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Objectives: The objectives of this study are to determine the predictors of success following extracorporeal shock-wave lithotripsy (ESWL) in a contemporary cohort at a high-volume stone center. Methods: We conducted a retrospective review all patients who underwent an elective ESWL within our institution over a 24-month period (January 2014 to December 2015). Data on patient demographics, stone variables, and inpatient treatment outcomes were evaluated. The presence of residual stone fragments larger than 4 mm on follow-up imaging was considered to be treatment failure. Using this threshold, clinically relevant variables between the treatment success and failure groups were identified. Multivariable logistic regression analyses (MVA) of clinically relevant variables were used to determine the independent factors predicting ESWL success. Results: Of 446 study eligible patients, 421 patients had complete follow-up data and were included in the analysis. Treatment was successful in 72.2% of patients in this study. Stone size, number of shocks delivered, and maximum treatment intensity were statistically different in the two groups. In a MVA where stone size, location, density, presence of ureteric stent, skin-stone distance (SSD), number of shocks, and maximum shock intensity were included, only stone size of <10 mm (odds ratio [OR] 3.4 [95% confidence interval [CI]: 1.98–5.84]) and SSD <15 cm (OR: 0.133, [95% CI: 0.027–0.65]) were the independent predictor of ESWL success. Conclusion: We have demonstrated "real world" outcomes with high-volume use of ESWL. In our experience that with diligent patient selection, ESWL remains an effective tool for the management of upper tract calculi. [ABSTRACT FROM AUTHOR]

Prostate cancer (PCa) has variable biological potential with multiple treatment options. A more personalized approach, therefore, is needed to better define men at higher risk of developing PCa, discriminate indolent from aggressive disease and improve risk stratification after treatment by predicting the likelihood of progression. This may improve clinical decision-making regarding management, improve selection for active surveillance protocols and minimize morbidity from treatment. Discovery of new biomarkers associated with prostate carcinogenesis present an opportunity to provide patients with novel genetic signatures to better understand their risk of developing PCa and help forecast their clinical course. In this review, we examine the current literature evaluating biomarkers in PCa. We also address current limitations and present several ideas for future studies., Competing Interests: Financial & competing interests disclosure The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript.

Aim: There are few published ERAS cost-analyses in colorectal surgery. The aim of this paper is to evaluate whether costs saved by reduced postoperative resource utilisation would offset the financial burden of setting up and maintaining such an ERAS programme., Methods: A cost-effectiveness analysis from a healthcare provider perspective using a case-control model. The study group consisted of patients enrolled in the ERAS program for elective colonic surgery at Manukau Surgical Centre between December 2005 and March 2007. The control group consisted of consecutive patients from September 2004 to September 2005 (before the start of ERAS). Groups were matched with respect to operation, BMI, ASA, and Cr-POSSUM score., Results: Data were available for 50 patients in each group. There was a significant reduction in total hospital stay, intravenous fluid use, and duration of epidural use in the ERAS group. There were significantly fewer complications in the ERAS group. Implementation of ERAS cost approximately $NZ102,000, but this has been more than offset by costs saved in reduced postoperative resource utilisation, with an overall cost-saving of approximately NZ$6900 per patient., Conclusion: Implementing an ERAS program is cost-effective in the medium term, with costs offset by those recovered by reduced resource utilisation in the postoperative period.

Introduction: Elective colorectal resection is associated with a postoperative stay (LOS) of 7-10 days. Counties Manukau District Health Board (DHB) has two sites for elective colorectal surgery: Manukau Surgery Centre (MSC)-a stand-alone elective surgical site; and Middlemore Hospital (MMH)-a general hospital. MSC opened in 2001 and it was noted that patients recovered more quickly there than patients operated on at MMH. It was thus our aim to identify if LOS following major elective colorectal surgery is influenced by hospital environment., Methods: 294 consecutive patients undergoing elective colorectal resection between January 2002 and October 2005 at the two facilities were analysed. Confounding factors (age, gender, race, duration of surgery, ASA grade, colonic vs rectal surgery, stoma/no stoma) were identified and corrected for using a multivariate Poisson log-linear regression model., Results: Patients who underwent surgery (colonic=227, rectal=67) at MMH (n=210, median length of stay 11 days) had a LOS 1.52 times longer (95%CI 1.28-1.81) than those who had their surgery at MSC (n=84, median length of stay 7 days). This figure was corrected for all other variables (p<0.0001)., Conclusion: Because MSC and MMH are both part of the same DHB, share the same surgeons, and service an identical population, it can be concluded that environmental differences are likely to be influential in the recovery process. However, further research is required to elucidate the significance of individual factors.