scholarly journals BladderScan Feedback Method in Predicting Bladder Filling for Prostate Radiotherapy: A Prospective Study

2021 ◽  
Vol 20 ◽  
pp. 153303382199527
Author(s):  
Deng-Yu Kuo ◽  
Chen-Yang Hsu ◽  
Wei-Chun Wang ◽  
Hsiu-Hsi Chen ◽  
Pei-Wei Shueng
Keyword(s):  
Prostate Cancer ◽  
Failure Rate ◽  
Conventional Method ◽  
Bladder Volume ◽  
Relative Reduction ◽  
Radiation Cystitis ◽  
Prostate Radiotherapy ◽  
Bladder Filling ◽  
Feedback Method ◽  
A Prospective Study

Purpose: Approximately 5%–10% of men who receive prostate cancer radiotherapy will suffer from radiation cystitis. Bladder filling before the administration of radiotherapy results in lower radiation exposure to the bladder. BladderScan, an ultrasound-based bladder volume scanner, has the potential to evaluate bladder volume during radiotherapy; thus, a prospective pilot study was initiated. Methods: Eleven men receiving tomotherapy for localized prostate cancer were enrolled. The validity of BladderScan was evaluated by comparing the measurements from BladderScan with the calculated volume from megavoltage computed tomography (MVCT). With a crossover design to compare different methods in bladder filling, the radiotherapy was divided into 2 sequences. Conventional method: the patient was asked to drink water after voiding urine. The amount of water and the duration of waiting were the same as in the setting of the simulation. BladderScan feedback method: the bladder filling procedure depended on the BladderScan measurements. Results: There were 314 sets of data from 11 patients. The correlation coefficient between VBS and VCT was 0.87, where VBS is the mean volume of 3 measurements by BladderScan and VCT is the bladder volume derived from MVCT. The BladderScan feedback method resulted in a significant larger bladder volume than the conventional method, with a mean difference of 36.9 mL. When the failure was defined as VCT <80% of planned volume, the BladderScan feedback method brought about a relative reduction in the failure rate with an odds ratio of 0.44 and an absolute reduction of 9.1%. Conclusion: The accuracy of BladderScan was validated by MVCT in our study. The BladderScan feedback method can help patients fill the bladder adequately, with a larger bladder volume and a lower failure rate.

Bladder filling during radiation therapy for prostate cancer treatment: Assessment via bladder ultrasound scanner.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 147-147
Author(s):  
Mark Raymond Waddle ◽  
Robin Landy ◽  
Karen Ryan ◽  
Katherine S. Tzou ◽  
William C Stross ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Older Patients ◽  
Radiation Treatment ◽  
Bladder Volume ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Bladder Filling ◽  
Full Bladder ◽  
Ct Simulation

147 Background: Prostate cancer patients treated with external beam radiation therapy are instructed to present daily with a full bladder to decrease small bowel and bladder toxicity and to increase reproducibility of treatment. However, older patients may have difficulty presenting with full bladders and variation of bladder volume with treatment is unknown. The objective of this study was to assess bladder filling at the time of radiation treatment (RT) using a bladder ultrasound in patients undergoing treatment for prostate cancer. Methods: Patients with prostate cancer were prospectively enrolled prior to CT simulation from January to August 2017. Bladder volume was recorded during CT simulation and daily immediately prior to RT. Patients were instructed to drink 8-12 ounces of water 30-60 minutes prior to RT. Three bladder volume measurements were recorded daily and averaged at the time of each treatment. Average bladder volume during treatment and the number of treatments with low bladder volumes ( < 50cc, < 60cc, and < 100cc) were reported using descriptive statistics. Results: A total of 13 patients completed a median of 42 days of RT during the study period, resulting in 550 daily bladder volumes. Ten patients were treated definitively and 3 with salvage radiation after prostatectomy. The median age of patients in the study was 72 years. Older patients were statistically more likely to present with low bladder volumes, with percentage of treatments with a bladder volume less than 50cc, 60cc, and 100cc being 29%, 42%, and 66% compared to only 4%, 7%, and 18% in patients aged < 70 (P < 0.01). The average bladder volume at the time of CT simulation was 176cc ± 57cc and the average volume during treatment was 140cc± 93cc, which was not statistically different (P = 0.28). The bladder volume did not significantly change over the course of treatment. Conclusions: Older patients (age 70+) with prostate cancer were more likely to present for RT with low bladder volumes in this prospective study. Our findings suggest that older patients should receive extra counseling about bladder filling and/or may require less bladder filling at the time of CT simulation to provide more accurate bowel dosimetry measurements.

Management of late events after conventional radical prostate radiotherapy: against the odds of secondary tumours and recurrence of prostate cancer

2021 ◽  
Vol 14 (8) ◽  
pp. e242640
Author(s):  
Rodriguez-Perez AR ◽  
Montero-Feijoo M ◽  
Blanco-de-Córdoba LA ◽  
Luna-Tirado J
Keyword(s):  
Prostate Cancer ◽  
Medical Care ◽  
Locally Advanced ◽  
Iliac Vein ◽  
Base Case ◽  
Ureterovesical Junction ◽  
Prostate Radiotherapy ◽  
Prostate Cancer Relapse ◽  
Anatomic Locations ◽  
Old Men

We present two 85-year-old men, with a similar history of prostate cancer treated more than 10 years ago with radiotherapy, who were in remission, but sought medical care at a time, due to alarm sign and symptoms. Case 2 resulted in a locally advanced secondary radiation-induced sarcoma of the penile base. Case 1 suffered from a round, 2 cm soft-tissue lesion with spiculated borders at the ureterovesical junction responsible for ipsilateral iliac vein compression and urinary obstruction without proven biochemical prostate cancer relapse, raising concerns about recurrence or secondary tumour. Both patients followed an oncological geriatric assessment and were ‘vulnerable’ at their presentation. Hence, we describe the effort to perform medical care adequacy regarding patient’s frailty and the anatomic locations within the prior radiation field. In case 2, we got a pathological diagnose and followed sequential multimodal treatments without success. But in case 1, minimal intervention resulted in improvement.

scholarly journals 1342. Clinical failure rates of amoxicillin for the treatment of acute otitis media in young children

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S682-S683
Author(s):  
Holly M Frost ◽  
Samuel Dominguez ◽  
Sarah Parker ◽  
Andrew Byars ◽  
Sara Michelson ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Otitis Media ◽  
Failure Rate ◽  
Acute Otitis Media ◽  
Relative Reduction ◽  
Failure Rates ◽  
Beta Lactamase ◽  
Clinical Failure ◽  
Recurrence Rates ◽  
Antibiotic Failure

Abstract Background Acute otitis media(AOM) is the most common indication for antibiotics in children. The primary pathogens that cause AOM have changed since the introduction of the pneumococcal conjugate vaccine(PCV). The clinical failure rate of amoxicillin for treatment of AOM post-PCV is unknown.We aimed to determine the clinical failure rate of amoxicillin for the treatment of uncomplicated AOM in children. Organisms identified on culture and amoxicillin treatment failure from nasopharyngeal specimens of children age 6-35 months with uncomplicated acute otitis media at Denver Health, Denver, CO from April 2019-March 2020. Methods Children age 6-35 months seen at Denver Health, Denver, CO with uncomplicated AOM and prescribed amoxicillin were prospectively enrolled. An interim analysis of patients enrolled from April 2019-March 2020 was completed. Patients completed surveys that included the AOM-SOS©(UPMC, Pittsburgh, PA) at enrollment, days 5, 14, and 30 and had chart abstraction completed. Treatment failure was defined as: (1) requiring a new antibiotic within 14 days; (2) AOM-SOS© score on day 5 or 14 not improved by a relative reduction of ≥ 55% from baseline. Recurrence was defined as requiring a new antibiotic within 15-30 days. Nasopharyngeal swabs were obtained and bacterial culture was completed. Results In total,110 patients were enrolled. Rates of treatment failure defined by AOM-SOS© were 28.4%(37; 95%CI:25.5-33.6%) at 5 days and 15.5%(27; 95%CI:17.5-24.5%) at 14 days. However, only 4.5%(5; 95%CI:2.0-4.5%) required a new antibiotic. Recurrence occurred in 5.5% (6, 95%CI:2.5-5.5%) of patients. Of patients who had not received antibiotics before enrollment(82), culture yielded no organism in 17.0%, one organism in 42.7%, and multiple organisms in 40.0% (Table). M.catarrhalis was the most frequently identified organism (53.7% of children). Of H.influenzae isolates 52.9% (9/17) produced beta-lactamase, resulting in no treatment failures or recurrences requiring a new antibiotic. Failure rates were similar between organisms. Conclusion Despite the change in otopathogen prevalence post-PCV, preliminary data suggest that while early subjective treatment failure was common, the 14 day treatment failure and 30 day recurrence rates was low when measured by need for a new antibiotic. Failure was low even among patients with organisms that would not be expected to be treated successfully with amoxicillin, such as those with beta-lactamase producing H.influenzae and M.catarrhalis. Disclosures Samuel Dominguez, MD, PhD, BioFire (Consultant, Research Grant or Support)

scholarly journals Ultrasound assessed a new method of needle insertion at an angle of 90°to the apex of the sacral hiatus for caudal block in newborns: a randomized controlled study

2019 ◽  
Author(s):  
Shangyingying Li ◽  
Yanzhe Tan ◽  
Fei Yang ◽  
Lifei Liu ◽  
Shengfen Tu
Keyword(s):  
Failure Rate ◽  
Conventional Method ◽  
Local Anesthetic ◽  
Needle Insertion ◽  
New Method ◽  
Controlled Study ◽  
Minimal Risk ◽  
Caudal Block ◽  
Sacral Hiatus ◽  
Method Group

Abstract Background Caudal block is widely used in paediatric anaesthetic practice. Many angles for needle insertion were compared to find a optimal angle during caudal block with high successful caudal injection and minimal risk of complications. The aim of this study is to evaluate the safety and effectivity of a new method of needle insertion at an angel of 90°to the apex of the sacral hiatus for caudal block in newborns. Methods Sixty patients were included in our study, aged 0 to 28 days, posted for inguinal hernia surgery, randomly divided into two groups: a conventional method (CM) group and a new method (NM) group. In both groups, 1 ml∙kg-1 0.5% lignocaine at a rate of approximately 0.5 ml∙s-1 was given for caudal blocks after anaesthesia, and ultrasonographic observation of local anesthetic in the epidural space. Failure rate at the first attempt, puncture frequency, complications, and durations of block were recorded. Results The failure rate at the first attempt of caudal block were 16.7% in the conventional method group and 3.3% in the new method group (p<0.05). The mean time required (standard deviation) to perform needle insertion in the conventional method group was 2.6±0.5 minutes and in new method group 1.6±0.5 minutes (p<0.05). There were three cases aspirating the needle to find blood and one case to find cerebrospinal fluid in the conventional method group. The majority level which the local anesthetic reached are L1 by ultrasound imaging, 86.7% in the conventional method group and 83.3% in the new method group. Conclusion The study found that using the new method, the chance of performing a successful caudal injection can be increased, the time and the risk can be minimized compared to conventional technique. It is a safe and effective method.

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