A phase 2 pilot study of water irrigation after transurethral resection of bladder tumor (WATIP) demonstrating safety, feasibility and activity.

PURPOSE: Non-muscle-invasive bladder cancer (NMIBC) can recur, partly due to seeding of free tumour cells after transurethral resection of bladder tumour (TURBT). Intravesical chemotherapy post-TURBT can reduce the risk but is used infrequently and inconsistently due to cost, complexity and side effects. The objective of this study was to prospectively assess continuous bladder irrigation using water, which may be a safer and easier alternative with comparable effectiveness. METHODS: WATIP was a prospective, single-arm phase 2 study of water irrigation during and for at least 3 h after TURBT for bladder tumours noted on imaging or flexible cystoscopy. Participants were assessed clinically for adverse effects and with blood tests within 24 h for sodium, haemoglobin and lactate dehydrogenase. The primary endpoints were safety (defined as < 10% adverse events of CTCAE grade ≥ 3), and feasibility (defined as the intervention being delivered as planned in > 90% of cases) and secondary endpoint was recurrence-free rates (RFR). RESULTS: Water irrigation was delivered as planned in 29 (97%) of 30 participants (median age 67 years, 25 (83%) males). The only adverse event (grade 2) was clot retention in one (3.3%) participant. Water irrigation significantly reduced urothelial cell counts in catheter effluent over time, unlike saline irrigation which did not. RFR was 56.2% (9/16 participants with low-risk NMIBC) at first cystoscopy (median interval 108 days) and 62.5% (5/8 evaluable low-risk NMIBC) at 12 months. CONCLUSION: Water irrigation during and after TURBT is feasible and safe. Prospective assessment of its effect on NMIBC recurrence compared to post-TURBT intravesical chemotherapy is needed before recommending its use in routine clinical practice. Trial registration ANZCTR registration ID ACTRN12619000517178 on 1 April 2019.

Following the Trend: A Comparative Analysis of Public Engagement and Funding for Annual Prostate and Breast Cancer Campaigns Using Google Trends.

BACKGROUND/AIM: Google Trends (Google Inc., USA) is a web-based service that offers data on the time and volume of Google Internet searches. We used Google Trends to identify increases in search traffic caused by cancer campaigns, which are held in October and November each year for breast cancer (BC) and prostate cancer (PC), respectively, in our region. We investigated whether this increase in search traffic coincided with increased research funding or public donations. MATERIALS AND METHODS: Google searches for PC were compared and scaled against searches for BC from January 2010 to December 2021. The month with the highest volume of search hits for either term was given a relative search volume index of 100. All other months for both search terms were scaled against this index of 100. The degree of government research spending and public donations were contrasted against search traffic. RESULTS: Search volume increased for both campaign months (49% for BC in October, 5% for PC in November). The mean relative search volume for each campaign's specific month was 72.6 for BC, 18.4 for PC; mean difference of 50.75 (95% confidence interval=42.7-58.8, p<0.001). Annual mean (±standard deviation) expenditure of Government research grants was $22.2 million (± $1.5 million) for BC and $9.7 million (± $2.9 million) for PC with a mean difference of $12.5 million (95% confidence interval=$10.5-14.6 million, p<0.001). CONCLUSION: The BC campaign resulted in a statistically significant increase in search traffic compared to that for PC and correlated with statistically significant increases in research spending. Google Trends offers a method of evaluating cancer campaign efficacy and public interest.

Continuous bladder irrigation after transurethral resection of non-muscle invasive bladder cancer for prevention of tumour recurrence: a systematic review.

BACKGROUND: Non-muscle invasive bladder cancer (NMIBC) can recur despite transurethral resection of bladder tumour (TURBT) that clears macroscopic disease, partly from re-implantation of exfoliated cells. Immediate instillation of intravesical chemotherapy (IC) can reduce recurrence, is guideline-recommended but is under-utilized. Continuous bladder irrigation (CBI) immediately post-TURBT is postulated to prevent re-implantation, and may provide a simple, cheap and practical alternative. We undertook a systematic review to assess the effect of CBI on NMIBC recurrence. METHODS: Following PRISMA guidelines, relevant publications were identified by online search of databases, including Ovid Medline and EMBASE (1980-2019). All published prospective randomized controlled trials comparing CBI post-TURBT to a control group were included. The primary end-point was recurrence. RESULTS: Our search yielded 514 studies, of which six met inclusion criteria. Two studies (935 participants), albeit without peer-reviewed publication, comparing CBI to no CBI both showed a reduction in recurrence at 2 years. Four publications from three trials (331 participants) compared CBI to IC, showing similar recurrence rates at 1 year (odds ratio 1.29, 95% confidence interval 0.78-2.13) but a lower risk of adverse events (6-34% versus 27-48%). CONCLUSION: CBI post-TURBT appears to yield 1-year recurrence rates of NMIBC comparable to immediate IC. However, existing studies are small and of heterogenous design, precluding definitive conclusions. Further trials are required to determine if CBI can be implemented routinely to reduce NMIBC recurrence, as well as the optimal irrigant, volume and duration.

Vein diameter is a predictive factor for recanalization in treatment with ultrasound-guided foam sclerotherapy.

OBJECTIVE: Ultrasound-guided foam sclerotherapy (UGFS) is a low-cost and minimally invasive treatment option for varicose veins. There is a relative paucity of outcome reports. METHODS: UGFS procedures at a tertiary public hospital between 2010 and 2017 were studied. Either the great saphenous vein (GSV) or small saphenous vein (SSV) was treated. Pretreatment, in-treatment, 6-week, and 1-year post-treatment ultrasound reports were analyzed. The primary outcome was to determine whether vein diameter predicts obliteration failure. RESULTS: There were 457 treatments completed in 290 patients. The GSV was targeted in 372 (81%). Mean vein diameters of the GSV were not different from those of the SSV (GSV, 5.7 mm; SSV, 6.2 mm; P = .18); 109 (24%) had a Clinical, Etiology, Anatomy, and Pathophysiology score of at least 4. Of the 457 UGFS procedures, 360 (78.8%) were for primary veins. Baseline information, including vein diameter, was not different between primary and recurrent veins. At 6 weeks, complete obliteration, partial recanalization, and complete recanalization rates were 54.9%, 29.1%, and 16%, respectively. Of those with complete obliteration at 6 weeks, the recanalization rate at 1 year was 25%. Increasing vein diameter was associated with recanalization at 1 year (obliteration, 4.9 mm; recanalization, 5.7 mm; P = .03), especially for primary veins (4.8 vs 5.8 mm; P = .009). Multivariate analysis showed similar outcome. Vein diameter of >6 mm had good specificity (88%) but poor sensitivity (43%) for predicting obliteration failure. There were 15 (3%) new-onset deep venous thromboses reported on follow-up, all of which were from treatment of primary veins (P = .049). CONCLUSIONS: Only 44% of UGFS procedures were observed to have complete obliteration at 1 year after a single intervention. Significant recanalization developed at 1 year. Increased vein diameter was associated with recanalization. The impact on clinical recurrence is unknown.

Risk Factors for Glaucoma in a Cohort of Patients with Fuchs Heterochromic Iridocyclitis.

PURPOSE: To describe the incidence and risk factors for ocular hypertension and/or glaucoma in patients with Fuchs heterochromic iridocyclitis (FHC). METHODS: Retrospective analysis of 88 patients with FHC. Kaplan-Meier curves estimated the time to develop cataract and ocular hypertension/glaucoma. Possible prognostic factors were investigated in univariate Kaplan-Meier analyses using the Mantel-Cox logrank test. RESULTS: At presentation with FHC, 52% of patients had a cataract and 26% of patients had ocular hypertension/glaucoma. The estimated percentage of patients with a cataract or ocular hypertension/glaucoma by 4 years after presentation was 71% (CI: 58-81%) and 39% (CI: 28-51%), respectively. Patients aged ≥50 years had significantly greater risk of developing glaucoma (p = 0.0065). After adjusting for age-group, having a cataract at presentation was associated with increased risk of glaucoma (p = 0.032). CONCLUSIONS: Risk factors for development of ocular hypertension/glaucoma were increasing patient age and having a cataract at presentation with FHC.

Retrospective analysis of the natural history and management of serpiginous choroiditis in Australia and New Zealand.

BACKGROUND: To examine the prevalence of serpiginous choroidopathy in a predominantly Caucasian community, to examine associations between serpiginous choroiditis and other systemic diseases, and to report on the effect of immunosuppression on the long-term course of serpiginous choroiditis. DESIGN: Retrospective cohort study with patients from tertiary care centres and private practices. PARTICIPANTS: 18 patients, mean age 48 years at baseline. One patient was seen only once. Median follow-up was 69 months (5.8 years, range 0.4-29.7 years). METHODS: Patients were identified using the Australian and New Zealand Ophthalmic Surveillance Unit. A chart analysis was performed for all patients. Three treatment groups were identified: no treatment, prednisolone monotherapy, or combination of prednisolone and immunosuppression. Negative binomial regression was used to calculate incidence rate ratios for patient relapse. MAIN OUTCOME MEASURES: Patient demographics, clinical features, associated systemic diseases, treatments administered and dates of relapse. RESULTS: The disease prevalence in Australia and New Zealand is 1 case per 1.5 million people. Five cases (28%) had a positive QuantiFERON. A total of 32 relapses were observed: 14 while receiving no treatment, 11 on prednisolone and 7 on combination therapy. Compared with the no treatment group, the incidence rate ratio for prednisolone monotherapy and combination therapy was 1.29 and 2.92, respectively (95% confidence interval 0.40-4.14 and 0.96-8.88). CONCLUSION: Although the confidence intervals indicate that the difference in incidence rate ratios are not significant, these results suggest that there is a group of patients who have a benign course without long-term immunosuppression or corticosteroid treatment.