Jaspal S Virdi

The Princess Alexandra Hospital NHS Trust | PAH · Department of Urology

Aims Focal therapy treats individual areas of tumour in non-metastatic prostate cancer in patients unsuitable for active surveillance. The aim of this work was to evaluate the cost-effectiveness of focal therapy versus prostatectomy and external beam radiotherapy (EBRT). Materials and methods A Markov cohort health state transition model with four...

Objectives To externally validate a published model predicting failure within 2 years after salvage focal ablation in men with localised radiorecurrent prostate cancer using a prospective, UK multicentre dataset. Patients and methods Patients with biopsy‐confirmed ≤T3bN0M0 cancer after previous external beam radiotherapy or brachytherapy were incl...

Purpose: In older patients who do not wish to undergo watchful waiting, focal therapy could be an alternative to the more morbid radical treatment. We evaluated the role of focal therapy (FT) in patients 70 years and older as an alternative management modality. Materials and methods: 649 patients across 11 UK sites receiving focal high intensity...

Background Recurrent prostate cancer after radiotherapy occurs in one in five patients. The efficacy of prostate magnetic resonance imaging (MRI) in recurrent cancer has not been established. Furthermore, high-quality data on new minimally invasive salvage focal ablative treatments are needed. Objective To evaluate the role of prostate MRI in dete...

Background Focal therapy aims to treat areas of cancer to confer oncological control whilst reducing treatment-related functional detriment. Objective To report oncological outcomes and adverse events following focal high-intensity focused ultrasound (HIFU) for treating nonmetastatic prostate cancer. Design, setting, and participants An analysis...

Background For localised prostate cancer, focal therapy offers an organ-sparing alternative to radical treatments (radiotherapy or prostatectomy). Currently, there is no randomised comparative effectiveness data evaluating cancer control of both strategies. Methods Following the eligibility criteria PSA < 20 ng/mL, Gleason score ≤ 7 and T-stage ≤...

Focal therapy (FT) ablates areas of prostate cancer rather than treating the whole gland. We compared oncological outcomes of FT to radical prostatectomy (RP). Using prospective multicentre databases of 761 FT and 572 RP cases (November/2005-September/2018), patients with PSA < 20 ng/ml, Gleason </= 4 + 3 and stage </= T2c were 1–1 propensity score...

Objective To compare cancer control in anterior compared to posterior prostate cancer lesions treated with a focal HIFU therapy approach.Materials and methodsIn a prospectively maintained national database, 598 patients underwent focal HIFU (Sonablate®500) (March/2007–November/2016). Follow-up occurred with 3-monthly clinic visits and PSA testing i...

5582 Background: Patients that have previously failed radiotherapy for prostate cancer is usually limited to systemic therapy due to morbidity from salvage prostatectomy. We reviewed the outcomes following focal salvage ablative therapy with HIFU or cryotherapy within the UK’s HEAT and ICE registries. Methods: 356 consecutive patients underwent foc...

Objective: Analysis of treatment success regarding oncological recurrence rate between standard and dose escalation focal high-intensity focused ultrasound (HIFU) of prostate cancer. Materials and Methods: In this analysis of our prospectively maintained HIFU (Sonablate® 500) database, 598 patients were identified who underwent a focal HIFU (Sonab...

Objectives To assess change in functional outcomes after a second focal high‐intensity focused ultrasonography (HIFU) treatment compared with outcomes after one focal HIFU treatment. Patients and Methods In this multicentre study (2005–2016), 821 men underwent focal HIFU for localized non‐metastatic prostate cancer. The patient‐reported outcome me...

Objective: To determine if PSA criteria following focal HIFU for the treatment of prostate cancer can diagnose treatment failure. Materials and methods: In a prospectively maintained national database, 598 patients underwent focal HIFU (Sonablate®500) (March/2007-November/2016). Follow-up occurred with 3-monthly clinic visits and PSA testing in...

Background: The oncological outcomes in men with clinically significant prostate cancer following focal cryotherapy are promising, although functional outcomes are under-reported. Objective: To determine the impact of focal cryotherapy on urinary and sexual function, specifically assessing return to baseline function. Design, setting, and parti...

Background: Clinically significant nonmetastatic prostate cancer (PCa) is currently treated using whole-gland therapy. This approach is effective but can have urinary, sexual, and rectal side effects. Objective: To report on 5-yr PCa control following focal high-intensity focused ultrasound (HIFU) therapy to treat individual areas of cancer with...

Background Multiparametric magnetic resonance imaging (MRI), with or without targeted biopsy, is an alternative to standard transrectal ultrasonography–guided biopsy for prostate-cancer detection in men with a raised prostate-specific antigen level who have not undergone biopsy. However, comparative evidence is limited. Methods In a multicenter, r...

Background Multiparametric magnetic resonance imaging (MRI), with or without targeted biopsy, is an alternative to standard transrectal ultrasonography-guided biopsy for prostate-cancer detection in men with a raised prostate-specific antigen level who have not undergone biopsy. However, comparative evidence is limited. Methods In a multicenter, ra...

Objectives To evaluate diagnostic accuracy of mpMRI in a non-academic hospital using transperineal template prostate mapping (TPM) biopsy as a reference standard. Secondary objectives included evaluating why mpMRI missed significant cancer. Materials and methods 101 men received pre-biopsy mpMRI and TPM-biopsy over 16 months. Disease status was as...

Primary testicular tumour is unusual in elderly population. We present a case of 74 year old with adult type granulosa cell tumour, located at the right testis. The patient had right radical inquinal orchiectomy. The tumour composed of a cystic component which had a number of different areas. Many areas showed a granulosa cell morphology with Call-...

Anejaculation may occur as a result of neurological disease, iatrogenic injury or be drug induced. We report a case of a 66 year old man who presented with anejaculation following an emergency abdominal aortic aneurysm repair. Due to an elevated prostate specific antigen (PSA) level, the patient underwent a prostate biopsy and was diagnosed with a...

Cancer detection at repeat biopsy is significantly higher in patients who have inflammation on the initial biopsy U Mufti, KR Ghani, BS Potluri, J McKenzie & JS Virdi Department of Urology and Pathology, Princess Alexandra Hospital, Harlow, Essex Objective To analyse histological changes observed at repeat TRUS prostate biopsy for predictive fact...

Flexible cystoscopy is commonly performed under local anaesthesia. Instillation of lignocaine gel is commonly associated with urethral discomfort, which in some cases results in fierce opposition to further flexible cystoscopy under local anaesthesia. Although studies have demonstrated that the temperature of lignocaine can influence the level of d...

Introduction: A comparative prospective three-arm study was conducted to evaluate the efficacy and safety of interstitial energies (diode laser 830 nm vs. radiofrequency 460 kHz) to produce coagulation necrosis of prostatic adenoma against standard TURP. Patients and methods: From January 1997 to July 1997, 80 patients entered the study (mean age 6...

Introduction: The aim of the study was to evaluate the longterm efficacy of laser ablation of the prostate (using a freebeam technique) and its associated morbidity. Patients and methods: Between November 1992 and November 1995. a prospective study of 170 patients with symptomatic BPH (mean age 64.9 years, range 51-87) was conducted. Before startin...

Introduction: Transurethral needle ablation of the prostate (TUNA) is used to deliver low-level radiofrequency through a catheter device equipped with adjustable needles placed in selected prostatic tissue areas. TUNA ablation produces necrosis by heating tissue to 110 °C. The objectives of this study were to determine the clinical efficacy of TUNA...

Although stone formers are advised to maintain a dilute urine at all times, it is difficult to know if their urine is sufficiently dilute. Urimho (Gyrus Medical Ltd) is a hand-held portable device enabling patients to self-monitor urinary conductivity.

A nonrandomized pilot study was done of 139 patients with symptomatic benign prostatic hyperplasia treated with 3 prostatic heating devices. Of the patients 19 underwent transrectal hyperthermia with the Biodan Prostathermer and in 15 the Primus Prostate Machine was used. At 2 1/2 years 7 of 19 patients (37%) patients in the Prostathermer group and...

A scheme for the chemical microanalysis of renal stone fragments recovered from urine voided immediately after lithotripsy has been developed and evaluated. The analytical procedure includes assay of calcium, magnesium, phosphate, oxalate and urate and has been applied to 78 such urine samples. Problems relating to co-existing crystalluria and bloo...

A series of 108 renal tumour nephrectomies carried out between 1975 and 1984 was studied to determine the prognostic statistical significance of the relationship between venous involvement and various pathological features. Tumour size, spread, histological grade and lymph node involvement were compared between V0 tumours (58%), V1 (32%) and V2 tum...

The records of 111 patients with multiple superficial grade 1-2 transitional cell tumours of the bladder treated with intravesical Epodyl and followed up for a mean period of 6.4 years were retrospectively analysed. The study showed that 65% of patients responded completely after 12 weekly instillations and 46% of these remained continuously free o...

Intravesical balloon distention was used in 8 patients to stop intractable hemorrhage after radiotherapy for carcinoma of bladder. We recommend this method of treatment only in patients with no evidence of recurrent or residual invasive tumor in the bladder, where the source of bleeding is from superficial submucosal telangiectatic vessels.

Natural history of 'solitary', histological grade 1, stage Ta-T1 transitional cell carcinoma of the bladder was studied in 198 patients retrospectively over a period from 1975 to 1987. Three patterns of tumour behaviour were evident. In 56% of patients the tumour did not recur following the initial resection. Twenty-one percent developed recurrence...

Four patients with transitional cell tumour of the renal pelvis and ureter who had atypical presentations are described. The associated presenting problem delayed an earlier diagnosis in two patients and facilitated it in the other two.

This is a prospective study of first two hundred consecutive cases of TUR-P, computerised and reviewed. So far, not even a single 'open' prostatectomy has been carried out at this centre. Indications for prostatectomy were acute urinary retention (100 patients), chronic urinary retention (9 patients) and disabling prostatic symptoms (91 patients)....