Impact of tumour size on prognosis of upper urinary tract urothelial carcinoma after radical nephroureterectomy: a multi-institutional analysis of 795 cases.

OBJECTIVE: To evaluate the prognostic impact of tumour size on survival outcomes in upper urinary tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). PATIENTS AND METHODS: Data on 795 patients treated with RNU for UTUC from seven centres were retrospectively analysed with focus on tumour size. Clinicopathological features and relevant prognostic factors were compared between patients with tumours ≤3.0 cm and those with tumours >3.0 cm in size. The primary endpoints were cancer-specific survival (CSS), disease recurrence-free survival (RFS) and overall survival (OS). RESULTS: At a median follow-up of 32 months, 313 (39.4%) patients died from UTUC, 321 (40.4%) developed cancer recurrence, and 359 (45.1%) died from all causes. Tumour size >3.0 cm was associated with unfavourable clinicopathlogical features. Kaplan-Meier analysis showed that tumour size was significantly correlated with worse CSS, RFS and OS (all P < 0.001). Multivariate analysis showed that tumour size was an independent predictor of CSS (hazard ratio [HR] 2.296; P < 0.001), RFS (HR 2.193; P < 0.001) and OS (HR 2.417; P < 0.001). CONCLUSIONS: Tumour size >3.0 cm was a significant predictor of CSS, RFS and OS after RNU for patients with UTUC. Further studies are warranted before tumour size is included in risk prediction tools.

Randomized controlled trial on the efficacy of bladder training before removing the indwelling urinary catheter in patients with acute urinary retention associated with benign prostatic hyperplasia.

OBJECTIVE: The aim of this study was to investigate the efficacy of bladder training before removing the indwelling urinary catheter in patients with acute urinary retention (AUR) associated with benign prostatic hyperplasia (BPH). MATERIAL AND METHODS: In total, 845 consecutive patients with their first episode of spontaneous AUR associated with BPH were enrolled in this prospective randomized controlled trial. They were randomly assigned to be given either pharmacological treatment combined with bladder training or pharmacological treatment (tamsulosin 0.2 mg and finasteride 5 mg once daily) with free drainage of urinary catheter for 7 days, and a trial without catheter (TWOC) was performed. Data on patients' baseline demographics, history of BPH, International Prostate Symptom Score, prostate size, serum prostate-specific antigen, intravesical prostatic protrusion, TWOC success rates and related complications were collected and statistically analysed. RESULTS: The two groups of spontaneous AUR patients with BPH were given pharmacological treatment combined with bladder training before catheter removal (n = 440) or pharmacological treatment alone (n = 405) for 7 days. All 845 patients underwent a first TWOC with an overall success rate of 66.9% after first 7 days' catheterization; TWOC was successful in 65.2% of cases in the intervention group and 68.6% in the control group. There was no statistically significant difference in TWOC success rate between the two groups (p > 0.05). CONCLUSION: This randomized controlled trial showed that bladder training before urinary catheter removal did not increase the chance of TWOC success significantly in spontaneous AUR patients with BPH.

Clinical and urodynamic evaluation of women referred with diabetes mellitus.

INTRODUCTION AND HYPOTHESIS: We investigated the impact of diabetes mellitus (DM) on female lower urinary tract dysfunction. METHODS: We prospectively collected data of 1,640 consecutive diabetic women from the inpatient departments and outpatient clinics of urology, endocrinology, geriatrics, and nephrology in primary, secondary, and tertiary referral hospitals, rural healthcare stations, and nursing homes in Dujiangyan, China. Clinical histories were taken on an individualized basis depending on patient presentation. Urodynamics were performed in the enrolled female diabetic patients after excluding other causes of lower urinary tract dysfunction. Data on lower urinary tract symptoms and urodynamic parameters were analyzed. RESULTS: Ninety-three percent of diabetic women complained of lower urinary tract symptoms, and 88 % had positive urodynamic findings. Sixty-three percent presented with storage symptoms, 918 cases of which had detrusor overactivity, 787 impaired detrusor contractility, and 131 detrusor areflexia. Among the 918 patients with impaired detrusor contractility or detrusor areflexia, the mean first sensation of filling was 238.1 ml, with a mean maximum cystometric capacity of 624 ml, mean maximum flow rate of 9.6 ml/s, mean detrusor pressure at maximum flow rate of 32.4 cmH2O, and mean postvoid residual of 323 ml. Thirty-eight of 131 patients with detrusor areflexia had impaired renal function on blood chemistry test, and massive bilateral ureterohydronephrosis and "Christmas-tree-shaped" bladder in videourodynamic studies. On the whole, 95 % diabetic women had diabetic cystopathy. CONCLUSIONS: DM alters voiding patterns significantly, causing various lower urinary tract symptoms in a significant proportion of diabetic women. Diabetic cystopathy is a progressive condition with a spectrum of clinical symptoms and urodynamic findings. The prevalence of diabetic cystopathy is very high in Dujiangyan, China.