Music during flexible cystoscopy for pain and anxiety - a patient-blinded randomised control trial.

OBJECTIVES: To assess the role of music in reducing the pain and anxiety associated with flexible cystoscopy using a blinded trial design. PATIENTS AND METHODS: A patient-blinded randomised control trial of music during flexible cystoscopy was performed comparing the pain, measured by visual analogue scale (VAS), anxiety, measured by the State-Trait Anxiety Inventory (STAI), and vital signs of 109 patients across two public hospitals in New South Wales, Australia. The purpose and hypothesis of the study was concealed from patients until after results had been collected. RESULTS: There were no statistically significant differences detected between the No Music and Music groups in VAS pain score (mean [SD] 2.04 [1.94] vs 2.10 [1.90], P = 0.86), change in STAI anxiety score (mean [SD] 4.87 [9.87] vs 6.8 [11.07], P = 0.33) or post-procedural vital signs (mean [SD] heart rate 74 [14] vs 72 [13] beats/min, P = 0.66; systolic blood pressure 144 [20] vs 141 [19] mmHg, P = 0.47) between the two groups. CONCLUSION: Music does not appear to decrease perceived pain or anxiety when used during flexible cystoscopy. These findings may differ from the literature due to several factors, most significantly blinding of participants, but also potentially due to the ethnic composition of the study population or lack of choice of music.

High negative predictive value of 68Ga PSMA PET-CT for local lymph node metastases in high risk primary prostate cancer with histopathological correlation.

BACKGROUND: Current guidelines highlight the importance of accurate staging in the management and prognostication of high risk primary prostate cancer. Conventional radiologic imaging techniques are insufficient to reliably detect lymph node metastases in prostate cancer. Despite promising results, there is limited published data on the diagnostic accuracy of PSMA PET-CT to assess local nodal metastases prior to radical prostatectomy. This study aims to assess the diagnostic efficacy of 68Ga PSMA PET-CT in local lymph node staging of high risk primary prostate cancer when compared to histopathological findings following radical prostatectomy with pelvic lymph node dissection. METHODS: We retrospectively analysed consecutive patients with high risk primary prostate cancer referred by urologists for primary staging PSMA PET-CT using a 68Ga-labeled PSMA ligand, Glu-NH-CO-NHLys-(Ahx)-[HBEDD-CC], from October 2015 to October 2017. The scans of patients who underwent radical prostatectomy with pelvic lymph node dissection were interpreted by the consensus reading of two experienced nuclear medicine physicians blinded to clinical and histopathological data. The contemporaneous records of the referring urologists were retrospectively reviewed for noteworthy unexpected PET findings that altered their personal preference for surgical management. RESULTS: Seventy-one patients were recruited and analysed. PSMA PET-CT showed findings compatible with local disease in 47 patients (66.2%), lymph node metastases in 10 patients (14.1%) and distant metastases in 14 patients (19.7%). Twenty-eight patients (twenty-seven of whom had local disease only) underwent surgery yielding 214 lymph nodes, all of which were negative on histopathological analysis. On a node-based analysis, 213 of 214 lymph nodes were accurately identified as negative for disease with a negative predictive value of 100%. 11 patients had unexpected PET findings contemporaneously documented by urologists to alter their preference for surgical management. CONCLUSIONS: PSMA PET-CT appears to have a high negative predictive value for local lymph node metastases in high risk primary prostate cancer when compared to histopathological findings following radical prostatectomy with pelvic lymph node dissection.

A Case Report of Priapism With Unusual Presentation and Clinical Course.

This is a case report on a patient with an unusual presentation and clinical course of priapism. It further discusses treatment options with reflection on current literatures and guidelines. 48 year old patient presented with a history of more than 50 episodes of priapism, each lasting for five minutes. Patient had history of brain tumor that was resected and had since been in remission. On examination and further biochemistry assessment revealed conflicting clinical findings, making it difficult to ascertain the type of priapism in this case. The patient, however, recovered from the acute attacks of priapism after 24 hours of conservative management and no obvious cause had been identified on post-discharge follow-up. Priapism, despite being rare, is a medical emergency. This case report reflected upon the limitations of treatment guidelines and the lack of level one evidence to support treatment decisions.

Carcinoid tumors of the urinary tract and prostate.

CONTEXT: Carcinoid tumors are exceedingly rare in the genitourinary tract and may occur in the kidney, urinary bladder, urethra, or prostate. OBJECTIVE: To review the clinical and pathologic features of carcinoid tumors occurring in the urinary tract and prostate. DATA SOURCES: We searched the English language literature using MEDLINE and Ovid. CONCLUSIONS: Carcinoid tumors of the urinary tract and prostate share similar morphologic features with their counterparts in other organs. The differential diagnosis includes metastatic carcinoid tumor, paraganglioma, and nested variants of urothelial and prostatic carcinomas. Correlation of the clinical presentation and histopathologic features (including the immunohistochemical profile) will ensure accurate diagnosis of these rare tumors.

The Dornier Compact Delta lithotripter: the first 150 ureteral calculi.

BACKGROUND AND PURPOSE: Shockwave lithotripsy (SWL) is the least invasive treatment for ureteral calculi and is the best accepted by patients and clinicians. This prospective study was performed to evaluate the results of SWL for all ureteral calculi. PATIENTS AND METHODS: Between April 1999 and May 2000, there were 150 SWL treatments for ureteral calculi at our center. All patients who completed treatment (24 females, 126 males with an average age of 54 +/- 14 years) were entered in the study and were assessed at 1 and 3 months with a plain film of the kidneys, ureters, and bladder and an ultrasound scan or intravenous urogram if clinically indicated. The outcome has been analyzed according to stone size, location (lower ureter [LU], midureter [MU], and upper ureter [UU], number of treatments per stone, number of shocks per stone, and stone-free rate (SFR). The analgesia requirements during each treatment and complications have also been analyzed. RESULTS: The SFR in the UU was 77% at 1 month and 85% at 3 months. The SFR in the MU was 74% at both 1 and 3 months. The SFR in the LU was 65% at 1 month and 74% at 3 months. Overall, the SFR for all calculi was 72% at 1 month and 79% at 3 months. Ureteroscopic extraction was necessary in 19% of the patients and conservative management for the remaining asymptomatic fragments, which were 2 mm or smaller. All of these asymptomatic fragments were seen to have passed spontaneously on follow-up imaging studies. Ureteral stents were not placed routinely prior to SWL, but there were 32 calculi (21%) for which stents had been placed prior to SWL: 29 (19%) in the UU, 3 (2%) in the MU, and 0 in LU. There was no difference in the SFR or ureteroscopy rate in UU calculi treated with or without stents and no difference in the number of treatments needed to achieve these SFRs. The efficiency quotient for the UU was 55%, 45% for the MU, and 45% for the LU. Oral analgesia was given routinely; however, additional intravenous analgesia was necessary in 24% of treatments. No serious complications were seen. CONCLUSIONS: The Dornier Compact Delta lithotripter provides an effective noninvasive treatment for ureteral calculi that is achieved with minimal anesthesia and a low complication rate. Placement of ureteral stents prior to SWL does not enhance the SFR or obviate intervention if SWL fails. We recommend a low threshold for ureteroscopic treatment if significant progress is not made in fragmenting the stone with SWL.

The Dornier Compact Delta lithotripter: the first 500 renal calculi.

BACKGROUND AND PURPOSE: Extracorporeal Shockwave Lithotripsy (SWL) is now the best noninvasive treatment for renal calculi, rendering many patients stone free. This prospective study was performed to evaluate the short-term results of patients undergoing SWL with the Dornier Compact Delta lithotripter for all renal calculi. PATIENTS AND METHODS: Between April 1999 and May 2000, there were 500 renal calculi treated in 166 female and 334 male patients with a mean age of 53 +/- 15 years. All patients who completed treatment were entered in the study and assessed at 1 and 3 months with a plain film of the kidneys, ureters, and bladder. Stone-free rate and final outcome have been evaluated. Final outcome is defined as stone free or residual fragments 4 mm or less. Analysis has been made according to stone size, location, number of treatments per stone, and number of shocks per stone. The analgesia requirements during each treatment and complications have also been analyzed. RESULTS: The overall stone-free rate for stones <10 mm was 62% at 1 month and 76% at 3 months. For stones 10 to 20 mm, these rates were 53% and 66%, while the rates for stones >20 mm were 41% and 47%, respectively. The final outcome for stones <10 mm was 90% at 1 month and 93% at 3 months, for stones 10 to 20 mm 73% and 84%, and for stones >20 mm 57% and 67%, respectively. The effectiveness quotient for calculi <10 mm was 60%. For calculi 10 to 20 mm, it was 51%, and for those >20 mm, it was 31%. Oral analgesia was given routinely; however, additional intravenous analgesia was necessary in 22% of treatments. No serious complications have been seen. CONCLUSIONS: These results show that with proper patient selection, good results at 1 and 3 months can be achieved with minimal anesthesia during treatment and low retreatment rates. We do not recommend SWL as primary therapy for stones >20 mm.