A prospective study of the natural history of hematuria associated with benign prostatic hyperplasia and the effect of finasteride.

PURPOSE: We prospectively studied the effect of finasteride on chronic hematuria associated with benign prostatic hyperplasia. MATERIALS AND METHODS: We prospectively evaluated 57 patients with chronic intermittent hematuria who were randomized to a finasteride treated or a control arm. RESULTS: In the untreated control group hematuria recurred in 17 patients (63%) within a year but in only 4 (14%) in the finasteride group, which was a statistically significant difference (p <0.05). Surgery was required for bleeding in 7 controls (26%), while no patient on finasteride required surgery. CONCLUSIONS: Hematuria secondary to prostatic bleeding may be significant if not treated. Finasteride appears to be effective for suppressing hematuria caused by benign prostatic hyperplasia and should be considered as treatment.

A prospective trial of flexible cystodiathermy for recurrent transitional cell carcinoma of the bladder.

PURPOSE: The flexible cystoscope has a proved role in the followup of patients with transitional cell carcinoma of the bladder but the full extent of its therapeutic role has yet to be defined. We analyzed 171 flexible cystodiathermies to assess patient tolerance and treatment success. Potential cost savings were also analyzed. MATERIALS AND METHODS: All patients with single or multiple small papillary (Ta) recurrences at followup flexible cystoscopy were treated with flexible cystodiathermy. Plain lubricating gel was used and no other analgesia was prescribed. A visual analog pain scale was completed by the patient after the procedure and an observer rating of discomfort was recorded. Followup for efficacy of treatment was performed. RESULTS: A total of 103 patients were treated with cystodiathermy during the last 3 years. Median followup was 21 months (range 12 to 42). Of the patients 52 (50.5%) had no recurrence of transitional cell carcinoma after treatment and 51 (49.5%) required treatment for recurrence. Only 13 patients (12.6%) had recurrences at or close to the original tumor site. Pain scales indicated that the procedure was well tolerated and all patients agreed to undergo it in the future if required. Estimated cost savings were approximately $66,500 per 100 patients. CONCLUSIONS: Flexible cystodiathermy is a well tolerated and efficacious treatment for recurrent small papillary (Ta) transitional cell carcinoma of the bladder. Since transitional cell carcinoma of the bladder frequently occurs in an elderly and often unfit population treatment that avoids general anesthetic offers considerable advantages.

A survey of post-operative care after day case surgery.

A prospective survey of patients undergoing day surgery was performed with the main aim of identifying the need for post-operative follow-up after minor or intermediate surgery. The degree of patient satisfaction and the increased workload that this group of patients caused general practitioners was also analysed. Patients underwent either varicose vein surgery, inguinal hernia repair or vasectomy and were asked to return a prepaid reply questionnaire two weeks after surgery. Ninety-eight patients were recruited into the survey, 89 (90.8 per cent) correctly completed forms were returned. Of these patients 58 (69 per cent) believed that they would not benefit from an outpatient appointment, 19 (21.3 per cent) made one or more visits to their general practitioner but had no continuing problem at two weeks postoperation. Six (6.7 per cent) continued to have a problem and thought they would benefit from a surgical outpatient appointment. Of the five patients given routine follow-up appointments before discharge four expected no benefit from an outpatient appointment and only one wished to be seen. This survey suggests that patients should be given the option of an outpatient appointment after minor or intermediate surgery via a postal questionnaire. Unnecessary appointments would thereby be reduced.