The edition · Urology
After cystectomy with urinary diversion, women had about twice the fracture risk
A Swedish national cohort found more fractures after radical cystectomy, yet bone treatment was started no more often. Plus PSMA PET for PI-RADS 3 lesions, and a coated stent that encrusted less.
The edition in brief
A Swedish national register study of 2,908 patients after radical cystectomy with urinary diversion, compared with 13,669 matched referents, found more fractures after surgery: women had about twice the risk of femoral fracture (HR 1.97) and of any fracture (HR 2.06), and men a 51% higher risk of any fracture, yet bone-specific drug therapy was started no more often. In 66 men with an equivocal PI-RADS 3 lesion, PSMA PET-targeted biopsy found clinically significant cancer in 15% against 6% for MRI-targeted biopsy, and no cancers were missed among the 68% whose PSMA PET was negative; it is a small single-centre study. A two-centre randomised trial of 100 stone patients found a sulfonic acid-coated stent halved encrustation weight and lessened urinary symptoms. In a matched comparison, Hautmann and modified Studer neobladders had similar complications, though the Studer was associated with more outlet obstruction. The pearl covers water intoxication before uroflowmetry.
PSMA PET found more significant cancer than MRI-targeted biopsy in PI-RADS 3 lesions
Consider PSMA PET for selected PI-RADS 3 lesions, but do not yet skip biopsy on a negative scan alone.
A sulfonic acid-coated stent encrusted less and was better tolerated
Coated stents may cut encrustation and symptoms; meanwhile keep dwell times short and track removal dates.
Hautmann and Studer neobladders performed alike, apart from outlet obstruction
Choose the neobladder your team performs regularly, and look for outlet obstruction in Studer patients with retention.
Do not let a uroflow test cause water intoxication
Give a measured fluid instruction before uroflowmetry, and think of hyponatraemia in a confused waiting patient.
Fracture risk rose after cystectomy, but bone treatment did not
Assess fracture risk and check for acidosis and vitamin D deficiency after cystectomy with urinary diversion.
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