Abbreviations & Acronyms MRI = magnetic resonance imaging PSA = prostate-specific antigen TUR = transurethral resection Correspondence: Takeo Introduction: Iatrogenic foreign bodies can cause urolithiasis. However, iodine seeds used in brachytherapy are not a known cause of stone formation. We report a rare case of urethral stone formation with brachytherapy seeds determined to be the nidus, which occurred 9 years after permanent seed brachytherapy for prostate cancer. Case presentation: An 87-year-old man with a history of prostate cancer treated with brachytherapy presented to our hospital with macroscopic hematuria. He underwent transurethral resection of the mucosa with erythema 4 years after brachytherapy. Cystoscopy revealed urethral stones on the bladder neck. Transurethral lithotripsy was performed and the nidus of stone formation was revealed to be an aggregate of iodine seeds. Conclusion: In the course of the long-term follow-up after brachytherapy for prostate cancer, the possibility of the formation of the urethral stone associated with iodine seeds should be considered when gross hematuria is observed. Keynote messageIatrogenic foreign bodies can cause urolithiasis. This is the first report of urethral stone formation following brachytherapy for prostate cancer, wherein iodine seeds acted as the nidus. In the course of the long-term follow-up after brachytherapy for prostate cancer, the possibility of the formation of the urethral stone associated with iodine seeds should be considered when gross hematuria is observed.

Background: Ureterosciatic hernia (USH) is a rare benign disease. We report a case of USH treated with laparoscopic intraperitonization of the ureter. Case Presentation: A 70-year-old woman was admitted to our hospital with right abdominal pain lasting for 2 months. CT showed right hydronephrosis and invagination of the right ureter into the right sciatic foramen. She underwent retrograde ureterography, which revealed abnormal tortuosity of the right lower ureter, and was found to have USH. We performed laparoscopic intraperitonization of the ureter and she presented good postoperative course. Conclusion: Laparoscopic intraperitonization of the ureter can be a useful treatment for USH.

The purpose of this study was to investigate factors predicting the sensitivity to cabazitaxel therapy in metastatic castration‐resistant prostate cancer (mCRPC) patients with phosphatase and tensin homolog deleted from chromosome 10 (PTEN) alterations. This single‐institution, retrospective study included 12 mCRPC patients with PTEN alterations who had received cabazitaxel therapy. Five patients (41%) responded to cabazitaxel therapy with a prostate‐specific antigen (PSA) level decline of ≥30% from baseline, and all of them had responded to prior docetaxel therapy with a PSA decline of ≥30%. None of the patients with a poor response to prior docetaxel therapy responded well to cabazitaxel therapy. Of the seven patients who did not respond to cabazitaxel and whose PSA declined from baseline was <30%, five (71%) were also refractory to prior docetaxel therapy. The PSA responses to docetaxel and cabazitaxel were significantly correlated ( p = 0.027). Kaplan–Meier analysis revealed that progression‐free survival (PFS) for cabazitaxel was significantly shorter for prior docetaxel nonresponders (3.3 versus 9.1 months, p = 0.028). Multivariate analysis revealed that a poor response to prior docetaxel (PSA decline < 30%) (hazard ratio [HR] = 6.382, 95% confidence interval [CI] 1.172–34.750, p = 0.032) and baseline PSA of ≥20 ng/ml (HR = 33.584, 95% CI 2.332–483.671, p = 0.010) were independent prognostic factors for PFS with cabazitaxel therapy. These results demonstrate cross‐resistance between docetaxel and cabazitaxel. The response to prior docetaxel therapy can influence the sensitivity to cabazitaxel therapy in mCRPC patients with PTEN alterations.

Background The relationship between guideline adherence for radical cystectomy of non-muscle-invasive bladder cancer and patient prognoses currently remains unclear. We investigated whether guideline adherence at the time of non-muscle-invasive bladder cancer affects the oncological outcomes of bladder cancer patients who underwent radical cystectomy. Methods Among 267 cTa-4N0-2M0 bladder cancer patients, 70 who underwent radical cystectomy under the non-muscle-invasive bladder cancer or muscle-invasive bladder cancer status that progressed from non-muscle-invasive bladder cancer were identified. Patients who followed the guidelines from initial transurethral resection of bladder tumors to radical cystectomy were defined as the guideline adherent group (n = 52), while those who did not were the guideline non-adherent group (n = 18). Results In the guideline non-adherent group, 8 (44.4%) out of 18 were diagnosed with highest risk non-muscle-invasive bladder cancer for Bacillus Calmette Guérin-naïve patients and 7 (38.9%) had a Bacillus Calmette Guérin unresponsive tumor status. Five-year recurrence-free survival and cancer-specific survival rates for the guideline non-adherent group vs guideline adherent group were 38.9% vs 69.8% (P = 0.018) and 52.7% vs 80.1% (P = 0.006), respectively. A multivariate analysis identified guideline non-adherence as one of independent indicators for disease recurrence (hazard ratio = 2.81, P = 0.008) and cancer-specific death (hazard ratio = 4.04, P = 0.003). In a subgroup analysis of 49 patients with cT1 or less non-muscle-invasive bladder cancer at the time of radical cystectomy, guideline non-adherence remained an independent prognostic factor for cancer-specific survival (hazard ratio = 3.46, P = 0.027). Conclusions Guideline adherence during the time course of the non-muscle-invasive bladder cancer stage may result in a favorable prognosis of patients who receive radical cystectomy. Even under non-muscle-invasive bladder cancer status, radical cystectomy needs to be performed with adequate timing under guideline recommendations.

INTRODUCTION AND OBJECTIVE: Patients undergoing Robotic Assisted Radical Prostatectomy (RARP) commonly require 2 group and screen samples pre-operatively. However, literature suggests intra-operative transfusion rates are between 0.7 e 2%. Additionally, day 1 post-operative blood tests are routinely undertaken in urology centres around the world. We aim to assess the need for 2 group and screen samples pre-operatively and the need for routine post-operative blood tests.METHODS: We retrospectively reviewed 310 patients who underwent a primary or salvage RARP operation. All patients were operated on at University College London Hospital (UCLH) over a 6month period.RESULTS: Pre-Operative The median age of our patients was 66 with a median ASA of 2. 26% of patients had Charlson Co-Morbidities. Intra-Operative 21% of patients underwent pelvic lymph node dis section. 31% had no nerve sparing, 30% had unilateral nerve sparing and 38% had bilateral nerve sparing. Our median optime was between 120 and 240 minutes and our median estimated blood loss was 200mls (IQR: 100-350). 7.1% of our series had BAUS intra-operative complications 0.3% (N[1) of patients received an intra-operative blood transfusion.Post-Operative 1.3% (N[4) of patients received a post-operative blood transfusion. Our median length of stay was 1 day (IQR: 1-2). 9.4% (N[29) of patients had a delayed discharge due to delayed routine blood results.Analysis 7% were judged to need post-operative higher dependency care and necessary blood tests. 3% had blood tests requested from intraoperative suspicion and 19% had blood tests requested from clinical post-operative suspicion. 71% had routine blood tests requested with no justification. 5.2% of patients (N[16) had post-operative complications; 4 patients had blood tests requested from intraoperative suspicion, 11 patients had blood tests requested from overnight or day 1 clinical suspicion and 1 patient suffered a complication (haematoma) that was not picked up from clinical suspicion, or routine blood tests.CONCLUSIONS: Intra-operative or post-operative clinical judgement flagged post-operative complications in 99% of patients. Routine blood tests, without an indication, did not flag any (0%) post-operative complications that were not flagged by clinical judgement. The use of a second Group and Screen samples was not useful intraoperatively. By removing unnecessary blood tests, we would save our trust roughly £5000 a month as well as reducing delays in discharge and workload on medical staff. Furthermore, we would maintain the same level of patient safety and care.