Repeat testing for haematuria and underlying urological pathology.

OBJECTIVE: To assess the incidence of urological pathology in a group of patients referred for the investigation of haematuria and whose symptoms had resolved at the time of investigation. PATIENTS AND METHODS: The results from examination of 395 patients attending for investigation of haematuria were analysed. The group comprised 198 men and 197 women with a mean age of 51 years (range 19-73). RESULTS: In 220 patients (56%) no evidence of haematuria was detected despite its diagnosis in all patients at the time of referral. One-hundred and thirteen patients (51%) without detectable haematuria had urological pathology and 16 of these (14%) had an underlying malignancy in the urinary tract. CONCLUSION: Repeat urine analysis to determine whether haematuria persists has been considered as a way to define a high risk group which requires urgent investigation. Our results clearly indicate that the finding of haematuria, even in one urine specimen, warrants full urological assessment.

Rapid diagnostic service for patients with haematuria.

OBJECTIVE: To assess the feasibility of a clinic for the investigation of haematuria, with open access to general practitioners. PATIENTS AND METHODS: A total of 395 patients (198 men and 197 women), with mean age 51 years (range 19-73), were referred from 13 general practitioner clinics. All investigations were performed at the patient's first visit at which time either a provisional or a definitive diagnosis was made. RESULTS: Urinary tract infection was the most common diagnosis. Of all the patients, 43 (11%) had a malignancy of whom nine presented with microscopic haematuria. Fifty-nine per cent of patients were discharged after their first visit and 26% were placed on the waiting list for in-patient procedures. CONCLUSION: An open access clinic such as this is efficient and easily run. The high incidence of pathological abnormalities makes it a worthwhile facility.

Treatment preferences of urologists in Great Britain and Ireland in the management of prostate cancer.

A questionnaire was sent to all full-time British and Irish urologists (n = 278) on the management of prostate cancer and was answered by 229 (82%). The questions included 3 specific clinical situations, namely the management of incidental disease, the timing of treatment for metastatic disease and the mode of hormonal manipulation used for advanced disease. It was found that 79% of urologists preferred a deferred treatment policy for incidental disease in the over-75 age group. Radical prostatectomy was advocated by 10% of those questioned for patients in the under-60 age group. Radiotherapy was the mainstay of treatment for incidental disease in the poorer prognosis groups of incidental disease, namely younger patients with more aggressive tumours. Most urologists treated patients with asymptomatic metastatic disease at the time of diagnosis, with 18% entering patients into the Medical Research Council trial comparing immediate with deferred therapy. Orchiectomy was advocated by 57% of urologists as their first-line treatment for patients where hormonal manipulation was indicated. Consequently orchiectomy should remain the "gold standard" in comparative phase III trials in advanced prostate cancer.

Urologists' attitudes to the management of bladder cancer.

All consultant urologists in Great Britain and Ireland were sent 2 questionnaires relating to their management policies in bladder cancer; 82% and 78% respectively of questionnaires were completed and returned. The answers demonstrated a wide variation among urologists about the management of common clinical problems.

Phase III randomised study of zoladex versus stilboestrol in the treatment of advanced prostate cancer.

An open randomised Phase III trial was conducted of the depot GnRH analogue goserelin (Zoladex) versus stilboestrol (3 mg/day) in patients with advanced or metastatic prostate cancer. The study included 250 patients and the median follow-up was 43 months. In the Zoladex arm the time to first response was achieved earlier and more patients reported an improvement in symptoms. There was no statistically significant difference between the Zoladex and the stilboestrol arms with regard to survival and time to treatment failure. A major reason for treatment failure was the preponderance of adverse events in patients receiving stilboestrol. It is suggested that stilboestrol should no longer be used for prostate cancer when equally effective alternative treatments are available.

Paravesical suture granuloma: a problem following herniorrhaphy.

We discuss the diagnosis and management of a paravesical suture granuloma and review 11 such cases reported in the literature. Granulomas are an unusual complication of surgery, which have been noted to occur from several months to 11 years postoperatively. Of the 11 patients reported on 10 had undergone previous inguinal herniorrhaphy and presented with urinary symptoms and a palpable mass, and 1 had undergone femoral herniorrhaphy. In 7 cases the clinical diagnosis was a malignancy. It is important to consider suture granulomas in the differential diagnosis of a suprapubic mass involving the bladder so that unnecessary major surgery can be avoided.

Long-term assessment of 107 patients undergoing bladder neck incision.

The notes of 134 consecutive patients undergoing bladder neck incision (BNI) were analysed retrospectively. Details of pre-operative symptoms and the short-term results of the operation were studied, as well as the need for reoperation. Long-term results of the operation were not available in 100 patients and a questionnaire was sent to them asking for details of their present symptoms. This produced results on the long-term follow-up of 107 patients with a mean follow-up of 31 months (range 18-48); 86% of patients showed an improvement in symptoms in the short term whilst 68% maintained a subjective improvement in symptoms in the long term. Further surgery was required in 18 patients (13%). Possible reasons for this are discussed.