Sharjah: A 27-year-old Indian expatriate says she urgently needs around Dh100,000 to settle her dialysis bill.

Nikita Hari, whose kidneys have failed, said she also needs around Dh3,000 per week to continue the life-saving treatment.

Nikita, an executive at a shipping company, added she requires rectification of her neurogenic bladder and a kidney transplant.

The costs are too high for her and the family has appealed for financial support.

The transplant will cost around $70,000 (around Dh257,000) if a non-family donor is found and the procedure is done outside the UAE, her sister, Namrata, 22, said.

Namrata is willing to donate her kidney but Nikita said she first requires the bladder surgery.

Nikita added that she has no estimate yet for the rectification surgery as she has been unable to find a surgeon willing to take her case.

The Sharjah resident was born prematurely with a bladder that hadn’t developed fully and complications eventually led to renal failure.

The patient had her bladder expanded earlier but complications and infections caused her stressed kidneys to give out.

A kidney transplant was done seven years ago in the Philippines but she suffered renal failure again.

Nikita has been on dialysis three times a week for around a year and three months now.

She cannot drink more than 800ml of water a day as it would interfere with her dialysis.

“No one has really found a solution. They can’t guarantee what will be the outcome of the [bladder rectification] surgery. It’s risky,” Nikita said.

Namrata added: “Her doctor is looking for a way. They need to rectify the bladder so the pressure isn’t on the kidneys. We don’t want to go back to the same position again.”

Nikita said a transplant was bound to “fail within days” if the bladder issue isn’t sorted out first.

Meanwhile, the outstanding dialysis cost has soared to some Dh100,000. Her health-care provider has “not pressurised us” but “they’ve been asking” for settlement, Namrata said.

“It’s life-threatening for her if she misses even one session.”

Nikita, who was born and raised in the UAE, is on life-long medication, which is currently costing her Dh2,500 a month, she added.

Despite her dialysis appointments, she started working twice a week to supplement the family income. Her sister and father also work but the costs are too high for them.

“I get low blood pressure, I feel faint. I’m too tired on my dialysis days to do anything. Every day it’s a new problem,” Nikita said.

She also cannot drink more than a few glasses of water or any fluids a day.

“That’s hard for me because I used to be a waterholic. Now I feel very thirsty all the time.”

Still, the young woman daily distributes free water, juice and snacks to workers toiling in the sun.

“I know what it’s like not to drink water, especially in this part of the world,” Nikita said.

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NEW ORLEANS—Patients who undergo radical prostatectomy for high-risk prostate cancer (PCa) seldom receive adjuvant radiation therapy (ART), despite evidence that it is associated with better outcomes, researchers reported at the 2015 American Urological Association annual meeting.

In a study of 105,226 men who underwent radical prostatectomy and had high-risk PCa features found on final pathology, only 7,741 (7.4%) received ART, according to a research team at the University of Chicago Medical Center led by Charles U. Nottingham, MD. For the study, the investigators defined high-risk features as pT2 tumors with a positive surgical margin (PSM) or pT3 and pT4 tumors with or without a PSM. The study excluded patients with lymph node involvement and metastatic disease. They defined ART as receipt of radiation therapy within 6 months of surgery.

Younger age was among the significant predictors of ART receipt. Compared with patients younger than 65 years, those aged 65–75 and older than 75 years were 24% and 51% less likely to receive ART. Other patient factors that significantly predicted receipt of ART included residing within the zip code of the treatment facility, surgery at a low-volume facility (50 cases or fewer per year), private insurance, a preoperative PSA level of 10 ng/mL or higher, a Gleason score of 7–10 at prostatectomy, and pT3 and pT4 cancers regardless of margin status.

Compared with patients who had surgery at a facility in their zip code, patients who had surgery at a facility 61–120 miles and more than 120 miles away were 59% and 69% less likely to receive ART.

Compared with patients who had surgery at a facility that treats 50 or fewer prostatectomy cases per year (first quartile), those who had surgery at facilities in the second, third, and fourth quartiles were 43%, 58%, and 67% less likely to receive ART. The lower use of ART at higher-volume centers may reflect a propensity to perform surveillance on high-risk patients and preferential treatment with salvage radiation therapy, Dr. Nottingham's team concluded.

Privately insured patients were 24% more likely to receive ART than uninsured patients. Patients with a preoperative PSA level of 10–20 and more than 20 ng/mL were 17% and 49% more likely to receive ART than those with a PSA level below 10 ng/mL. Patients with a Gleason score of 7 and 8–10 were 1.8 and 4.7 times more likely to receive ART than those with a Gleason score of 6. Patients with pT3 or pT4 tumors with a negative surgical margin and those with pT3 or pT4 tumors with a PSM were 1.3 and 3.9 times more likely to undergo ART than patients with pT2 tumors with a PSM.

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NEW ORLEANS—Active surveillance (AS) is widely used by community-based urologists to manage newly diagnosed localized prostate cancer (PCa), according to the findings of a study presented at the American Urological Association annual meeting.

In a retrospective investigation involving a chart review of 1,401 PCa patients treated in 8 large urology practices from January 2013 to March 2014, AS was the primary management strategy for 71% and 40% of patients with very-low-risk and low-risk disease, respectively, as defined by National Comprehensive Cancer Network (NCCN) criteria. Urologists placed 8% of patients with intermediate-risk disease on AS. The use of surgery and radiation was equivalent by risk group.

The study, which was conducted by the Large Urology Group Practice Association Benchmarking Committee, also showed that AS use varied by age group in a manner consistent with recommended principles of care. It was used in 23.2% of patients aged 55 years or less, 28.4% of those aged 56–65 years, and 32.5% of those aged 66–75 years. Race did not predict AS use.

Further analysis showed that compared with patients who had very-low-risk disease, those with low- and intermediate-risk disease had a significant 72% and 97% decreased odds of being managed with AS. Compared with patients aged 55 years or less, those aged 66–75 years had a significant 2.5-fold increased odds of being placed on AS.

“We have analyzed a large contemporaneous cohort of newly diagnosed prostate cancer patients, and found that community-based urologists practicing in large integrated groups have been quick to adopt evidence-based recommendations for management of lower-risk prostate cancer patients,” said lead investigator Jeremy Shelton, MD, MSHS, of Skyline Urology in Los Angeles. “Our data demonstrate that in a geographically diverse cohort of community urologists, the adoption rate of active surveillance as the initial treatment choice appears to be higher than in previously reported studies. However, there is variation between some practices, pointing to an opportunity for enhanced educational initiatives and ongoing quality improvement efforts.”

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NEW ORLEANS—Current and former smokers may be at increased risk of adverse perioperative outcomes following radical prostatectomy and cystectomy compared with non-smokers, according to study data presented at the 2015 American Urological Association annual meeting.

The study, led by Akshay Sood, MD, of the Vattikuti Urology Institute, Henry Ford Hospital, Detroit, examined 30-day post-surgical morbidity and mortality in a cohort of 9,014 patients who underwent radical prostatectomy (RP), radical cystectomy, or nephrectomy. Of the 5,835 RP patients, 720 radical cystectomy patients, and 2,259 nephrectomy patients, 12.5%, 26.6%, and 21.1%, respectively, were active smokers at the time of surgery. The proportions of former smokers—those who had not smoked for at least a year before surgery—were 20.9%, 29.8%, and 18.8%, respectively.

For the 3 surgery groups combined, the overall complication and readmission rates differed significantly among the current, former, and non-smokers. The complication rates were 14.9%, 13.5%, and 11.1%, respectively, and the readmission rates were 10.9%, 8.7%, and 7.2%, respectively.

In the RP group, current smokers had a significant 4.5-fold increased odds for pulmonary complications and 3-fold increased odds of renal complications compared with non-smokers. Former smokers were not at increased odds for 30-day complications compared with non-smokers, and they had significantly decreased odds compared with current smokers.

In the radical cystectomy group, current smokers had a significant 2.5-fold increased odds of re-intervention and former smokers had a significant 2-fold increased odds of readmission compared with non-smokers. Smoking status was not associated with 30-day outcomes in the nephrectomy group.

Smoking status did not significantly affect perioperative mortality rates.

“These findings suggest that smoking not only predisposes to development of cancers, but also adversely affects the outcomes following definitive surgical treatment of these conditions,” Dr. Sood told Renal & Urology News. “Patients planning to undergo elective urological oncological procedures may be better counseled using the data from this study. Smoking cessation would not only improve patient outcomes but would also reduce the burden of healthcare expenditure associated with these adverse events.”

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