Search

Objectives: To assess the cost-effectiveness, resource use implications, quality-adjusted life-years (QALYs) and cost per QALY of care pathways starting with either extracorporeal shockwave lithotripsy (SWL) or with ureteroscopic retrieval (ureteroscopy [URS]) for the management of ureteric stones., Patients and Methods: Data on quality of life and resource use for 613 patients, collected prospectively in the Therapeutic Interventions for Stones of the Ureter (TISU) randomized controlled trial (ISRCTN 92289221), were used to assess the cost-effectiveness of two care pathways, SWL and URS. A health provider (UK National Health Service) perspective was adopted to estimate the costs of the interventions and subsequent resource use. Quality-of-life data were calculated using a generic instrument, the EuroQol EQ-5D-3L. Results are expressed as incremental cost-effectiveness ratios and cost-effectiveness acceptability curves., Results: The mean QALY difference (SWL vs URS) was -0.021 (95% confidence interval [CI] -0.033 to -0.010) and the mean cost difference was -£809 (95% CI -£1061 to -£551). The QALY difference translated into approximately 10 more healthy days over the 6-month period for the patients on the URS care pathway. The probabaility that SWL is cost-effective is 79% at a society's willingness to pay (WTP) threshold for 1 QALY of £30,000 and 98% at a WTP threshold of £20,000., Conclusion: The SWL pathway results in lower QALYs than URS but costs less. The incremental cost per QALY is £39 118 cost saving per QALY lost, with a 79% probability that SWL would be considered cost-effective at a WTP threshold for 1 QALY of £30 000 and 98% at a WTP threshold of £20 000. Decision-makers need to determine if costs saved justify the loss in QALYs., (© 2022 The Authors. BJU International published by John Wiley & Sons Ltd on behalf of BJU International.)

Objective: To reinvestigate whether South Asian men in the UK are at lower risk of being diagnosed with prostate cancer in a UK-based retrospective cohort study and to examine possible reasons that may explain this., Patients and Methods: The catchment areas were predefined in four areas of southern England, and age- and race-specific populations for those areas taken from census data. Cases were ascertained through review of multiple hospital sources, while race, other demographic factors, and medical history were determined using questionnaires sent to the men, hospital records review and death certificates. The South Asian group included men of Indian, Bangladeshi and Pakistani origin., Results: There was modest evidence of lower prostate cancer rates in South Asian men compared with their White neighbours (age-adjusted rate ratio 0.81; 95% confidence interval 0.65-1.00). This difference did not reflect less use of prostate-specific antigen (PSA) testing or differences in clinical features at presentation., Conclusion: This study provides evidence of a lower incidence of prostate cancer amongst South Asian men living in England, in comparison with their White counterparts. If anything, South Asian men presented with clinical features of earlier disease suggesting that the reduced risk is unlikely to be an artefact of poorer access to health care.

Objective: To examine the microbial colonization of urinary catheters that have been used by patients, to model catheter colonization in vitro and thus provide information about the way bacteria gain access to the bladder during catheterization., Materials and Methods: Microbial growth patterns from patients' indwelling catheters and from catheters used in an in vitro model of the catheterized urinary tract were compared. Catheters were cut into short segments, microorganisms from the inside and outside of each segment of the catheters were removed by sonication, and viable bacteria counted. DNA was extracted from selected patient catheter isolates and the DNA fragment of 16S ribosomal RNA was amplified by polymerase chain reaction and confirmed by DNA sequencing. The DNA sequences from the isolates obtained from different catheter sections and from urine in the same patient were compared., Results: After 1 day of catheterization there was significant bacterial growth on the outside of all the segments of patient catheters; there was significant growth on the inside of all segments by 4 days. Higher viable counts and a wider spectrum of genera were found on the outside than on the inside of these catheters. The same strains of bacteria, as determined by >or=98% similarity of the 16S ribosomal DNA sequence, were found on the outside and inside of catheters and in the urine. In the in vitro model, when the distal urethra was inoculated before inserting the catheter, the viable counts after incubation were variable along the outside of the catheter and the inside counts were uniformly high. By contrast, there was a different pattern after inoculating the inside of the distal end of the catheter, leading to an ascending biofilm on the inside. A smaller inoculum delayed but did not prevent infection in the model., Conclusion: The present results are consistent with the hypothesis that contamination of the tip of the catheter while it is being inserted is a possible means by which bacteria gain access to the bladder.