Publications by authors named "Niall O"

3 Publications

  • Page 1 of 1

The dilemma of distance: patients with kidney cancer from regional Australia present at a more advanced stage.

BJU Int 2014 Mar;113 Suppl 2:57-63

Department of Urology, St Vincent's Hospital, Melbourne, Australia.

Objective: To determine whether patients from regional areas undergoing surgery for kidney cancer present with more advanced disease as a result of geographic isolation.

Patients And Methods: Retrospective analysis of 221 patients undergoing surgery for renal cell carcinoma (RCC) from January 2004 to June 2012, from both a metropolitan centre and a large inner regional hospital. Data was collected on age, gender, presentation (incidental or symptomatic), clinical stage and pathological features. The Australian Standard Geographical Classification-Remoteness Area (ASGC-RA) is a system developed to allow quantitative comparisons between metropolitan and rural Australia. A score was assigned to each patient based on their location of residence at the time of surgery: metropolitan, RA1; inner regional, RA2; outer regional, RA3. Statistical significance was specified as P < 0.05 on Pearson's chi-square tests.

Results: Patients in each ASGC-RA group did not differ significantly in age, sex or mode of presentation. Pathological T stage on presentation increased with increasing ASGC-RA and thus distance from tertiary centres (P = 0.004). The proportion of patients with ≥T3 disease rose from 30% of RA1 to 73% of RA3 patients (P = 0.016) treated at our tertiary centre. Similarly, our regional centre had a larger proportion of patients presenting with ≥T3 disease from RA3 (31% vs 5%, P = 0.003). When the 221 patients with RCC were analysed as a group, clinical T stage was significantly associated with ASGC-RA (P < 0.001), symptomatic presentation (P < 0.001), N stage (P < 0.001), M stage (P < 0.001) and Fuhrman grade (P < 0.001).

Conclusions: Our data quantifies the detrimental effect of physical distance on the health outcomes of regional Australians with kidney cancer. Australia's unique geography and rural culture may preclude any attempts to centralise cancer care to specialised metropolitan units, as has occurred in other countries.
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March 2014

Isolated scalp nodule in patient with undiagnosed RCC.

ScientificWorldJournal 2006 May 17;6:2430-2. Epub 2006 May 17.

Department of Urology, The Northern Hospital, Victoria, Australia.

An unexpected diagnosis of metastatic RCC after excision biopsy of a skin nodule can bring uncertainty. A case of isolated scalp metastasis from undiagnosed RCC was noted and a review of the literature was undertaken to aid management. RCCs often present with distant disease involving multiple organ systems. Single metastasis to the scalp region without other organ involvement is uncommon. Cytoreductive nephrectomy and limited metastectomy offer survival advantage in physically fit patients with RCC.
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May 2006

A comparison of noncontrast computerized tomography with excretory urography in the assessment of acute flank pain.

J Urol 1999 Feb;161(2):534-7

Border Urology Clinic and Border Medical Imaging, Albury, New South Wales, Australia.

Purpose: We compare noncontrast enhanced computerized tomography (CT) and excretory urography (IVP) in the evaluation of acute flank pain.

Materials And Methods: A total of 40 consecutive patients presenting to the emergency department with acute flank pain were evaluated with noncontrast CT, films of the kidneys, ureters and bladder, and IVP. The patients were treated according to the clinical picture. All 40 sets of evaluations were later assessed randomly by an independent consultant radiologist for the presence, size and location of a stone, ureteral dilatation and secondary signs of ureteral obstruction.

Results: Of 40 patients 12 had no calculus and 28 had a calculus confirmed on removal or documented passage of a stone. Absence of a stone was based on clinical and radiological followup with clinical resolution. CT revealed all 28 calculi and no calculus in 11 of 12 patients with 100% sensitivity and 92% specificity. IVP demonstrated 18 calculi (64% sensitivity) and no calculus in 11 of 12 patients (92% specificity). Ureteral obstruction was seen in 28 of the 40 patients, and CT and IVP were equivalent in detection (100% sensitivity). Films of the kidneys, ureters and bladder alone demonstrated 15 of 28 stones (54% sensitivity).

Conclusions: Noncontrast CT is an accurate, safe, rapid technique to assess acute flank pain, and the evaluation of choice for patients who would otherwise require IVP for diagnosis.
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February 1999