Safety, efficacy and cost of intra-operative cell salvage during open radical prostatectomy.

BACKGROUND: We aim to examine the safety and efficacy of intra-operative cell salvage (ICS) in radical prostatectomy. METHODS: A retrospective cohort study was performed, enrolling consecutive patients undergoing open radical prostatectomy at two institutions during 01/01/18-31/12/19. Patients were grouped by ICS use. Primary outcomes were allogeneic transfusion rates, and biochemical recurrence (prostate specific antigen >0.2 mg/mL). Secondary outcomes were use of adjuvant therapies, Clavien-Dindo complications and transfusion-related cost (allogeneic transfusion + ICS setup + ICS reinfusion). RESULTS: In total, 168 men were enrolled. Patients were grouped based on whether they received no blood conservation technique (126 men) or ICS (42 men). Groups were similar in median age, pre- and post-operative haemoglobin and length of stay. They also had similar post-operative tumour Gleason score, TNM-stage and positive surgical margin rates. Compared with controls, the ICS group had shorter follow up (336 vs. 225 days; P=0.003). The groups had similar rates of biochemical recurrence (17% vs. 14%; P=0.90), adjuvant therapy use (30% vs. 29%; P=0.85) and complications (14% vs. 19% patients; P=0.46). There was no metastatic progression or cancer-specific mortality in either group. Although a similar proportion of patients received allogenic transfusion (2.4% vs. 4.8%; P=0.33) and units of packed red blood cells (PRBC) (9 vs. 5 units), transfusion-related costs were higher amongst the ICS group (AUD $11,422 vs. $43,227). CONCLUSIONS: ICS use in radical prostatectomy was not associated with altered rates of allogeneic transfusion, complications, biochemical recurrence or adjuvant or salvage therapies. Transfusion related costs were higher in the ICS group.

Patient preference for urologist gender.

OBJECTIVES: To determine the factors associated with patients preferring the gender of their treating urologist in various clinical settings. METHODS: A total of 400 urology outpatients participated in a structured interview on the nature of their presenting complaint, perception of their complaint and the preference for the gender of their urologist in four specific scenarios of consultation, physical examination, office-based procedure and surgery. Patients who expressed a gender preference received follow-up telephone calls. RESULTS: A gender preference was expressed by 63 (15.8%), 108 (27.0%), 89 (22.3%) and 29 (7.3%) patients for the scenarios of consultation, physical examination, office-based procedure and surgery, respectively. Patients were more likely to have a preference if they were female or had a condition they considered embarrassing, with most preferences being for a gender-concordant urologist. Reasons included a previous negative experience and perceived gender-specific treatment styles. Patients who subsequently saw a doctor of the opposite gender to their preference were more likely to change their mind if their clinical interaction was positive. CONCLUSIONS: Female patients, those with a perceived embarrassing condition and patients undergoing examination or office-based procedures are more likely to have a gender preference for their urologist, with a subsequent positive experience leading to patients discarding pre-existing preferences. With improved understanding of how patient characteristics, perception of their condition and previous experiences can affect their choices in various clinical situations, urologists can better meet patient expectations and address barriers to healthcare in urology.

Detection of clinically significant cancer in the anterior prostate by transperineal biopsy.

OBJECTIVE: To determine the incidence of clinically significant prostate cancer (csPCa) detected exclusively in the anterior prostate using transperineal prostate biopsy. PATIENTS AND METHODS: Histopathology results of all patients who underwent transperineal prostate biopsy between February 2016 and March 2018 at a single institution were assessed for distribution of cancer within the prostate. Patients with cancer found exclusively in the anterior prostate were then compared to those with any cancer found in the posterior or lateral prostate with International Society of Urological Pathology Grade Group 2-5 cancers being considered csPCa. RESULTS: A total of 508 patients were included. Overall, 12.0% of the cohort had csPCa detected only in anterior biopsies. When stratified by prostate-specific antigen (PSA) level, 6.6% of men with a PSA level of 4.1-10.0 ng/mL and 8.2% of men with a PSA level of >10.0 ng/mL had csPCa detected in the anterior prostate alone. CONCLUSION: Transperineal biopsy has the ability to diagnose anteriorly located csPCa that would potentially have been missed by the transrectal approach.

Practice patterns of female urologists in Australia and New Zealand.

OBJECTIVE: To analyse the practice patterns of female urologists in Australia and New Zealand. PARTICIPANTS AND METHODS: An electronic survey was sent to female urologists and urology trainees of the Urological Society of Australia and New Zealand in December 2016, with questions on demographics, practice patterns and views on mentorship. RESULTS: Of 82 recipients of the questionnaire, 60 (73.2%) responded. Of these, 61.7% were aged <40 years, 81.7% were married or in a long-term relationship and 56.7% had children. A total of 67.8% had completed urology training. Of these, most had commenced clinical practice within the preceding 12 years, most had taken no time off in training and most had taken <1 year away from clinical practice. A total of 74.4% practised in a metropolitan area and 42.5% described their practice as being general urology. High or moderate satisfaction levels were reported by 88.1% of respondents and 92.9% intended to retire before the age of 70 years. A total of 17.2% had not had a mentor and 80.7% thought a mentorship scheme would be useful. CONCLUSION: These results provide information on the practice patterns of the increasing number of women urologists in Australia and New Zealand and have the potential to shape workforce and training planning in this region and worldwide.

Position statement: a clinical approach to the management of adult non-neurogenic overactive bladder.

INTRODUCTION: Overactive bladder (OAB) is a highly prevalent medical condition that has an adverse impact on various health-related quality-of-life domains, including a significant psychosocial and financial burden. This position statement, formulated by members of the Urological Society of Australia and New Zealand and the UroGynaecological Society of Australasia, summarises the current recommendations for clinical diagnosis and treatment strategies in patients with non-neurogenic OAB, and guides clinicians in the decision-making process for managing the condition using evidence-based medicine. Main recommendations: Diagnosis and initial management should be based on thorough clinical history, examination and basic investigations to exclude underlying treatable causes such as urinary tract infection and urological malignancy. Initial treatment strategies for OAB involve conservative management with behavioural modification and bladder retraining. Second-line management involves medical therapy using anticholinergic or ß3 agonist drugs provided there is adequate assessment of bladder emptying. If medical therapy is unsuccessful, further investigations with urodynamic studies and cystourethroscopy are recommended to guide further treatment. Intravesical botulinum toxin and sacral neuromodulation should be considered in medical refractory OAB. Changes in management as a result of this statement: OAB is a constellation of urinary symptoms and is a chronic condition with a low likelihood of cure; managing patient expectations is essential because OAB is challenging to treat. At present, the exact pathogenesis of OAB remains unclear and it is likely that there are multiple factors involved in this disease complex. Current medical treatment remains far from ideal, although minimally invasive surgery can be effective. Further research into the pathophysiology of this common condition will hopefully guide future developments in disease management.

Intravesical fat entrapment as a cause of failure of extraperitoneal bladder perforation to heal spontaneously.

We report a case of intravesical fat entrapment leading to failure of extraperitoneal bladder perforation to heal spontaneously. A 68-year-old woman underwent trans-abdominal hysterectomy complicated by an extraperitoneal bladder perforation. Despite prolonged catheterization, cystographic leakage persisted after 3 months. Bladder imaging and cystoscopy demonstrated a mass of perivesical pelvic fat protruding into the bladder cavity. The patient was symptomatic with pain and persistent urinary tract infection with episodes of sepsis. A transurethral resection of the mass was performed which led to bladder healing and resolution of symptoms.