Regional cancer centre demonstrates voluntary conformity with the national Radiation Oncology Practice Standards.

Radiation Oncology Practice Standards have been developed over the last 10 years and were published for use in Australia in 2011. Although the majority of the radiation oncology community supports the implementation of the standards, there has been no mechanism for uniform assessment or governance. North Coast Cancer Institute's public radiation oncology service is provided across three main service centres on the north coast of NSW. With a strong focus on quality management, we embraced the opportunity to demonstrate conformity with the Radiation Oncology Practice Standards. The Local Health District's Clinical Governance units were engaged to perform assessments of our conformity with the standards and this was signed off as complete on 16 December 2013. The process of demonstrating conformity with the Radiation Oncology Practice Standards has enhanced the culture of quality in our centres. We have demonstrated that self-assessment utilising trained auditors is a viable method for centres to demonstrate conformity. National implementation of the Radiation Oncology Practice Standards will benefit individual centres and the broader radiation oncology community to improve the service delivered to our patients.

Ductal adenocarcinoma of the prostate: a Hong Kong case series.

OBJECTIVES: To review and report our local experience in the management of ductal adenocarcinoma of the prostate. METHODS: Retrospective review of patients diagnosed with ductal adenocarcinoma of the prostate in two regional urological centres in Hong Kong during 1995-2009. Clinical information, treatment and outcomes were retrieved for further analysis. RESULTS: We identified 19 Chinese patients diagnosed with ductal adenocarcinoma of the prostate. Majority of our patients presented with retention of urine and haematuria. At presentation, seven patients were already at an advanced stage with evidence of rectal invasion or distant metastasis. The overall treatment outcome was poor with high failure rate after either local or systemic hormonal therapy. CONCLUSION: We observed a predilection of this tumour to be locally aggressive, and hence a relatively high incidence of intra-luminal growth and rectal invasion. We observed a high failure rate after either radical prostatectomy or hormonal therapy.

Percutaneous nephrostomy, nephrolithotomy and combined ureteroscopic lithotripsy using the supine approach.

OBJECTIVES: (1) To evaluate the safety and efficacy of supine percutaneous nephrostomy, nephrolithotomy, and combined percutaneous nephrolithotomy and ureteroscopic lithotripsy. (2) To describe the skill-acquiring process in supine procedures and share our initial experience. DESIGN: Three-staged case series with prospective data collection. SETTING: Two public hospitals in Hong Kong. PATIENTS AND INTERVENTION: Stage 1: Forty patients indicated for percutaneous renal access were recruited for supine percutaneous nephrostomy with prospective data collection. Stage 2: A prospective comparative study of percutaneous nephrolithotomy involving 60 patients allocated non-randomly to a supine (n=25) or prone (n=35) approach was conducted. Stage 3: Data of 11 patients who underwent simultaneous supine percutaneous nephrolithotomy and ureteroscopic lithotripsy were prospectively captured. RESULTS: Stage 1: The procedural success rate was 100%. The mean operating time in unilateral procedures was 44 minutes; one patient had perinephric haematoma as a complication. Stage 2: Overall stone-free rates for prone and supine procedures were 46% and 68%, respectively (P=0.087), and mean operating times were 122 and 123 minutes, respectively (P=0.905). Stage 3: Of the 11 patients, six were rendered stone-free after the first combined procedure, and one experienced transient postoperative fever. There was no major complication. CONCLUSION: Percutaneous nephrolithotomy was feasible via both prone and supine approaches. With the exception of staghorn stones, the supine percutaneous approach was an equally safe and effective option for patients with specific conditions favouring such an approach. The ability to incorporate simultaneous ureteroscopic lithotripsy was an additional benefit of adopting the supine approach.