Undiagnosed macroscopic haematuria revisited: a follow-up of 146 patients.

OBJECTIVE: To further investigate a group of patients with macroscopic haematuria who had no abnormalities on upper tract imaging and cystoscopy, to determine the appropriate follow up. PATIENTS AND METHODS: The hospital notes of patients who presented with frank haematuria between 1990 and 1998 and had no abnormality on cystoscopy and/or upper tract imaging were reviewed, with particular note made of any further bleeding or any other further urological problems. Those with < 2 years of follow-up in the hospital notes were investigated by telephone or via their general practitioner to ensure that all patients had at least 2 years of follow-up after the initial investigation. RESULTS: Of the 146 patients in the study, 98 were alive and had no more bleeding after the initial investigation. None of them were found to have renal or urothelial tumours during the follow-up. Thirty-three patients had recurrent episodes of bleeding after the initial investigation; 26 of these had repeat investigations and one was found to have a renal pelvic transitional cell carcinoma on repeat intravenous urography. One patient in this subgroup had died from a subarachnoid haemorrhage; 15 other patients had died, 13 of non-urological causes and two of unknown causes. CONCLUSIONS: Of 146 patients with undiagnosed macroscopic haematuria, only one had a missed tumour and this was detected on further investigation for recurrent bleeding. These results confirm that repeat cystoscopy and upper tract imaging is only warranted in patients who have recurrent bleeding after initial investigation.

Investigation of upper tracts after resolution of symptoms due to ureteric calculi.

OBJECTIVE: To determine whether patients with proven ureteric calculi on IVU require repeat IVU after resolution of symptoms and passage of calculus on plain X-ray. METHODOLOGY: IVU reports for a 12-month period were obtained and notes and X-rays of those patients with ureteric calculi were reviewed. Presentation, management and subsequent imaging after resolution of symptoms were determined for each patient. All X-rays were reviewed by a uroradiologist. RESULTS: Fifty-eight patients were investigated for the study. All initial IVUs showed upper tract dilation or obstruction. Forty-three eventually passed their calculi spontaneously and of these, 18 had KUB, all of which showed passage of the calculus and 25 had repeat IVU, 22 of which were normal. The 3 abnormal IVUs showed persisting calculi which were visible on the plain film. Fifteen patients required surgical intervention and all had repeat IVU, of which 5 were abnormal. CONCLUSION: This study suggests that following resolution of symptoms due to ureteric colic, patients who pass their calculi spontaneously can be followed up by KUB. Only those with persistent calculi on KUB or those who have had surgical intervention require repeat IVU.

The development and validation of a quality-of-life measure to assess partner morbidity in benign prostatic enlargement.

OBJECTIVE: To investigate morbidity in the partners of patients with benign prostatic enlargement (BPE) by developing and validating a disease-specific questionnaire. PATIENTS AND METHODS: Phase 1 of the study comprised preliminary interviews with 15 patients who had newly diagnosed BPE, and with their partners, to determine the relevant issues for the partners. In phase 2, using these issues, a questionnaire was produced and tested on the 15 partners. In phase 3 the questionnaire was completed by 90 further partners, 50 at interview and the next 40 by post. As part of the validation process, the partners were also asked to complete the Short-Form-36 questionnaire, and the patients the Internation Prostate Symptom Score (IPSS) and the ICSmale questionnaires. RESULTS: In phase 1 all 15 of the partners were affected by the patients' disease and nine issues were identified. In phase 2, of the 90 partners, only one had no morbidity from the patient's symptoms; 71% were worried that the patient may have cancer and 69% concerned that the patient may require an operation. Only six partners were present at the patients' urological consultation. The partners' questionnaire scores were related significantly to the Mental Health and Vitality domains of the SF36 and with the patients' IPSS. CONCLUSIONS: The study confirmed the presence of significant morbidity in the partners of patients with BPE. The degree of partner morbidity was related to the severity of the patients' symptoms. Many of the questionnaire issues can be addressed in the consulting room by open discussion with patient and partner.

Quality of life changes following KTP/Nd:YAG laser treatment of the prostate and TURP.

OBJECTIVE: To compare health-related quality of life (HRQL) changes in patients receiving hybrid KTP/Nd:YAG laser treatment of the prostate with TURP. PATIENTS AND METHODS: Patients complaining of symptomatic benign prostatic enlargement were studied. Their symptoms (IPSS), disease-specific (BPH Impact Index (BPHII)) and generic HRQL (Short Form-36 (SF-36)) was evaluated before and at 6 weeks, 6 months and 1 year following treatment. RESULTS: 204 patients were randomized into the study. Patients in both groups reported an improvement in IPSS and BPHII at each postoperative assessment, but there were significant differences between the two groups at the 6-week stage in favor of the TURP group. At 6 weeks, patients in the laser group reported significantly worse scores in the SF-36 domains of bodily pain, social function and role emotional when compared to the TURP group. These differences disappeared at both the 6-month and 1-year follow-up assessments. CONCLUSIONS: Although hybrid KTP/Nd:YAG laser treatment and TURP differed in the way they affected patients in the early postoperative period, at 1 year, patients reported similar improvements in symptoms and enjoyed a similar disease-specific and generic HRQL.

A prospective randomized controlled trial of hybrid laser treatment or transurethral resection of the prostate, with a 1-year follow-up.

OBJECTIVE: To compare the clinical outcome after hybrid laser treatment of the prostate, combining potassium titanyl phosphate (KTP) and Nd:YAG lasers, with transurethral resection of the prostate (TURP). PATIENTS AND METHODS: A prospective randomized trial was conducted to compare laser treatment and TURP. The hybrid laser treatment technique involved performing initial 30 W KTP vaporizing bladder neck incisions and prostatotomies followed by a 'free-paint' application of 60 W Nd:YAG coagulation energy. Patients were re-assessed after 6 weeks, 6 months and 1 year, using the International Prostate Symptom Score (IPSS) and uroflowmetry. TURP was conducted using conventional methods. RESULTS: In all, 204 patients were randomized into the study; at 6 weeks there were significant differences between the groups for the IPSS (12.4 vs 9.1, P=0.001) and maximum urinary flow rates (16.1 vs 20.8 mL/S, P<0. 001) in favour of the TURP group. At 6 months and one year this difference had disappeared. Similar numbers of patients in each group complained of bothersome postoperative urinary symptoms (23% vs 19%). Blood transfusions (5% vs none) and urethral strictures (9% vs 2%) were more common after TURP, whereas more early infective complications occurred after hybrid laser treatment (24% vs 5%). Only one patient in each group required re-operation because of poor resolution of symptoms. CONCLUSIONS: At one year, hybrid KTP/Nd:YAG laser treatment of the prostate was equivalent to TURP in the improvements in IPSS, maximum urinary flow rate and post-void residual urine.