differential diagnosis for infants presenting with gross hematuria. Initial workup includes urine analysis, serum laboratory values and abdominal ultrasound. We describe an infant presenting with gross hematuria found to have a calcified renal mass upon initial ultrasound and subsequent computed tomography scan. We considered a differential diagnosis of, but not exclusive to, staghorn calculi, nephroblastoma, Wilms' tumour, mesoblastic nephroma and ossifying renal tumour of infancy (ORTI). A nephrectomy was performed, and the pathology report identified the calcified mass as an ORTI.

45,X/46,XY mixed gonadal dysgenesis: A case of successful sperm extraction.

Infertility is common among couples, about one third of cases are the result of solely male factors, and rarely abnormalities of genetic karyotypes are the root cause. Individuals with a 45X,/46,XY mosaiscism are rare in the literature and very few have fertile potential. We discuss a case of a 27-year-old male with known mixed gonadal dysgenesis, 50:50 split mosaiscism of 45,X/46,XY, presenting for evaluation of 1.5 year history of infertility. He demonstrated low volume non-obstructive azoospermia. Upon testicular biopsy, spermatozoa were extracted. These sperm were subjected to aneuploidy studies demonstrating 95.95% euploidy. The sperm were further assessed and placed in cryopreservation after being deemed sufficient for potential intracytoplasmic sperm injection. This is a unique case of viable sperm in a man with mixed gonadal dysgenesis, 45,X/46,XY mosaiscism.