Introduction of Rezum system technology to Ireland for treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: a pilot study on early outcomes and procedure cost analysis.

OBJECTIVE: Rezum technology uses heat from radiofrequency-generated water vapour to ablate prostate tissue. We evaluate the introduction of this thermal therapy to an Irish teaching hospital for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia. METHODS: A pilot study of men with moderate to severe lower urinary tract symptoms who underwent Rezum treatment to the prostate was performed. Perioperative efficacy was evaluated using international prostate symptom score (IPSS), quality of life score (IPSS-QOL), uroflowmetry and post-void residual (PVR) volumes. Costs were evaluated and compared against matched patients undergoing the standard of care, transurethral resection of the prostate (TURP). RESULT: Ten patients with a mean age of 70 ± 9 years who met the inclusion criteria underwent Rezum treatment. Mean PSA was 4.73 ± 4 ng/mL and mean prostate volume 72 ± 30 cc. Rezum therapy significantly improved both IPSS by 74% from mean baseline score of 20.8 ± 4 to 5.3 ± 1.49 (p < 0.001) and IPSS-QOL score by 84% from mean baseline score of 4.4 ± 0.7 to 0.6 ± 0.7 (p < 0.001) at 3 months. Maximum flow rate increase by 44% from 9.26 ± 2.5 to 13.34 ± 2.3 mL/s (p < 0.001). When compared to ten matched patients undergoing TURP in the same period, there was a significant cost saving of €1986.52 per patient for Rezum, overall up-front cost saving of €22,819 with an additional 19 bed days and 5 theatre hours spared. CONCLUSION: Rezum, a minimally invasive thermal therapy, provides significantly improved symptom relief and quality of life with a significant cost saving to the institution.

The recurrent urinary tract infection health and functional impact questionnaire (RUHFI-Q): design and feasibility assessment of a new evaluation scale.

INTRODUCTION: We aim to design a tool to assess the impact of recurrent urinary tract infection (rUTI) on quality of life (QoL) in adult women, given the notable absence of an established instrument for this purpose. MATERIALS AND METHODS: Best practice guidelines in health-related survey design were reviewed. A literature review informed creation of an interview guide. Following ethical approval, 10 female patients (23-38 years) with rUTI were invited to participate in phase 1 of questionnaire design; all agreed. Individual semi-structured interviews were conducted exploring the impact of rUTI on patients' QoL. Interviews were repeated with 5 staff members (3 urology nurses and 2 consultant urologists). Responses were recorded and thematic analysis performed, to inform the design of a new questionnaire. A further 10 patients were recruited to assess feasibility of completion. RESULTS: All participants found available questionnaires unfit for assessment of rUTI-related QoL. Multiple themes emerged as integral to an rUTI questionnaire, including: frequency of UTIs, duration of symptoms, time to full recovery, specific symptoms of UTI, constitutional symptoms, impact on work/education, impact on leisure activities, impact on interpersonal relationships, impact on sexual relationships, psychological aspects and implications of treatment. Data saturation was reached. Based on responses, the Recurrent Urinary tract infection Health and Functional Impact Questionnaire (RUHFI-Q) was drafted, comprising 10 domains and 16 items. CONCLUSIONS: We propose a novel self-administered questionnaire, the RUHFI-Q, as an instrument to standardize evaluation of the QoL impact of rUTI in a population of premenopausal women. Further validation studies are in progress.

Management of colon-invading renal cell carcinoma: Operative technique and systematic review.

Invasion into adjacent organs by non-metastatic renal cell carcinoma (RCC) occurs in 1% of patients suitable for resection. Colonic invasion is rare and presents technical challenges. No prospective data exists to guide management of these patients. We present the first reported case of a colon-invading RCC managed with simultaneous open right radical nephrectomy and extended right hemicolectomy. PubMed, Scopus and EMBASE databases were searched for relevant case reports reporting management of colon-invading renal cell carcinoma. Case reports, case series and cohort studies were eligible. A chart review was performed on a patient who presented with right-sided colon-invading RCC. Four previously reported cases were identified. The current case was managed with simultaneous open radical nephrectomy and extended right hemicolectomy. The patient remains well six months postoperatively with no evidence of disease recurrence. Histopathological evaluation of the resected specimen confirmed a T4 clear cell RCC with sarcomatoid differentiation. Colon-invading RCC is rare. This is the first reported case of right-sided, colon-invading RCC treated with radical resection. The current case confirms radical resection is a feasible management strategy for similar presentations. En bloc resection of involved organs remains the only potentially curative option for locally advanced disease.

Biopsy at flexible cystoscopy: is it worthwhile?

INTRODUCTION: Flexible cystoscopy is the gold standard for diagnosis and surveillance of bladder carcinoma. Most flexible cystoscopes feature a working channel allowing for bladder biopsy and diathermy if a suspicious lesion is observed. However, the working channel permits only small instruments which limit the volume of material retrieved for histological analysis. There are no published standards for quality control of biopsy specimens taken at flexible cystoscopy. We reviewed the diagnostic yield of biopsies taken at flexible cystoscopy at our institution. METHODS: Theatre log books were retrospectively examined to identify cases of flexible cystoscopy where bladder biopsy was performed. Histopathology reports were reviewed. All biopsies were taken using single-use biopsy forceps, diameter 1.8 mm, open cup width 4.5 mm. RESULTS: From January 2014 to December 2017, a total of 143 biopsies were performed. All biopsies were taken for suspicious lesions where the differential diagnosis included malignancy. Of the 143 samples taken, 27 biopsies showed evidence of malignancy, and 9 cases were high-grade urothelial cancer. A total of 16 samples were inadequate for any histological diagnosis. All remaining samples excluded malignancy within the sample provided. A histopathological diagnosis was provided for almost 89% of cases. CONCLUSION: Approximately 18% of biopsies detected malignancy. While only small volumes of tissue are collected at flexible cystoscopy, these can help to distinguish malignancy from benign pathology. Our institution reports a non-diagnostic rate of approximately 11%, and in these cases, when there is still a suspicion of malignancy, a rigid cystoscopy and biopsy should be performed.

Is Movember synonymous with moustaches or men's health? An examination of internet search activity for prostate and testicular cancer during the campaign.

BACKGROUND: The Movember campaign encourages men to grow a moustache during the month of November. The campaign's aims include promotion of prostate and testicular cancer awareness. AIMS: To examine the effectiveness of the Movember campaign at generating awareness of prostate and testicular cancers by examining Internet search activity. METHODS: Google Trends was used to review weekly Internet search activity from January 2004 to December 2015. We reviewed search activity for the search terms "prostate cancer", "testicular cancer", "Movember" and "moustache". The weeks in November from 2004 to 2015 were examined for changes in search activity for our chosen search terms, which could be attributed to the annual Movember campaign. Search activity was recorded weekly and scored from 0 to 100 with 100 representing peak search activity. RESULTS: Mean search activity for each term during the weeks of Movember campaign. However, throughout the 11 years assessed, only the term "moustache" was consistently statistically associated with increasing publicity for the Movember campaign. Cancer awareness was inconsistent. Testicular cancer shows a significant association in only one of the 11 years and prostate cancer in only 2 years. CONCLUSION: We concluded that the Movember campaign is consistently linked in the public consciousness with novelty facial hair and only weakly associated with an awareness of prostate and testicular cancers. Whilst the funding generated by the campaign should be commended, more could be done to link the campaign and moustaches to awareness of common male cancers.

Parental awareness of testicular torsion amongst Irish parents.

PURPOSE: Testicular torsion is the most concerning underlying cause of acute scrotal pain that can lead to loss of the affected testicle. Whether a torted testicle can be salvaged surgically is directly affected by prompt presentation and diagnosis. This study aims to evaluate the awareness of testicular torsion amongst Irish parents and evaluate their response to a potential torsion. METHODS: An anonymous questionnaire was distributed to parents attending general paediatric clinics and an acute paediatric unit in two paediatric tertiary referral centres. SPSS statistical analysis software was used to perform multivariant analysis of the data. RESULTS: There were 242 completed surveys. Fifty-six percent of responders had an awareness of torsion. In the event of an episode of severe testicular pain parents who were aware of testicular torsion were 4 times more likely to present immediately than those who had no awareness of torsion (OR 4.2, 95% CI 1.4-12.2, P < 0.01), and those who identified correctly the critical timeframe were 3 times more likely to present immediately than those who did not (OR 3.0, 95% CI 0.85-10.8, P = 0.08). Of those parents with boys only 11% had discussed what to do in the event of acute scrotal pain. CONCLUSIONS: Education of this topic to the general Irish population and in particular to parents and young males is not established. Both knowledge of testicular torsion and awareness of the urgency in presentation are factors that determine parents promptness in seeking medical attention for their child in the setting of acute scrotal pain.

Diverticular disease is associated with benign intra-abdominal cystic disease.

BACKGROUND: Diverticular disease (DD) and hepatic and renal cysts have been linked with defects in collagen and dysfunctional matrix metalloproteinases. METHODS: Consecutive abdominal computed tomography scans between January-July 2015 were prospectively studied to determine a correlation between visceral cysts and DD. Patients with a sigmoid colectomy for pathology other than DD and scans in which DD and/or solid organs were not fully visualized were excluded. A subgroup analysis was performed on youthful DD patients (<55 years of age, n = 32) vs. older controls (>55, n = 213). RESULTS: 238 DD patients (50.8% male) and 369 controls (40.5% male, p = .02) were included. Incidence of visceral cystic disease in DD patients vs. controls was 71.4% vs. 22.5% (p < 0.00001). Renal cysts, present in 53.4% of the DD patients and 18.7% of the controls (p < .00001), were more common than hepatic cysts in both groups. Hepatic cyst prevalence was 8.8 vs. 2.4% (p = .0008). In the subgroup analysis, cystic disease was present in 56.2% of youthful DD patients vs. 29.1% of older controls (p = .004). CONCLUSIONS: A significant association between cystic disease and DD was demonstrated overall and in subgroup analysis inclusive of youthful DD patients and older controls. These findings suggest a global defect in connective tissue integrity in DD patients.

The 100 most influential manuscripts in colorectal cancer: A bibliometric analysis.

PURPOSE: Bibliometric analysis highlights the key topics and studies which have led to the current understanding and treatment of a disease of interest. In this original article we analyze the 100 most cited manuscripts in the field of colorectal cancer (CRC). MATERIALS AND METHODS: The Thomson Reuters Web of Science database with the search terms 'colorectal cancer,' 'colorectal cancer surgery,' 'colon cancer,' 'rectal cancer,' 'colorectal carcinoma,' 'colon carcinoma,' 'rectal carcinoma' and/or 'colonoscopy' was used to identify the manuscripts for the study. Only full length manuscripts were included. The 100 most cited papers were identified and further analyzed by topic, journal, author, year and institution. The journals' 5 year impact factor and Eigenfactor scores were recorded. RESULTS: 146,833 eligible papers were returned. Within the top 100 cited manuscripts, the most studied topic was genetics in CRC (n = 41), followed by chemotherapy (n = 20) and surgical management (n = 7). The most cited paper authored by Fearon et al. (7850 citations) focused on genetic models of tumorgenesis. The NEJM published the highest number of papers (n = 23 with 42,576 citations). The country and year with the greatest number of publications were the USA (n = 62) and 2004 (n = 13) respectively. CONCLUSION: The most cited manuscripts highlighted in the current work describe the genetic, immunologic, basic science and surgical techniques that have resulted in the current understanding and treatment of CRC. The majority of these works were published in high impact journals and have been cited at least 900 times each reflecting their quality and influence. This work provides a reference of what could be considered as the most influential papers in CRC and serves as a reference for researchers and clinicians as to what makes a 'citable' paper.

Pseudomyxoma peritonei diagnosed 19 years after appendicectomy.

Pseudomyxoma peritonei (PMP) is an uncommon clinical finding describing the intraperitoneal accumulation of abundant mucinous, jelly-like material. This entity may represent a spectrum of diseases ranging from mucinous ascites, commonly associated with ruptured epithelial tumours of the appendix, to frank mucinous carcinomatosis. In cases of appendiceal origin, the patient may present with signs and symptoms of acute appendicitis, and thus careful diagnosis must be made in order to correctly and appropriately guide management. This may include a combination of surgical debulking with or without intraperitoneal or systemic chemotherapy. We present a 52-year-old woman with a 4-month history of abdominal pain and distension with a previous appendicectomy 19 years earlier. Radiological and pathological investigations diagnosed a probable PMP secondary to ruptured appendicitis many years ago. We describe her unique case, with emphasis on length of time to diagnosis and clinical management by surgical cytoreduction alone.