Search

Objective: To compare bleeding and transfusion rate between patients who undergo standard transurethral resection of the prostate (TURP) and patients who undergo DRY CUT® TURP. Materials and methods: A retrospective comparison was made of 626 patients who underwent a standard monopolar TURP during 2004–2007 at the Karolinska University Hospital Huddinge with 620 patients who underwent monopolar DRY CUT® TURP during 2011–2014 at the same clinic. Transfusion rate, perioperative bleeding, prostate volume, resection weight, use of anticoagulation therapy, presence of prostate cancer, whether the operation was performed by a specialist doctor in urology or a resident and length of hospital stay were evaluated. Results: The median bleeding was 300 ml (IQR = 100–645 ml) in the group of patients who underwent standard TURP compared to 75 ml (IQR 30–268 ml) in the DRY CUT® TURP group. The bleeding quotient for standard TURP was 2.3-times the perioperative bleeding for DRY CUT® TURP. In a logistic regression model the patients who underwent standard TURP were more likely to undergo blood transfusion compared to DRY CUT® TURP (OR = 3.18, 95% CI = 1.72–5.88). The results were not affected by adjustment for patient age, presence of prostate cancer, anticoagulation therapy or operation performed by a specialist in urology. However, the resection weight did influence the bleeding quotient. Conclusions: The shift from standard TURP to DRY CUT® TURP has decreased the perioperative bleeding and need for blood transfusion at our hospital. [ABSTRACT FROM AUTHOR]

Objective:The aim of this population-based study was to evaluate the impact of quality indicators on the adherence to guidelines for renal cell carcinoma (RCC).Material and methods:Since 2005, virtually all patients with newly diagnosed RCC in Sweden have been registered in the National Swedish Kidney Cancer Register (NSKCR). The register contains information on histopathology, nuclear grade, clinical stage, preoperative work-up, treatment, recurrence and survival. In addition, a number of quality indicators have been measured in the register aiming to increase the quality of care. The quality indicators are: the coverage of the register, histology reports, preoperative chest computed tomography (CT), partial nephrectomy, laparoscopic surgery, centralization to high-volume hospitals and waiting times.Results:A total of 8556 patients with diagnosed RCC were registered from 2005 to 2013 (99% coverage). In 2013, 99% of the histopathology reports were standardized. The number of patients with preoperatively chest CT increased from 59% in 2005 to 89% in 2013. The proportion of patients with RCC T1aN0M0 who underwent partial nephrectomy increased from 22% in 2005 to 56% in 2013. Similarly, laparoscopic radical nephrectomies increased from 6% in 2005 to 24% in 2013. The median tumour size at detection decreased from 60 mm in 2005 to 55 mm in 2013. The proportion of patients who were incidentally detected increased from 43% in 2005 to 55% in 2013.Conclusions:The data show an improved adherence to the guidelines for RCC as measured by quality indicators and a steady process of earlier detection of patients with RCC. [ABSTRACT FROM PUBLISHER]

Objective To evaluate the risk of different in-hospital complications for patients undergoing a radical cystectomy ( RC), as limited nationwide population data on short- and long-term complications after RC is available, despite it being the standard treatment for localised muscle-invasive urinary bladder cancer ( UBC)., Patients and Methods In all, 7608 persons underwent a RC after UBC diagnosis, as registered in the Swedish National Patient Register between 1964 and 2008., We estimated the frequency and incidences and calculated hazard ratios ( HR) and 95% confidence intervals ( CI) using multivariate Cox proportional hazards models., Results Urinary tract infection/septicaemia was the most common complication following radical cystectomy, with an incidence of 90.4 per 1,000 person years., There was a higher risk of urinary tract infection among patients who had a continent cutaneous reservoir ( HR: 1.11 (0.94-1.30) or orthotopic neobladder 1.21 (1.05-1.39) than among those with ileal conduit., Similarly, continent cutaneous reservoir and orthotopic neobladder were associated with increased risks for wound and abdominal wall hernias, stones in the urinary tract, hydronephrosis and nephrostomy tube treatment, and kidney failure., In contrast, risk of bowel obstruction was lower among those with orthotopic neobladder than those with ileal conduit ( HR: 0.64 (0.50-0.81)) and those with continent cutaneous reservoir ( HR: 0.92 (0.73-1.16)., Conclusions In-hospital complications after RC are numerous and continue to accumulate for many years after surgery, indicating the need for life-long follow-up of these patients., Comparison between different types of diversion should, however, be made with care because of potential confounding by indication. [ABSTRACT FROM AUTHOR]

Objective. To assess whether diagnostic random bladder biopsies and the detection of concomitant carcinoma in situ (CIS) have an impact on the frequency of intravesical bacille Calmette–Guérin (BCG) instillations or radical cystectomy; and whether this affects the cancer-specific survival in patients with pTaG3 or pT1G1–G3 transitional cell carcinoma of the urinary bladder. Material and methods. A population-based cohort of 538 patients with newly diagnosed bladder cancer was prospectively registered in the Stockholm County during 1995 and 1996 and followed for more than 5 years. Results. Random biopsies were recommended in all patients but the decision to take biopsies was made by the treating urologist and hence performed in 326 out of 538 patients (61%), which revealed concomitant CIS in 47 patients(14%). Sixty out of 103 (58%) patients with pTaG3 or pT1G1–G3 tumours, in whom random biopsies were performed, received intravesical BCG compared with five out of 22 patients (23%) where random biopsies were not taken ( p = 0.004). Moreover, 23 out of 103 patients (22%) with pTaG3 or pT1G1–G3 tumours in whom random biopsies were performed underwent radical cystectomy compared with none out of 22 patients (0%) without random biopsies ( p = 0.013). The Cox proportional hazard ratio for death due to bladder cancer in patients with pTaG3 or pT1G1–G3 tumours among patients not having versus having undergone random biopsies was 2.5 (95% confidence interval 1.1–5.6). Conclusion. Patients diagnosed in Stockholm in 1995 or 1996 with pTaG3 or pT1G1–G3 bladder tumours having undergone random bladder biopsies more frequently underwent BCG treatment and radical cystectomy and had higher cancer-specific survival than patients who did not undergo random biopsies. [ABSTRACT FROM AUTHOR]

Objective: To compare bleeding and transfusion rate between patients who undergo standard transurethral resection of the prostate (TURP) and patients who undergo DRY CUT ® TURP. Materials and methods: A retrospective comparison was made of 626 patients who underwent a standard monopolar TURP during 2004-2007 at the Karolinska University Hospital Huddinge with 620 patients who underwent monopolar DRY CUT ® TURP during 2011-2014 at the same clinic. Transfusion rate, perioperative bleeding, prostate volume, resection weight, use of anticoagulation therapy, presence of prostate cancer, whether the operation was performed by a specialist doctor in urology or a resident and length of hospital stay were evaluated. Results: The median bleeding was 300 ml (IQR = 100-645 ml) in the group of patients who underwent standard TURP compared to 75 ml (IQR 30-268 ml) in the DRY CUT ® TURP group. The bleeding quotient for standard TURP was 2.3-times the perioperative bleeding for DRY CUT ® TURP. In a logistic regression model the patients who underwent standard TURP were more likely to undergo blood transfusion compared to DRY CUT ® TURP (OR = 3.18, 95% CI = 1.72-5.88). The results were not affected by adjustment for patient age, presence of prostate cancer, anticoagulation therapy or operation performed by a specialist in urology. However, the resection weight did influence the bleeding quotient. Conclusions: The shift from standard TURP to DRY CUT ® TURP has decreased the perioperative bleeding and need for blood transfusion at our hospital.