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Turo R, Horsu S, Calinciuc A, Smolski M, Thygesen H, Doyle G, Gulur DM, Das S, Pettersson B, Awsare N. Is magnetic resonance imaging helpful in detecting significant prostate cancer in patients with haematospermia, normal prostate specific antigen level and digital rectal examination. A single institution, observational, and retrospective study in a United Kingdom hospital. Cent European J Urol 2018; 71:26-30. [PMID: 29732203 PMCID: PMC5926635 DOI: 10.5173/ceju.2017.1517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/31/2017] [Accepted: 01/20/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction Haematospermia is an uncommon clinical condition that may be associated with prostate cancer. The optimal investigation of haematospermia is unknown. The aim of this study was to investigate haematospermia as a presenting symptom of significant pathology and to assess the diagnostic value of magnetic resonance imaging (MRI). Material and methods Patient and treatment parameters were collected from a practice cohort of men referred to a urology center presenting with haematospermia. We used a multivariate logistic regression model to test the independent significance of MRI in detecting prostate cancer (PCa) after adjusting for other known predictors of PCa detection. Results A total of 125 men (median age 58 years) were evaluated between 2012-2015. In the univariate and multivariate logistic regression model MRI was a significant predictor of PCa diagnosis after adjusting for age, prostate specific antigen (PSA) and digital rectal examination (DRE) results (Odds Ratio (OR) 14.15, p = 0.001). Of 107 patients who underwent MRI prostate imaging, 31 (28.9%) had reports suspicious of PCa. In 26 patients, other benign conditions were detected on MRI. PCa was detected in 12 (25.5%) of the 47 men (median age 61 years; range 43 to 85) who underwent prostate biopsies. Eight (17%) of these patients had Gleason ≥7 grade cancer. The persistence of haematospermia was not an independent predictor of cancer diagnosis (OR 0.20, p = 0.15). Conclusions PCa is not commonly associated with haematospermia. MRI seems to be improving detection rate of a significant PCa, particularly in patients presenting with haematospermia and normal PSA levels and DRE examination. Duration of haematospermia does not predict the presence of PCa.
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Affiliation(s)
- Rafał Turo
- Countess of Chester Hospital, Department of Urology, Chester, United Kingdom
| | - Seth Horsu
- Countess of Chester Hospital, Department of Urology, Chester, United Kingdom
| | - Andra Calinciuc
- Countess of Chester Hospital, Department of Urology, Chester, United Kingdom
| | - Michal Smolski
- Stepping Hill Hospital, Department of Urology, Stockport, United Kingdom
| | | | - Gerard Doyle
- Countess of Chester Hospital, Department of Radiology, Chester, United Kingdom
| | - Dev Mohan Gulur
- Countess of Chester Hospital, Department of Urology, Chester, United Kingdom
| | - Sanjay Das
- Countess of Chester Hospital, Department of Urology, Chester, United Kingdom
| | - Bo Pettersson
- Countess of Chester Hospital, Department of Urology, Chester, United Kingdom
| | - Ninaad Awsare
- Countess of Chester Hospital, Department of Urology, Chester, United Kingdom
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Turo R, Smolski M, Gulur D, Das S, Awsare N, Pettersson B. MP08-06 DISTRACTIONS IN THE OPERATING THEATRE. ARE WE TOO LOUD? J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Turo R, Bromage S, Smolski M, Thygesen H, Cleaveland P, Esler R, Hartley S, Thompson A, Adeyoju A, Brown SCW, Brough R, Oakley N, Sinclair A, Collins GN. The changes in prostate cancer and its management in the North West of England over a 10-year period. Journal of Clinical Urology 2015. [DOI: 10.1177/2051415815575218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objectives: Our aim was to evaluate changes in prostate cancer diagnosis and management and to examine changes in the stage and grade of newly diagnosed prostate cancer in the North West of England over a 10-year period. Materials and methods: Data was collected concerning the diagnosis (including stage and grade) and management of newly diagnosed prostate cancer in the North West of England. There were three time points: 2003, 2007 and 2011 including a total of 648 patients. For assessment of median time changes Spearman’s Rank correlation test was used, for the assessment of changes in Gleason grade and clinical stage Mann–Whitney U test was used, and assessment of positive margin rates was done with Fisher’s test. Results: Median time from management decision to surgery has reduced from 46 (2003), 34 (2007) to 27 days (2011) ( p=0.074). The proportion of patients managed with active surveillance has remained relatively constant over time (18%, 16% and 21% respectively). More minimally invasive, nerve-sparing prostatectomies are now performed, and positive margin rates have significantly reduced from 53% (2003) to 23% (2011) ( p<0.001). Gleason grade significantly increased over time ( p<0.001); Gleason 7 disease was diagnosed in 23% of patients in 2003, 32% in 2007 and 49% in 2011 ( p<0.001). There was an increase in Gleason 8 disease; 6% (2003) to 8.6% (2011), but this was not significant ( p=0.27). Increase in clinical stage was also noted over time; identification of T3 disease rose from 2% (2003 and 2007) to 5% (2011) ( p=0.045) (excluding cases with non-recorded stage). Conclusion: Prostate cancer management in the North West of England has evolved over the last decade, with overall improvements in management quality. We have demonstrated an increase in the presenting stage and grade of prostate cancer over a 10-year period.
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Affiliation(s)
- R Turo
- Department of Urology, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, UK
| | - S Bromage
- Department of Urology, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, UK
| | - M Smolski
- Department of Urology, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, UK
| | - H Thygesen
- Section of Experimental Oncology, Leeds Institute of Cancer Studies and Pathology, St James’s University Hospital, UK
| | - P Cleaveland
- Department of Urology, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, UK
| | - R Esler
- Department of Urology, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, UK
| | - S Hartley
- Department of Urology, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, UK
| | - A Thompson
- Department of Urology, Wrightington, Wigan and Leigh NHS Foundation Trust, Royal Albert Edward Infirmary, Wigan, UK
| | - A Adeyoju
- Department of Urology, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, UK
| | - SCW Brown
- Department of Urology, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, UK
| | - R Brough
- Department of Urology, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, UK
| | - N Oakley
- Department of Urology, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, UK
| | - A Sinclair
- Department of Urology, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, UK
| | - GN Collins
- Department of Urology, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, UK
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Smolski M, Turo R, Whiteside S, Bromage S, Collins GN. Prevalence of prostatic calcification subtypes and association with prostate cancer. Urology 2015; 85:178-81. [PMID: 25530382 DOI: 10.1016/j.urology.2014.09.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 09/14/2014] [Accepted: 09/19/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the prevalence and to classify prostatic calcification on transrectal ultrasonography (TRUS) and correlate the findings with histology. METHODS A prospective, blinded study of men undergoing TRUS and prostatic biopsy was designed. A standardized reproducible technique was used with a BK 7.5- to 12.5-MHz multiplanar probe. Representative images of the calcification in the sagittal and transverse planes were captured. Blind analysis by an experienced observer was performed. TRUS findings were categorized using a novel classification and correlated with histologic data. RESULTS A total of 274 patients (58.8%) had prostate cancer, 88 patients (18.9%) inflammation, and 104 patients (22.3%) had benign pathology. Interface calcification was present in 42.3% of patients. Peripheral or transitional zone calcification was unusual (6.8% and 9.0%, respectively). Of the peripheral zone calcification group patients, 78.1% had cancer on histology examination (P = .020). CONCLUSION Prevalence and characteristics of prostatic calcification have been described using this novel and practical classification. Although interface calcification is common and not associated with any particular pathology, peripheral zone calcification appears to be strongly associated with prostate cancer.
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Affiliation(s)
- Michal Smolski
- Department of Urology, Stepping Hill Hospital, Stockport, United Kingdom.
| | - Rafal Turo
- Department of Urology, Stepping Hill Hospital, Stockport, United Kingdom
| | - Sigrid Whiteside
- Medical Statistic Department, The University of Manchester, Wythenshave Hospital, Manchester, United Kingdom
| | - Stephen Bromage
- Department of Urology, Stepping Hill Hospital, Stockport, United Kingdom
| | - Gerald N Collins
- Department of Urology, Stepping Hill Hospital, Stockport, United Kingdom
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Turo R, Derbyshire LF, Smolski M, Collins GN, Lynch N, Lewinski M, Brough RJ, Sinclair AM. Embryology and adult urology - Not always mutually exclusive: A case report on true hermaphroditism at an adult urology clinic. Can Urol Assoc J 2014; 8:E650-3. [PMID: 25295140 DOI: 10.5489/cuaj.2035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
True hermaphrodite (TH) is one of the rarest varieties of disorders of sexual differentiation. Most patients present early in the life and are managed by pediatricians. We present a rare case of an adult TH which was first diagnosed by a urologist. We discuss the pathology of TH and its clinical relevance. Knowledge and awareness of embryology are vital to all specialties.
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Affiliation(s)
- Rafal Turo
- Urology Department, St. James's University Hospital, Leeds, West Yorkshire, United Kingdom
| | | | - Michal Smolski
- Urology Department, Stepping Hill Hospital, Stockport, Cheshire
| | | | - Niall Lynch
- Radiology Department, Stepping Hill Hospital, Stockport, Cheshire
| | - Maryna Lewinski
- Radiology Department, Stepping Hill Hospital, Stockport, Cheshire
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Turo R, Smolski M, Hatimy U, Bromage SJ, Brown SCW, Brough R, Collins GN. A rare case of testicular metastasis of bladder transitional cell carcinoma. Can Urol Assoc J 2014; 8:E181-3. [PMID: 24678361 DOI: 10.5489/cuaj.1690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Metastases from bladder transitional cell carcinoma (TCC) to the testis are very rare. These are usually found on autopsy and occur in advanced or metastatic bladder cancers. More common, known primary tumors that metastasize to the testis include prostate, lungs, melanoma, gastro-intestinal tract and the kidney. We report a rare case of solitary and synchronous metastatic TCC of the bladder to the testis, discovered on histological examination. This case illustrates that metastatic neoplasm to uncommon sites should be considered in the differential diagnosis for patients with a history of advanced bladder TCC.
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Affiliation(s)
- Rafal Turo
- Department of Urology, Stepping Hill Hospital, United Kingdom
| | - Michal Smolski
- Department of Urology, Stepping Hill Hospital, United Kingdom
| | - Umi Hatimy
- Department of Histopathology, Stepping Hill Hospital, United Kingdom
| | | | | | - Richard Brough
- Department of Urology, Stepping Hill Hospital, United Kingdom
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Turo R, Smolski M, Kujawa M, Brown SCW, Brough R, Collins GN. Acute urinary retention in women due to urethral calculi: A rare case. Can Urol Assoc J 2014; 8:E99-E100. [PMID: 24554984 DOI: 10.5489/cuaj.1573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We present a case of a 51-year-old woman with acute urinary retention caused by a urethral calculus. Urethral calculi in women are extremely rare and are usually formed in association with underlying genitourinary pathology. In this case, however, no pathology was detected via thorough urological evaluation. We discuss the pathogenesis, clinical presentation and treatment of urethral calculi. To our knowledge, this is the second reported case of a primary urethral calculus in a female with an anatomically normal urinary tract and the first in a middle-aged Caucasian female.
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Affiliation(s)
- Rafal Turo
- Department of Urology, Stepping Hill Hospital, United Kingdom
| | - Michal Smolski
- Department of Urology, Stepping Hill Hospital, United Kingdom
| | - Magda Kujawa
- Department of Urology, Stepping Hill Hospital, United Kingdom
| | | | - Richard Brough
- Department of Urology, Stepping Hill Hospital, United Kingdom
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Turo R, Smolski M, Esler R, Kujawa ML, Bromage SJ, Oakley N, Adeyoju A, Brown SCW, Brough R, Sinclair A, Collins GN. Diethylstilboestrol for the treatment of prostate cancer: past, present and future. Scand J Urol 2013; 48:4-14. [PMID: 24256023 DOI: 10.3109/21681805.2013.861508] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this review was to discuss the most recent data from current trials of diethylstilboestrol (DES) to identify its present role in advanced prostate cancer treatment as new hormonal therapies emerge. The most relevant clinical studies using DES in castration-refractory prostate cancer (CRPC) were identified from the literature. The safety, efficacy, outcomes and mechanisms of action are summarized. In the age of chemotherapy this review highlights the efficacy of oestrogen therapy in CRPC. The optimal point in the therapeutic pathway at which DES should be prescribed remains to be established.
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Affiliation(s)
- Rafal Turo
- Department of Urology, Stepping Hill Hospital, Stockport NHS Foundation Trust , Stockport , UK
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Abstract
The role of a bladder neck sparing (BNS) technique in radical prostatectomy (RP) remains controversial. The potential advantages of improved functional recovery must be weighed against oncological outcomes. We performed a literature review to evaluate the current knowledge regarding oncological and functional outcomes of BNS and bladder neck reconstruction (BNr) in RP. A systematic literature review using on-line medical databases was performed. A total of 33 papers were identified evaluating the use of BNS in open, laparoscopic and robotic-assisted RP. The majority were retrospective case series, with only one prospective, randomised, blinded study identified. The majority of papers reported no significant difference in oncological outcomes using a BNS or BNr technique, regardless of the surgical technique employed. Quoted positive surgical margin rates ranged from 6% to 32%. Early urinary continence (UC) rates were ranged from 36% to 100% at 1 month, with long-term UC rate reported at 84-100% at 12 months if the bladder neck (BN) was spared. BNS has been shown to improve early return of UC and long-term UC without compromising oncological outcomes. Anastomotic stricture rate is also lower when using a BNS technique.
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Affiliation(s)
- Michal Smolski
- Department of Urology, Stepping Hill Hospital, Stockport, UK
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Smolski M, Cocks S, Venkateshan S, Collins G. MP-03.23 Prevalence and Classification of Prostatic Calcification and Correlation with Histology and Other Parameters. Urology 2011. [DOI: 10.1016/j.urology.2011.07.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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