BJU international
-
Randomized Controlled Trial Multicenter Study Comparative Study
Ability of C-reactive protein to complement multiple prognostic classifiers in men with metastatic castration resistant prostate cancer receiving docetaxel-based chemotherapy.
What's known on the subject? and What does the study add? Serum C-reactive protein (C-reactive protein) is emerging as a potential novel prognostic factor in metastatic castration-resistant prostate cancer (mCRPC). In the present study, a prospective trial was investigated retrospectively and a significant prognostic impact for C-reactive protein that was independent of multiple published prognostic models was identified in men receiving docetaxel-based chemotherapy for mCRPC. Prospective validation is warranted. ⋯ • Current prognostic classifications provide modest discrimination of outcomes in mCRPC receiving docetaxel-based chemotherapy, highlighting the need for improved risk-based models. • Baseline C-reactive protein appears to be an useful, independent prognostic factor and prospective external validation is warranted.
-
Multicenter Study Comparative Study Clinical Trial
Factors associated with treatment received by men diagnosed with prostate cancer in Queensland, Australia.
What's known on the subject? and What does the study add? Men diagnosed with prostate cancer are increasingly involved in making their own treatment decisions and the current recommendations for treatment are based on informed choice. The absence of scientific evidence regarding optimum treatment choices underlines the importance of understanding which factors influence the selection of treatment by men diagnosed with prostate cancer. Previous studies have found that men diagnosed with prostate cancer were more likely to choose radiation therapy over radical prostatectomy if they were older and had a higher PSA level. This is the first large-scale prospective study conducted outside the USA to quantify the factors associated with treatment decisions for men diagnosed with prostate cancer. It found that men who chose surgery were younger, above average physical health, and had lower grade cancers on the Gleason scale; men who had radiation therapy were older and had reduced physical health, with ADT added when men had more advanced disease. About two-thirds of the men said they primarily made the decision about treatment themselves, with the remaining men either sharing the decision-making process with their doctor or else leaving the decision more or less completely up to their doctor. These results highlight the importance of having quality up-to-date information readily available to guide these decisions. ⋯ • These results suggest that men's baseline health and tumour characteristics influence treatment choices. • Distance from tertiary treatment centres also influenced the treatment received and access to specialist urologists may play a role. • With most men indicating high levels of decisional control, the importance of having quality up-to-date information readily available to guide their decisions cannot be overstated.
-
Multicenter Study Comparative Study
Severe post-renal acute kidney injury, post-obstructive diuresis and renal recovery.
Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? The pathophysiology of post-renal acute kidney injury (PR-AKI), i.e. caused by urinary tract obstruction, has been extensively studied in animal models but clinical studies on this subject are outdated, and/or have focused on the mechanisms of 'post-obstructive diuresis' (POD), a potentially life-threatening polyuria that can develop after the release of obstruction. In severe PR-AKI, the risk of occurrence of POD is high. POD occurrence predicts renal recovery without the persistence of severe chronic kidney failure. In the present study, the occurrence of POD and the persistence of chronic renal sequelae could be predicted early from clinical variables at admission before the release of obstruction. ⋯ • In severe PR-AKI treated in ICU, POD occurrence was a frequent event that predicted renal recovery without severe CRF. • POD occurrence or severe CRF persistence could be predicted early from clinical and biological variables at admission before the release of obstruction.
-
Review
Systematic review of the impact of urinary tract infections on health-related quality of life.
What's known on the subject? and What does the study add? Values for equivalent health states can vary substantially depending on the measure used and method of valuation; this has a direct impact on the results of economic analyses. To date, the majority of existing economic evaluations that include UTI as a health state refer to an analysis in which the Index of Well Being was used to estimate the quality of life experienced by young women with UTIs. Currently, there are no validated methods or filters for systematically searching for the type of generic quality of life data required for decision analytic models. ⋯ The present review provides health researchers with several sources from which to select utility values to populate cost-utility models. It also shows that very few studies have measured quality of life in patients with UTI using generic preference-based measures of health and none have evaluated the impact of this health state on quality of life in children. Future studies ought to consider the inclusion of commonly used preference-based measures of health, such as the EQ-5D, in all patient populations experiencing symptomatic UTI or UTI-related complications.
-
Comparative Study
Preputial/penile skin flap, as a dorsal onlay or tubularized flap: a versatile substitute for complex anterior urethral stricture.
Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? For long complex anterior urethral stricture augmentation urethroplasty is considered the standard procedure but the best substitute material is still to be ascertained. Preputial/penile skin is a very good substitute especially when used as a dorsal onlay. It demonstrates exceptional functional and cosmetic results even in patients with unsuitable oral mucosa. ⋯ • A preputial/penile flap for complex anterior urethral stricture is a good treatment option, with results similar to other techniques, has acceptable donor site morbidity and is effective even in circumcised patients and for those patients with unsuitable oral mucosa. • A DOF is less likely to lead to diverticula formation and post-void dribbling. TFs have a higher failure rate than DOFs but, when combined judiciously with secondary endoscopic procedures, can provide good results.