Effectiveness of Decision Aid in Men with Localized Prostate Cancer: a Multicenter Randomized Controlled Trial at Tertiary Referral Hospitals in an Asia Pacific Country

There are several treatment options for localized prostate cancer with very similar outcome but vary in terms of technique and side effect profiles and risks. Considering the potential difficulty in choosing the best treatment, a patient decision aid (PDA) is used to help patients in their decision-making process. However, the use and applicability of PDA in a country in Asia Pacific region like Malaysia is still unknown. This study aims to evaluate the effectiveness of a PDA modified to the local context in improving patients' knowledge, decisional conflict, and preparation for decision making among men with localized prostate cancer. Sixty patients with localized prostate cancer were randomly assigned to control and intervention groups. A self-administered questionnaire, which evaluate the knowledge on prostate cancer (23 items), decisional conflict (10 items) and preparation for decision-making (10 items), was given to all participants at pre- and post-intervention. Data were analyzed using independent T test and paired T test. The intervention group showed significant improvement in knowledge (p = 0.02) and decisional conflict (p = 0.01) from baseline. However, when compared between the control and intervention groups, there were no significant differences at baseline and post-intervention on knowledge, decisional conflict and preparation for decision-making. A PDA on treatment options of localized prostate cancer modified to the local context in an Asia Pacific country improved patients' knowledge and decisional conflict but did not have significant impact on the preparation for decision-making. The study was also registered under the Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12614000668606 registered on 25/06/2014.

Does alkalinised urine reduce the rate of encrustation in patients with ureteric stents? A randomised controlled study

PURPOSE

Stent encrustation is not uncommonly encountered with a high number of ureteric stents. The exact pathophysiology is not well understood. Therefore, we investigated the relationship between the use of sodium citrate and likelihood of stent encrustation.

METHODS

This prospective, randomised, intervention study was conducted between October 2018 and October 2019 in a tertiary hospital. Overall, 115 patients with ureteral stents that were inserted after lithotripsy surgeries were recruited. The study subjects were randomised into two groups: one group was administered sodium citrate (Utix sachets) three times per day until stent removal (intervention group), and the second group was not administered Utix sachets (control group). Stents were removed after 1 month and inspected under macroscopic visualisation from the proximal to distal end for any crystallisation; a second inspection was done with a 60 × magnification lens. Any crystallisation observed was considered to be encrustation.

RESULTS

Patients who had Utix sachets post-insertion of a ureteric stent constituted 50.4% of the study cohort. The rate of encrustation in the control group was 52.6%. In the intervention group, the rate of encrustation was 46.6%. The difference was not statistically significant with the chi-squared test (p value, 0.514).

CONCLUSION

Alkaline citrate medications had no significant effect on stent encrustation rate. More studies are needed to elucidate different agents and their roles in reducing stent encrustation as it incurs high morbidity.