No abstract

BackgroundThere has been increasing interest in en bloc resection of bladder tumour (ERBT) as an oncologically non-inferior alternative to transurethral resection of bladder tumour (TURBT) with fewer complications and better histology specimens. However, there is a lack of robust randomised controlled trial (RCT) data for making recommendations. ObjectiveWe aimed to develop a consensus statement to standardise various aspects of ERBT for clinical practice and to guide future research. Design, Setting and ParticipantsWe developed the consensus statement on ERBT using a modified Delphi method.First, two systematic reviews were performed to investigate the clinical effectiveness of ERBT versus TURBT (effectiveness review), and to identify areas of uncertainty in ERBT (uncertainties review). Next, 200 health care professionals (urologists, oncologists and pathologists) with experience in ERBT were invited to complete a two-round Delphi survey. Finally, a 16-member consensus panel meeting was held to review, discuss and re-vote on the statements as appropriate. Outcome Measurements and Statistical AnalysisMeta-analyses were performed for RCT data in the effectiveness review. Consensus statements were developed from the uncertainties review. Consensus was defined as:(1) ≥70% scoring a statement 7-9 AND ≤15% scoring the statement 1-3 (consensus agree); OR (2) ≥70% scoring a statement 1-3 AND ≤15% scoring the statement 7-9 (consensus disagree). Results and LimitationsA total of 10 RCTs were identified upon systematic review. ERBT had a shorter irrigation time (mean difference -7.24 hours, 95% CI -9.29 --5.20, I 2 =85%, p<0.001) and lower rate of bladder perforation (Risk ratio [RR] 0.30, 95% CI 0.11-0.83, I 2 =1%, p=0.02) than TURBT, both with moderate certainty of evidence. There were no significant differences in recurrences at 0-12 months, 13-24 months or 25-36 months (all very low certainty of evidence). A total of 103 statements were developed and 99

Objectives: To assess intravesical prostatic protrusion (IPP) as a novel predictor of clinical progression in patients with benign prostatic enlargement (BPE). Methods: All patients attending the outpatient clinic at our institution who were being treated for lower urinary tract symptoms (LUTS) secondary to BPE between January 1997 and December 2003 were recruited into the study. International Prostate Symptom Score (IPSS) scores, uroflowmetry parameters, post-void residual urine volume (PVR), IPP and serum prostate-specific antigen (PSA) were collected. IPP was classified into Grade 1, 2 or 3. Patients were stratified to different treatment options including watchful waiting, alpha blockers or 5-alpha reductase inhibitors. Those who developed high post-void residual urine volume (>100 mL), acute urinary retention or a deterioration of at least 4 points in IPSS score were considered to have disease progression. Using the Grade 1 IPP group as a reference, the odds ratio for clinical progression of Grade 2 and Grade 3 IPP were calculated by using multivariate analysis. Results: A total of 259 patients with a mean age of 63 years (range 50-90 years) and mean follow-up time of 32 months were available for analysis. Fifty-two patients were found to have clinical progression. Odds ratio for progression of a Grade 2 IPP was 5.1 (95% confidence interval [CI] 1.6-16.2) and that of a Grade 3 IPP was 10.4 (95% CI 3.3-33.4). Conclusion: A higher IPP grade is associated with a higher risk of clinical progression in BPE. IPP is a useful non-invasive predictor for clinical progression in BPE.

No abstract