Publications by authors named "Steve McCombie"

15 Publications

  • Page 1 of 1

Spontaneous bleeding from an unusual renal mass: A case of gestational choriocarcinoma related to previous pregnancy over a decade earlier.

Urol Case Rep 2021 Jul 17;37:101614. Epub 2021 Mar 17.

Nepean Urology Research Group, Nepean Hospital, Kingswood, NSW, Australia.

Gestational choriocarcinoma is an uncommon trophoblastic malignancy, occurring in females after pregnancy, which is rarely encountered by urologists. It can be rapidly progressive, however metastases to other organs can occur after a prolonged latency period. We describe a rare case of solitary metastatic gestational choriocarcinoma presenting with spontaneous bleeding from a renal mass, over a decade after the associated pregnancy with a presumed sub-clinical primary tumour. This case demonstrates the importance of recognising gestational choriocarcinoma as a potential differential diagnosis of spontaneous bleeding renal mass in females of child-bearing age as a urologist given the often-aggressive nature of the disease.
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http://dx.doi.org/10.1016/j.eucr.2021.101614DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020421PMC
July 2021

Ten-year outcomes of the first 'one-stop haematuria clinic' in an Australian public hospital.

ANZ J Surg 2021 04 24;91(4):565-570. Epub 2020 Nov 24.

Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia.

Background: Urgent assessment of haematuria is critical to exclude malignancy. The utilization of haematuria clinics in Australia remains in its infancy. It is hoped that the streamlined investigative service will achieve earlier diagnosis of urological malignancy and subsequently decrease morbidity and mortality. We report the 10-year prospectively collected outcomes from Australia's first dedicated one-stop haematuria clinic (OSHC).

Methods: Since its commencement in May 2008 through to July 2018, all consecutive patients assessed in the OSHC were included in the analysis. Data collected included demographics, presentation, wait times, investigation, assessment, initial treatment, referral and histopathology.

Results: A total of 3008 patients were seen in the OSHC with non-visible haematuria (1024, 34%) and visible haematuria (1984, 66%). Three hundred and twenty-seven (10.9%) patients were diagnosed with urothelial malignancy. In all, 306 (10.2%) patients had lower tract disease and 21 (0.7%) had upper tract disease. Urothelial cases were compiled of 123 (37.6%) Ta LG, 39 (11.9%) Ta HG, 21 (6.4%) Tis, 67 (20.5%) T1 and 77 (23.6%) T2-4. Urothelial malignancy was diagnosed more often in males (odds ratio (OR) 1.74, 95% confidence interval (CI) 1.35-2.25), older patients elder than 60 years (OR 1.97, 95% CI 1.47-2.64) and patients with visible haematuria (OR 5.42, 95% CI 3.73-7.86). In all, 53.4% of patients were discharged after a single visit to the OSHC.

Conclusion: The OSHC has served as an effective tool for rapid, streamlined assessment of patients presenting with haematuria. This model of care has been subsequently adopted by numerous public centres across Australia. Current funding structures present a barrier to this excellent approach for rapid access diagnostics.
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http://dx.doi.org/10.1111/ans.16439DOI Listing
April 2021

'One Stop Prostate Clinic': prospective analysis of 1000 men attending a public same-day prostate cancer assessment and/or diagnostic clinic.

ANZ J Surg 2021 04 25;91(4):558-564. Epub 2020 Sep 25.

Urology Department, Fiona Stanley Hospital, Perth, Western Australia, Australia.

Background: This study reported the outcomes of the first 1000 men to attend the One Stop Prostate Clinic, a consultant-led same-day prostate cancer assessment and diagnostic clinic at a tertiary public hospital.

Methods: Prospective audit of demographic and clinical data between August 2011 and November 2017 was conducted for same-day urological assessment and/or trans-rectal ultrasound (TRUS)-guided prostate biopsies with peri-prostatic infiltration local anaesthetic (PILA) and antibiotic prophylaxis.

Results: A total of 466 (47%) rural and 534 (53%) metropolitan men attended. Rural mean (range) age was 63 years (38-86) and 65 years (37-89) for metro men (P = 0.006). Rural median (range) prostate specific antigen (PSA) level was 6.7 g/mL (0.2-450) and 7.3 ng/mL (0.5-860) for metro men (P = 0.011). Twenty-five men (2.5%) refused/could not tolerate TRUS-guided biopsy using PILA. One hundred and fifty-one (15%) men had multi-parametric magnetic resonance imaging prior to TRUS biopsy and 876 (88%) men had prostate biopsies, with a new cancer diagnostic rate of 51% (443 men). Clinically significant prostate cancer was detected in 339 (34%) men. The overall infective complication rate requiring hospital admission rose from 1.4% to 2.9% after the prophylactic antibiotic regimen changed from six doses of 500 mg ciprofloxacin to a single dose of 500 mg (P = 0.398).

Conclusion: This is the largest single institution prospective TRUS prostate biopsy series in Australasia. Biopsies using PILA were well tolerated with low complication rates and diagnosed a high rate of clinically significant prostate cancer. The 'One Stop' pathway generates efficiencies with combined assessment and diagnostic process, lessens demand on outpatient clinic appointments and reduces travel time and costs for rural men.
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http://dx.doi.org/10.1111/ans.16329DOI Listing
April 2021

Bladder infusion versus standard catheter removal for trial of void: a systematic review and meta-analysis.

World J Urol 2020 Aug 14. Epub 2020 Aug 14.

Nepean Urology Research Group, Nepean Hospital, Kingswood, NSW, 2747, Australia.

Purpose: To compare the efficacy and time-to-discharge of two methods of trial of void (TOV): bladder infusion versus standard catheter removal.

Methods: Electronic searches for randomized controlled trials (RCTs) comparing bladder infusion versus standard catheter removal were performed using multiple electronic databases from dates of inception to June 2020. Participants underwent TOV after acute urinary retention or postoperatively after intraoperative indwelling catheter (IDC) placement. Quality assessment and meta-analyses were performed, with odds ratio and mean time difference used as the outcome measures.

Results: Eight studies, comprising 977 patients, were included in the final analysis. Pooled meta-analysis demonstrated that successful TOV was significantly higher in the bladder infusion group compared to standard TOV (OR 2.41, 95% CI 1.53-3.8, p = 0.0005), without significant heterogeneity (I=19%). The bladder infusion group had a significantly shorter time-to-decision in comparison to standard TOV (weighted mean difference (WMD)-148.96 min, 95% CI - 242.29, - 55.63, p = 0.002) and shorter time-to-discharge (WMD - 89.68 min, 95% CI - 160.55, - 18.88, p = 0.01). There was no significant difference in complication rates between the two groups.

Conclusion: The bladder infusion technique of TOV may be associated with a significantly increased likelihood of successful TOV and reduced time to discharge compared to standard TOV practices.
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http://dx.doi.org/10.1007/s00345-020-03408-4DOI Listing
August 2020

Case of intermittent testicular torsion and de-torsion captured on scrotal ultrasound.

ANZ J Surg 2021 03 6;91(3):E135-E136. Epub 2020 Aug 6.

Nepean Urology Research Group, Nepean Hospital, Sydney, New South Wales, Australia.

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http://dx.doi.org/10.1111/ans.16161DOI Listing
March 2021

A prospective, matched comparison of ultra-low and standard-dose computed tomography for assessment of renal colic.

BJU Int 2020 09 23;126 Suppl 1:27-32. Epub 2020 Jun 23.

Nepean Urology Research Group, Kingswood, NSW, Australia.

Objective: To determine the diagnostic accuracy of ultra-low-dose computed tomography (ULDCT) compared with standard-dose CT (SDCT) in the evaluation of patients with clinically suspected renal colic, in addition to secondary features (hydroureteronephrosis, perinephric stranding) and additional pathological entities (renal masses).

Patients And Methods: A prospective, comparative cohort study was conducted amongst patients presenting to the emergency department with signs and symptoms suggestive of renal or ureteric colic. Patients underwent both SDCT and ULDCT. Single-blinded review of the image sets was performed independently by three board-certified radiologists.

Results: Among 21 patients, the effective radiation dose was lower for ULDCT [mean (SD) 1.02 (0.16) mSv] than SDCT [mean (SD) 4.97 (2.02) mSv]. Renal and/or ureteric calculi were detected in 57.1% (12/21) of patients. There were no significant differences in calculus detection and size estimation between ULDCT and SDCT. A higher concordance was observed for ureteric calculi (75%) than renal calculi (38%), mostly due to greater detection of calculi of <3 mm by SDCT. Clinically significant calculi (≥3 mm) were detected by ULDCT with high specificity (97.6%) and sensitivity (100%) compared to overall detection (specificity 91.2%, sensitivity 58.8%). ULDCT and SDCT were highly concordant for detection of secondary features, while ULDCT detected less renal cysts of <2 cm. Inter-observer agreement for the ureteric calculi detection was 93.9% for SDCT and 87.8% for ULDCT.

Conclusion: ULDCT performed similarly to SDCT for calculus detection and size estimation with reduced radiation exposure. Based on this and other studies, ULDCT should be considered as the first-line modality for evaluation of renal colic in routine practice.
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http://dx.doi.org/10.1111/bju.15116DOI Listing
September 2020

Metachronous ureteral metastasis of clear cell renal cell carcinoma in a duplex collecting system 1 year after nephrectomy.

Urol Case Rep 2020 Sep 16;32:101214. Epub 2020 Apr 16.

Nepean Urology Research Group, Nepean Hospital, PO Box 63, Penrith, NSW, 2751, Australia.

While renal cell carcinoma is known to metastasise in an unpredictable pattern, even after resection of a primary tumour, delayed ureteric metastasis is a very rarely reported phenomenon. In this case report, we describe a case of ipsilateral metachronous ureteric metastasis in a patient with a complete duplex collecting system. This case demonstrates some useful strategies in the diagnosis and treatment of renal cell carcinoma in this context. To our knowledge, this is the first case report of delayed ureteric metastasis of a renal clear cell carcinoma in a patient with a duplex collecting system.
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http://dx.doi.org/10.1016/j.eucr.2020.101214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184155PMC
September 2020

An inventive two-catheter technique to manage an extra-peritoneally ruptured and prolapsed bladder causing obstructive uropathy.

Urol Case Rep 2019 May 15;24:100874. Epub 2019 Mar 15.

Fiona Stanley Hospital Urology Department, Perth, WA, Australia.

An 84 year-old lady presented with extraperitoneal bladder rupture following a fall, in the setting of procidentia causing longstanding bilateral ureteric obstruction. Imaging demonstrated that while part of her bladder was in the pelvis, a large component was within the prolapse. After catheterising the pelvic portion, CT Cystogram confirmed decompression of the bladder in the pelvis, but on-going distension of the bladder in the prolapse. A second urethral catheter was placed in to the prolapsed portion of the bladder facilitating easy manual reduction of the prolapse. This reduction resolved the ureteric obstruction and was maintained with a pessary.
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http://dx.doi.org/10.1016/j.eucr.2019.100874DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6562317PMC
May 2019

Transrectal prostate biopsy sepsis rate following reduced quinolone antibiotic prophylaxis from six doses to single dose.

ANZ J Surg 2018 Jan 8. Epub 2018 Jan 8.

UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia.

Background: This study aimed to evaluate the rates of infective complication related to transrectal prostate biopsy (TRPB) as our centre changed its protocol from six doses over 3 days to a single pre-procedure prophylactic dose.

Methods: This prospective cohort study identified infective complication in patients who attended and subsequently underwent TRPB at the time of their one-stop prostate clinic at our public tertiary hospital between August 2011 and April 2017. Patients who underwent TRPB between August 2011 and November 2014 received six doses of 500 mg of ciprofloxacin, taken twice daily over 3 days. This protocol was changed to a single dose of 500 mg of ciprofloxacin prior to biopsy from February 2015 to April 2017. Patients who had travelled to South East Asia in the 6 months prior to TRPB received a single dose of 1 g intravenous ertapenem prior to biopsy, and this remained unchanged throughout the study period. The rates of infective complication were recorded and compared between the groups of patients who had undergone six doses versus a single dose of prophylactic ciprofloxacin.

Results: A total of 766 patients underwent TRPB from August 2011 to April 2017. Of these, 357 patients received the 3-day course of prophylaxis (Group 1) and 409 patients received the single dose prophylaxis (Group 2). Fifty-five patients were excluded from analysis. There was no significant difference in infective complications between the two groups (3.4% (11/326) Group 1 versus 4.9% (19/385) Group 2, P = 0.40).

Conclusion: Our study supports the use of a single dose of ciprofloxacin as sufficient antibiotic prophylaxis prior to TRPB.
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http://dx.doi.org/10.1111/ans.14360DOI Listing
January 2018

Delays in the diagnosis and initial treatment of bladder cancer in Western Australia.

BJU Int 2017 11 28;120 Suppl 3:28-34. Epub 2017 Jul 28.

Fiona Stanley Hospital, Murdoch, WA, Australia.

Objectives: To quantify and examine the causes of delays in the diagnosis and initial treatment of patients with bladder cancer in Western Australia.

Subjects And Methods: All attendances at a one-stop haematuria clinic at a public tertiary-level hospital in Western Australia between May 2008 and April 2014 were reviewed retrospectively. All patients diagnosed with a bladder tumour over this period were identified. These patients and their general practitioners were contacted retrospectively and invited to participate in telephone interviews, with additional data collected from clinical records as required. Waiting times to presentation, referral, assessment, and initial treatment were established for patients who presented with visible haematuria.

Results: Of 1 365 attendances, 151 patients were diagnosed with a bladder tumour and 100 of these were both suitable and agreed to participate in the study. For patients with visible haematuria the median (range) waiting time from initial bleeding to surgery was 69.5 (9-1 165) days. This was comprised of a median (range) pre-referral waiting time of 12 (0-1 137) days, assessment waiting time of 23.5 (0-207) days, and treatment waiting time of 20 (1-69) days. Reasons for prolonged waiting times included poor public awareness, patient fear and anxiety, delayed and non-referral from primary care, administrative delays, and resource limitations.

Conclusion: Many patients experience significant delays in the diagnosis and treatment of their bladder cancer in Western Australia, and this probably reflects national trends. These concerning data warrant consideration of how delays can be reduced to improve outcomes for these patients.
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http://dx.doi.org/10.1111/bju.13939DOI Listing
November 2017

BCG + Mitomycin trial for high-risk non-muscle-invasive bladder cancer: progress report and lessons learned.

BJU Int 2017 05;119 Suppl 5:55-57

Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia.

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http://dx.doi.org/10.1111/bju.13873DOI Listing
May 2017

Neobladder Obstruction: A Non-ischemic Cause for Hepatic Portal Venous Gas: Case Report.

Urol Case Rep 2017 May 9;12:31-33. Epub 2017 Mar 9.

Department of Urology, Fiona Stanley Hospital, Perth, Australia; School of Surgery, University of Western Australia, Perth, Australia.

Hepatic portal venous gas (HPVG) is a rare ominous radiological sign usually indicative of mesenteric ischemia. Increased detection of HPVG has been associated with a growing number of non-ischemic causes. A 64-year-old gentleman following radical cystectomy and neobladder formation developed clinical signs suggestive of bowel obstruction. HPVG was demonstrated on abdominal imaging. Urgent laparotomy revealed no evidence of ischemia. We hypothesize an obstructed neobladder permitted gas to enter the mesenteric circulation. The patient made a complete recovery with supportive management.
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http://dx.doi.org/10.1016/j.eucr.2017.02.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5345954PMC
May 2017

A 'One Stop' Prostate Clinic for rural and remote men: a report on the first 200 patients.

BJU Int 2015 Oct 27;116 Suppl 3:11-7. Epub 2015 Jul 27.

Fiona Stanley Hospital, Murdoch, Australia.

Objective: To report on the structure and outcomes of a new 'One Stop' Prostate Clinic (OSPC) designed specifically for rural and remote men.

Patients And Methods: Prospective cohort study of the first 200 rural or remote men to access a new OSPC at a public tertiary-level hospital in Western Australia between August 2011 and August 2014. Men attended for urological assessment, and proceeded to same-day transrectal ultrasonography-guided prostate biopsies, if appropriate. Referral criteria were either two abnormal age-related prostate-specific antigen (PSA) levels in the absence of urinary tract infection (UTI), or an abnormal digital rectal examination (DRE) regardless of PSA level.

Results: The median (range) distance travelled was 1545 (56-3229) km and median (range) time from referral to assessment was 33 (2-165) days. The median (range) age was 62 (38-85) years, PSA level was 6.7 (0.5-360) ng/mL and 39% (78/200) had a suspicious DRE. In all, 92% (184/200) of men proceeded to prostate biopsies, and 60% (111/184) of these men were diagnosed with prostate cancer. Our complication rate was 3.5% (6/172). Radical prostatectomy (46/111), active surveillance (28/111) and external beam radiation therapy (26/111) were the commonest subsequent treatment methods. A $1045 (Australian dollars) cost-saving per person was estimated based on the reduced need for travel with the OSPC model.

Conclusion: The OSPC is an effective and efficient model for assessing men suspected of having prostate cancer living in rural and remote areas of Western Australia, and this model may be applicable to other areas.
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http://dx.doi.org/10.1111/bju.13100DOI Listing
October 2015

BCG+MMC trial: adding mitomycin C to BCG as adjuvant intravesical therapy for high-risk, non-muscle-invasive bladder cancer: a randomised phase III trial (ANZUP 1301).

BMC Cancer 2015 May 27;15:432. Epub 2015 May 27.

Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, 1450, Australia.

Background: Despite adequate trans-urethral resection of the bladder tumour (TURBT), non-muscle-invasive bladder cancer (NMIBC) is associated with high rates of recurrence and progression. Instillation of Bacillus Calmette-Guérin (BCG) into the urinary bladder after TURBT (adjuvant intravesical administration) reduces the risk of both recurrence and progression, and this is therefore the standard of care for high-risk tumours. However, over 30 % of people still recur or progress despite optimal delivery of BCG. Our meta-analysis suggests that outcomes might be improved further by using an adjuvant intravesical regimen that includes both mitomycin and BCG. These promising findings require corroboration in a definitive, large scale, randomised phase III trial using standard techniques for intravesical administration.

Methods And Design: The BCG + MMC trial (ANZUP 1301) is an open-label, randomised, stratified, two-arm multi-centre phase III trial comparing the efficacy and safety of standard intravesical therapy (BCG alone) against experimental intravesical therapy (BCG and mitomycin) in the treatment of adults with resected, high-risk NMIBC. Participants in the control group receive standard treatment with induction (weekly BCG for six weeks) followed by maintenance (four-weekly BCG for ten months). Participants in the experimental group receive induction (BCG weeks 1, 2, 4, 5, 7, and 8; mitomycin weeks 3, 6, and 9) followed by four-weekly maintenance (mitomycin weeks 13, 17, 25, 29, 37, and 41; BCG weeks 21, 33, and 45). The trial aims to include 500 participants who will be centrally randomised to one of the two treatment groups in a 1:1 ratio stratified by T-stage, presence of CIS, and study site. The primary endpoint is disease-free survival; secondary endpoints are disease activity, time to recurrence, time to progression, safety, health-related quality of life, overall survival, feasibility, and resource use.

Trial Registration: This trial is registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12613000513718 ).
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http://dx.doi.org/10.1186/s12885-015-1431-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445809PMC
May 2015

The conservative management of renal trauma: a literature review and practical clinical guideline from Australia and New Zealand.

BJU Int 2014 Nov;114 Suppl 1:13-21

School of Surgery, University of Western Australia, Crawley, WA, Australia; Department of Urology, Fremantle Hospital, Fremantle, WA, Australia.

Objective: To review the literature and make practical recommendations regarding the conservative management of renal trauma.

Patients And Methods: Relevant articles and guidelines published between 1980 and 2014 were reviewed. Graded recommendations were constructed by a multi-disciplinary panel consisting of urologists, radiologists, and infectious disease physicians. These recommendations underwent formal review and debate at the Western Australian USANZ 2013 state conference, and were presented at the USANZ 2014 annual scientific meeting.

Results: The literature on the conservative management of renal trauma is reviewed within the framework of the American Association for the Surgery of Trauma (AAST) kidney injury severity scale. Graded recommendations are made regarding several key topics including: imaging, inpatient management, antibiotics, return to activity, and follow-up. Grade IV injuries and intraoperative consults are examined separately in view of the difficulties these groups cause in making appropriate treatment decisions.

Conclusion: A practical clinical guideline is provided regarding the conservative management of renal trauma.
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http://dx.doi.org/10.1111/bju.12902DOI Listing
November 2014