Transrectal ultrasound-guided prostate needle biopsy remains a safe method in confirming a prostate cancer diagnosis: a multicentre Australian analysis of infection rates.

PURPOSE: Worldwide, transrectal ultrasound-guided prostate needle remains the most common method of diagnosing prostate cancer. Due to high infective complications reported, some have suggested it is now time to abandon this technique in preference of a trans-perineal approach. The aim of this study was to report on the infection rates following transrectal ultrasound-guided prostate needle biopsy in multiple Australian centres. MATERIALS AND METHODS: Data were collected from seven Australian centres across four states and territories that undertake transrectal ultrasound-guided prostate needle biopsies for the diagnosis of prostate cancer, including major metropolitan and regional centres. In four centres, the data were collected prospectively. Rates of readmissions due to infection, urosepsis resulting in intensive care admission and mortality were recorded. RESULTS: 12,240 prostate biopsies were performed in seven Australian centres between July 1998 and December 2020. There were 105 readmissions for infective complications with rates between centres ranging from 0.19 to 2.60% and an overall rate of 0.86%. Admission to intensive care with sepsis ranged from 0 to 0.23% and overall 0.03%. There was no mortality in the 12,240 cases. CONCLUSION: Infective complications following transrectal ultrasound-guided prostate needle biopsies are very low, occurring in less than 1% of 12,240 biopsies. Though this study included a combination of both prospective and retrospective data and did not offer a comparison with a trans-perineal approach, TRUS prostate biopsy is a safe means of obtaining a prostate cancer diagnosis. Further prospective studies directly comparing the techniques are required prior to abandoning TRUS based upon infectious complications.

Concurrent Ilio-Enteric and Ilio-Vesical Fistula From Large Aorto-Iliac Aneurysm.

Iliac artery aneurysms (IAA) are associated frequently with abdominal aortic (AAA) and other degenerative large-vessel aneurysms. Concurrent fistulization of the aortoiliac tree into the gastrointestinal tract (GIT) and bladder is exceptionally rare. We herewith report a unique case of concurrent ilio-enteric and ilio-vesical fistula arising from a large aorto-iliac aneurysm.

Alternative access - Iliac artery angioplasty performed via left arm brachiocephalic fistula.

The majority of peripheral endovascular interventions are performed with access through the groin, followed by brachial and radial artery approaches. We describe a unique case of successful iliac artery endovascular intervention, performed via a left upper limb brachiocephalic fistula access site.

Utility of the American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator in predicting mortality in an Australian acute surgical unit.

BACKGROUND: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator provides an estimate preoperatively of operative risks including mortality; however, its utility is not known in Australian emergency general surgical patients. This study sought to determine accuracy of the calculator in predicting outcome of high-risk patients in an Australian acute surgical unit to establish if this calculator could be a useful tool to identify high-risk patients in an Australian setting. METHODS: Retrospective analysis of patients admitted to the acute surgical unit at a tertiary referral centre between 2018 and 2019 was conducted. High-risk patients were defined as those who underwent an emergency operation with an ACS-NSQIP surgical mortality score ≥5%. Post-operative outcomes assessed included mortality and return to operating theatre, readmission and discharge to nursing home. External validation of the calculator was performed using discrimination and calibration statistics. RESULTS: Over a 14-month period, 58 patients were high risk, with an average age of 75 years, 93% were classified as functionally independent/partially dependent and 91.4% underwent a laparotomy. Overall 30-day mortality rate was 20.7%. The ACS-NSQIP calculator was a reliable predictor of mortality, with c-statistic of 0.835 (0.654-0.977), Brier score of 0.125 (0.081-0.176) and Hosmer-Lemeshow statistic of 0.389. The calculator was less accurate in its prediction of other outcomes assessed. CONCLUSION: The ACS-NSQIP calculator accurately approximated mortality in high-risk Australian patients requiring emergency surgery. This study has demonstrated that in this patient population, the calculator could reliably be applied in the multidisciplinary care of emergency surgical patients.

Colorectal cancer screening in Australia: An update

Background: Colorectal cancer is the second most common cancer in Australia. The National Health and Medical Research Council (NHMRC) has introduced new recommendations for the prevention, early detection and management of colorectal cancer. General practitioners play a key part in the advocacy, risk stratification and implementation of colorectal cancer screening on the basis of a patient's individual risk. Objective: The aim of this paper is to summarise the NHMRC recommendations pertaining to screening so that they may be applied in general practice. Discussion: The recommended strategy for population screening in Australia remains the immunochemical faecal occult blood test, commencing at age 50 years in asymptomatic individuals with no family history of colorectal cancer. This test is to be performed every two years to age 74 years. Individuals with a family history of colorectal cancer will need appropriate risk stratification. Aspirin should now be considered for all patients aged 50­70 years in the prevention of colorectal cancer.