Total hip arthroplasty in Belgium: the contribution of a social health insurer to the debate.

This study describes current clinical practice and outcomes of Total Hip Arthroplasty in Belgian hospitals. Orthopaedic registries concentrate on implant related analyses and sometimes on patient reported outcomes. Our aim was to describe the extent and to generate hypotheses about the determinants of the variability of health care practices and of prosthesis survival in Belgium. Only unilateral elective primary Total Hip Arthroplasties were included. Length of stay, costs, transfusion rates and other care activities were analysed over 2008 and 2009 together. Prosthesis survival was studied using Kaplan-Meier and Cox regression hazard ratio computations over the period 2000-2009. 36798 elective Total Hip Arthroplasties have been included in a study of all members of the Belgian Christian Sickness Fund. The non-standardised ten year Total Hip Arthroplasty survival rate is 93% (Kaplan-Meier). Quality has progressed notably compared with 10 years earlier. Important variations still persist though between hospitals, for all studied indicators.

Neoadjuvant hormonal therapy before radical prostatectomy decreases the number of positive surgical margins in stage T2 prostate cancer: interim results of a prospective randomized trial. The Belgian Uro-Oncological Study Group.

PURPOSE: We investigated the effect of neoadjuvant treatment before radical prostatectomy for clinically localized prostate cancer. MATERIALS AND METHODS: A total of 130 patients with stages T2b and T3 prostate cancer was randomized in a multicenter study: 62 underwent immediate radical prostatectomy and 65 received 560 mg. estramustine phosphate daily for 6 weeks preoperatively. RESULTS: For clinical stage T2b tumors the neoadjuvant treatment resulted in a significant decrease in positive surgical margins compared to the nonpretreated group. This difference was not found for clinical stage T3 tumors. The impact on progression and survival still must be analyzed. CONCLUSIONS: Neoadjuvant treatment can be beneficial for clinical stage T2 prostate cancer. Optimal treatment for stage T3 tumors remains controversial.

[Hormone therapy before radical prostatectomy. Effects on surgical method and resection margins. Belgian Uro-Oncological Study Group (B.U.O.S.)]. / Hormonothérapie avant prostatectomie radicale. Effet sur l'acte chirurgical et les marges de résection. Belgian Uro-Oncological Study Group (B.U.O.S.).

127 patients with a clinical stage T2b and T3 prostate cancer were randomized in order to undergo either a radical prostatectomy alone or a radical prostatectomy after hormonal treatment (560 mg of estramustine phosphate daily for 6 weeks) in a prospective multi-center study. The clinical or radiological evaluation of an eventual downstaging being extremely difficult, the authors compared in the 2 groups the influence on the surgical act and the number of positive surgical margins at pathological examination of the resected specimen. There was no significant difference between the 2 groups concerning the surgery (duration of the procedure, blood transfusion, degree of difficulty). For clinical T2 prostate tumors the number of positive surgical margins was significantly lower in the group that had preoperative hormonal treatment. In the group with clinical T3 prostate cancer this difference was not found. The influence of positive margins on the later development of local or systemic recurrence and on survival still has to be awaited. At this moment one could conclude that only patients with a T2 prostate cancer benefit of a preoperative hormonal treatment.

Treatment of distal ureteral stones in the horse riding position.

From August 1986 through March 1987, 102 patients with 110 distal ureteral stones were treated in 110 sessions with the standard Dornier HM-3 lithotriptor in the so-called horse riding position. The majority of the patients (70 of 110, 63.7%) were treated for distal stones alone, whereas in a third (40 of 110, or 36.3%) treatment was performed for distal and upper stone localization during the same session. Additional treatment besides extracorporeal shock wave lithotripsy was necessary in 12.7% of the patients. Of the 110 patients 89.4% were without residual stones after a mean of 17.3 days. This modified position of the patient, which is specific to the Dornier HM-3 lithotriptor, makes possible treatment of distal ureteral stones with results comparable to those of endoscopic management but with less major complications (4.7%). A total of 7 patients had anal blood loss in the early postoperative period. Rectal bleeding ceased within 36 hours after treatment. The position also allows for treatment of stones at other, more proximal locations without great modifications to the position during the same session.

Long-term results of extracorporeal shock wave lithotripsy in children.

Extracorporeal shock wave lithotripsy was performed for treatment of calculi of the upper urinary tract in 73 children. All patients were treated with the standard HM3 Dornier lithotriptor. A total of 138 calculi in 86 renal units was treated, requiring 111 extracorporeal shock wave lithotripsy sessions. After therapy no serious complications were encountered. Six months after treatment 79 per cent of the patients were free of stones and 17 per cent had small residual fragments (less than 3 mm.), while extracorporeal shock wave lithotripsy was considered to be unsuccessful in 3 children, although disintegration could be obtained in all patients. During a median followup of 24 months (range 13 to 40 months) growth of residual fragments was noted in 33 per cent of the patients and the recurrence rate was 10 per cent.

[Experiences with extracorporeal shockwave lithotripsy in 61 children]. / Ervaringen met extracorporele schokgolfithotripsie bij 61 kinderen.

Between March 1985 and January 1987 2547 ESWL treatments were performed on 2064 patients, including 33 boys and 28 girls younger than 18 years. Almost identical results were obtained in children as in adults. All stones desintegrated and success was achieved in 97%; 79% was considered stone-free after 6 months and 18% had passable asymptomatic residual fragments (biggest fragments less than 3 mm) which did not grow larger during a mean follow-up of 17.8 months. One patient had a recurrent stone, after having been stone-free for 13 months. Post-ESWL complications and morbidity were minimal. Auxiliary measures were necessary in 5 patients before ESWL and in 6 patients after ESWL. Failure to render the kidney free of stones occurred in 2 patients with complex urolithiasis. Because of these results ESWL should be considered the treatment of choice in the paediatric age group for urolithiasis.

Risk factors in outpatient extracorporeal shock wave lithotripsy.

At present, outpatient extracorporeal shock wave lithotripsy (ESWL) is practiced in many centers for the treatment of urinary calculi. The safety of outpatient treatment is difficult to assess, no appropriate indications and criteria for patient selection have been established. In a retrospective study 1,203 patients, treated with ESWL using the Dornier HM-3 lithotriptor for the first time over the year 1986, were evaluated to analyze possible risk factors for outpatient ESWL. By multivariate analysis various pretreatment factors were investigated for their relation with complications arising from ESWL therapy. It was shown that stone size and sex of the patient were the strongest determining factors. In the present study a low-risk group (5% complications) could be identified, suitable for outpatient treatment, corresponding to 74% of the patient population. The remaining patients (26%) are at higher risk (18% complications) and should be considered for hospital treatment.