Pavlo Somov - Academia.edu (original) (raw)
Papers by Pavlo Somov
Journal of Pediatric Urology, Dec 1, 2016
European Urology Supplements, Apr 1, 2014
International Urology and Nephrology, Jan 21, 2016
To evaluate the accuracy of estimated glomerular filtration rate (eGFR) against the reference sta... more To evaluate the accuracy of estimated glomerular filtration rate (eGFR) against the reference standard of isotopic GFR (iGFR) in monitoring renal function during follow-up after cystectomy and urinary diversion. Patients who had undergone cystectomy and ileal conduit urinary diversion at two centres between August 2001 and August 2006 were identified. eGFR calculated using the MDRD formula was compared to (51)Cr EDTA measured iGFR values measured at similar time-points during follow-up. Six hundred and fourteen paired iGFR and eGFR results were analysed from 166 patients (18 % female, median age 70 years). There was a significant difference between paired iGFR and eGFR measurements (p < 0.0001) with a mean bias of +1.8 mls/min/1.73m(2) (SD 18.0) and a 95 % limit of agreement of -33.5 to 37.2 mls/min/1.73m(2). iGFR and eGFR values converged at a GFR of approximately 45 mls/min/1.73m(2). 70.6 % of patients experienced a loss of renal function greater than expected (>0.58 mls/min/1.73m(2)/year). In 22.4 % of these patients, a decline of greater than 10 % in iGFR occurred that was undetected by eGFR measurements, which overestimated GFR. There was no significant relationship between patient height, weight or body mass index and the accuracy of eGFR measurements. iGFR measurement is recommended following ileal conduit urinary diversion if early signs of renal function loss are to be detected. eGFR overestimates GFR in critically relevant ranges and fails to detect loss in a clinically significant proportion of patients.
Journal of Clinical Urology, 2013
Objective: To compare the clinical pathways of patients referred under the two-week rule (2WR) wi... more Objective: To compare the clinical pathways of patients referred under the two-week rule (2WR) with those referred in a standard manner and subsequently diagnosed as having urological cancer. Patients and methods: A retrospective case note review was undertaken of 209 patients coded as having urological cancer over a six-month period. Patients that were not referred through either pathway, who had no symptoms or signs suspicious of cancer or who did not have a newly-diagnosed cancer during this period were excluded. The dates of relevant clinical events within each patient pathway were recorded and compared (e.g. dates of referral, first clinic appointment, diagnosis and first treatment). Results: Of the 209 cases reviewed, 58 cases were excluded. Eighty-two cases were referred through the standard referral pathway and 69 by the 2WR. Overall, patients referred through the 2WR pathway were seen sooner, had their cancer diagnosed earlier and received treatment more quickly than those referred through the standard route. However, the delay between diagnosis and treatment was similar for both groups. Prostate cancer accounted for two thirds of diagnoses, with 54% of 2WR referrals having advanced disease and 66% of cases with localised disease being referred by the standard route. Conclusion: The 2WR accelerates all clinical event times but with little clinical advantage to the patient. The 2WR for suspected cancer should be abandoned in favour of retention of the existing 18-week standard for the commencement of treatment following referral.
Lower Urinary Tract Symptoms in Adults, 2019
The lower urinary tract (LUT) has two major organs, the bladder and the urethra, with complex str... more The lower urinary tract (LUT) has two major organs, the bladder and the urethra, with complex structures and physiological behaviour. They serve two key functions of urine storage and voiding, which require tight regulation from all levels of the nervous system. The behaviour of the LUT is driven by the task to handle the output from the kidneys, which is determined by the need of the body to balance water and salt, and to excrete toxins. This complexity makes the LUT vulnerable from a range of potential factors.
European Urology Supplements, 2019
Introduction: Donation after circulatory death (DCD) is the process by which organ donation occur... more Introduction: Donation after circulatory death (DCD) is the process by which organ donation occurs after death is declared by cardiorespiratory criteria, as distinct from patients who meet the neurologic criteria for donation after brainstem death (DBD). Organ donation in this circumstance poses ethical and technical challenges for both patients and doctors, but has the potential to be successful with careful donor and recipient selection. Methods: We performed a retrospective review of all kidney transplants after circulatory death in our centre from the beginning of the programme in 2011 to 2018, and compared this group to transplants from DBD donors during the same period. Results: From 2011-2018 we performed 62 kidney transplants from DCD donors. 37% of DCD transplants had delayed graft function, compared to 18% of DBD transplants (p = 0.002). Mean creatinine levels at 1 and 3 months post transplantation were 185 μmol/L and 146 μmol/L for DCD transplants, compared to 135 μmol/L (p < 0.0001) and 125 μmol/L (p = 0.03) for DBD transplants. At one year post transplant, mean creatinine level for DCD transplants was 124 μmol/L, compared to 119 μmol/L for DBD transplants (p = 0.29). There was no significant difference in graft survival or overall patient survival (p = 0.17) at 1 year. Conclusion: DCD transplants have higher rates of delayed graft function, but long-term outcomes are comparable with DBD transplants. Thus, donation after circulatory death has the potential to increase the number of organs available for transplant, and is a viable option with experienced ICU and transplant teams and newer developments in organ preservation.
Hypothesis / aims of study Over 16% of the adult population above 40 in Europe suffer from sympto... more Hypothesis / aims of study Over 16% of the adult population above 40 in Europe suffer from symptoms of overactive bladder (OAB). The first line therapy for OAB includes life style modification, bladder retraining and antimuscarinic pharmacotherapy. Although antimuscarinic treatment is effective and safe, few patients persist with treatment in the long-term: the reported discontinuation rate ranges from 68% to 88% at 6 months (1). Our patients are offered Botulinum toxin A (BTX-A) injection treatment only if maximum dose antimuscarinic treatment with at least two agents have failed and idiopathic detrusor overactivity (IDO) is confirmed on urodynamics. Although the effectiveness of intravesical BTX-A has been proven in several randomised placebo controlled trials (2), the overall number of patients who have undergone the procedure remains relatively low. We summarize our 5 years experience, so prospective patients may be informed of the effects and potential complications of intraves...
Journal of Clinical Urology, 2013
Objective: To compare the clinical pathways of patients referred under the two-week rule (2WR) wi... more Objective: To compare the clinical pathways of patients referred under the two-week rule (2WR) with those referred in a standard manner and subsequently diagnosed as having urological cancer. Patients and methods: A retrospective case note review was undertaken of 209 patients coded as having urological cancer over a six-month period. Patients that were not referred through either pathway, who had no symptoms or signs suspicious of cancer or who did not have a newly-diagnosed cancer during this period were excluded. The dates of relevant clinical events within each patient pathway were recorded and compared (e.g. dates of referral, first clinic appointment, diagnosis and first treatment). Results: Of the 209 cases reviewed, 58 cases were excluded. Eighty-two cases were referred through the standard referral pathway and 69 by the 2WR. Overall, patients referred through the 2WR pathway were seen sooner, had their cancer diagnosed earlier and received treatment more quickly than those ...
Journal of Clinical Oncology, 2016
396 Background: Cystectomy has become one of the standard forms of therapy for patients with musc... more 396 Background: Cystectomy has become one of the standard forms of therapy for patients with muscle invasive bladder cancer with long term follow-up data supporting radical surgical management. Methods: Data are collected retrospectively on patients who underwent cystectomy at the Royal Liverpool University Hospital. The aim was to document the overall survival of patients undergoing cystectomy at this centre. Results: Data were collected on 147 patients between September 2007 and June 2013. Median patient age was 66 (IQR: 61, 72) with 33 (23%) females. 107 (73%) patients had muscle invasive TCC, 13 (9%) had recurrent non-muscle invasice disease, 9 (6%) had salvage surgery following radical radiotherapy and 6 (4%) had persistent carcinoma in situ. 28 patients (20%) had hydronephrosis. 34 (23%) patients underwent neo-adjuvant chemotherapy. 2 (1%) patients had Combined synchronous urethrectomy and 5 (3%) had Combined synchronous nephroureterectomy. Post operatively positive lymph node...
Journal of Clinical Urology, 2013
Aims: To evaluate the medium and long-term results of abobotulinumtoxinA (aboBTX-A) injection tre... more Aims: To evaluate the medium and long-term results of abobotulinumtoxinA (aboBTX-A) injection treatment in the management of refractory overactive bladder (OAB) symptoms owing to idiopathic detrusor overactivity. Methods: Prospective data were collected from consecutive patients who underwent intravesical injection of 250 units of aboBTX-A under general anaesthetic for OAB symptoms that were refractory to antimuscarinic therapy. Overactive bladder symptom scores (OABSS), Likhart quality of life (QoL) indices and post-void residual volumes (PVR) were compared before and 6 weeks after treatment. The Wilcoxon Signed Ranks test was used to compare changes in OABSS, QoL and PVR from baseline scores. Results: Seventy-three patients received 93 aboBTX-A injection treatments over a 5-year period. Overall, OABSS and QoL improved by a mean of 3.7 + 4.17 ( p<0.001) and 2.1 + 2.06 ( p<0.001), respectively. An improvement in the combined OABSS and QoL scores of two or more points was obser...
European Journal of Cardio-Thoracic Surgery, 2010
Background: Both cancer patients and patients undergoing surgery are thought to be at an increase... more Background: Both cancer patients and patients undergoing surgery are thought to be at an increased risk of thrombo-embolic events. Consequently, low-molecular-weight heparin (LMWH) is administered to all such patients perioperatively. There is a lack of consensus in guidelines regarding the timing of administration and the dosage of thromboprophylactic agents. Studies have shown that thrombo-elastography (TEG) is a useful test in assessing global haemostatic function, and has been validated in monitoring the dosage of LMWH. In this study, we assess the coagulation status of patients undergoing thoracic surgery with TEG, and the effectiveness of administered LMWH for thromboprophylaxis. Methods: Thirty patients with primary lung cancer (LC) and 30 with benign lung disease (BL) were studied prospectively. Patients were randomised to receive subcutaneous LMWH 40 mg once or twice per day perioperatively. Their coagulation status was monitored with TEG preoperatively and postoperatively for 3 consecutive days. Results: Preoperative TEG parameters (k time, alpha angle and maximum amplitude (MA)) were within the normal range in both the LC and BL groups. Preoperative r time was prolonged in both the groups, but with no significant difference between the two groups (p > 0.05). Postoperatively, r time was prolonged in some patients receiving LMWH twice daily, suggesting a possible adequate thromboprophylaxis in these patients only. Conclusion: This study demonstrates that the majority of patients with LC are not hypercoagulable. We also showed that LMWH once or twice a day might not provide sufficient thromboprophylaxis. We advocate screening for patients demonstrating hypercoagulable states and ensuring adequate thromboprophylaxis in this group of patients with careful monitoring.
Journal of Pediatric Urology, Dec 1, 2016
European Urology Supplements, Apr 1, 2014
International Urology and Nephrology, Jan 21, 2016
To evaluate the accuracy of estimated glomerular filtration rate (eGFR) against the reference sta... more To evaluate the accuracy of estimated glomerular filtration rate (eGFR) against the reference standard of isotopic GFR (iGFR) in monitoring renal function during follow-up after cystectomy and urinary diversion. Patients who had undergone cystectomy and ileal conduit urinary diversion at two centres between August 2001 and August 2006 were identified. eGFR calculated using the MDRD formula was compared to (51)Cr EDTA measured iGFR values measured at similar time-points during follow-up. Six hundred and fourteen paired iGFR and eGFR results were analysed from 166 patients (18 % female, median age 70 years). There was a significant difference between paired iGFR and eGFR measurements (p < 0.0001) with a mean bias of +1.8 mls/min/1.73m(2) (SD 18.0) and a 95 % limit of agreement of -33.5 to 37.2 mls/min/1.73m(2). iGFR and eGFR values converged at a GFR of approximately 45 mls/min/1.73m(2). 70.6 % of patients experienced a loss of renal function greater than expected (>0.58 mls/min/1.73m(2)/year). In 22.4 % of these patients, a decline of greater than 10 % in iGFR occurred that was undetected by eGFR measurements, which overestimated GFR. There was no significant relationship between patient height, weight or body mass index and the accuracy of eGFR measurements. iGFR measurement is recommended following ileal conduit urinary diversion if early signs of renal function loss are to be detected. eGFR overestimates GFR in critically relevant ranges and fails to detect loss in a clinically significant proportion of patients.
Journal of Clinical Urology, 2013
Objective: To compare the clinical pathways of patients referred under the two-week rule (2WR) wi... more Objective: To compare the clinical pathways of patients referred under the two-week rule (2WR) with those referred in a standard manner and subsequently diagnosed as having urological cancer. Patients and methods: A retrospective case note review was undertaken of 209 patients coded as having urological cancer over a six-month period. Patients that were not referred through either pathway, who had no symptoms or signs suspicious of cancer or who did not have a newly-diagnosed cancer during this period were excluded. The dates of relevant clinical events within each patient pathway were recorded and compared (e.g. dates of referral, first clinic appointment, diagnosis and first treatment). Results: Of the 209 cases reviewed, 58 cases were excluded. Eighty-two cases were referred through the standard referral pathway and 69 by the 2WR. Overall, patients referred through the 2WR pathway were seen sooner, had their cancer diagnosed earlier and received treatment more quickly than those referred through the standard route. However, the delay between diagnosis and treatment was similar for both groups. Prostate cancer accounted for two thirds of diagnoses, with 54% of 2WR referrals having advanced disease and 66% of cases with localised disease being referred by the standard route. Conclusion: The 2WR accelerates all clinical event times but with little clinical advantage to the patient. The 2WR for suspected cancer should be abandoned in favour of retention of the existing 18-week standard for the commencement of treatment following referral.
Lower Urinary Tract Symptoms in Adults, 2019
The lower urinary tract (LUT) has two major organs, the bladder and the urethra, with complex str... more The lower urinary tract (LUT) has two major organs, the bladder and the urethra, with complex structures and physiological behaviour. They serve two key functions of urine storage and voiding, which require tight regulation from all levels of the nervous system. The behaviour of the LUT is driven by the task to handle the output from the kidneys, which is determined by the need of the body to balance water and salt, and to excrete toxins. This complexity makes the LUT vulnerable from a range of potential factors.
European Urology Supplements, 2019
Introduction: Donation after circulatory death (DCD) is the process by which organ donation occur... more Introduction: Donation after circulatory death (DCD) is the process by which organ donation occurs after death is declared by cardiorespiratory criteria, as distinct from patients who meet the neurologic criteria for donation after brainstem death (DBD). Organ donation in this circumstance poses ethical and technical challenges for both patients and doctors, but has the potential to be successful with careful donor and recipient selection. Methods: We performed a retrospective review of all kidney transplants after circulatory death in our centre from the beginning of the programme in 2011 to 2018, and compared this group to transplants from DBD donors during the same period. Results: From 2011-2018 we performed 62 kidney transplants from DCD donors. 37% of DCD transplants had delayed graft function, compared to 18% of DBD transplants (p = 0.002). Mean creatinine levels at 1 and 3 months post transplantation were 185 μmol/L and 146 μmol/L for DCD transplants, compared to 135 μmol/L (p < 0.0001) and 125 μmol/L (p = 0.03) for DBD transplants. At one year post transplant, mean creatinine level for DCD transplants was 124 μmol/L, compared to 119 μmol/L for DBD transplants (p = 0.29). There was no significant difference in graft survival or overall patient survival (p = 0.17) at 1 year. Conclusion: DCD transplants have higher rates of delayed graft function, but long-term outcomes are comparable with DBD transplants. Thus, donation after circulatory death has the potential to increase the number of organs available for transplant, and is a viable option with experienced ICU and transplant teams and newer developments in organ preservation.
Hypothesis / aims of study Over 16% of the adult population above 40 in Europe suffer from sympto... more Hypothesis / aims of study Over 16% of the adult population above 40 in Europe suffer from symptoms of overactive bladder (OAB). The first line therapy for OAB includes life style modification, bladder retraining and antimuscarinic pharmacotherapy. Although antimuscarinic treatment is effective and safe, few patients persist with treatment in the long-term: the reported discontinuation rate ranges from 68% to 88% at 6 months (1). Our patients are offered Botulinum toxin A (BTX-A) injection treatment only if maximum dose antimuscarinic treatment with at least two agents have failed and idiopathic detrusor overactivity (IDO) is confirmed on urodynamics. Although the effectiveness of intravesical BTX-A has been proven in several randomised placebo controlled trials (2), the overall number of patients who have undergone the procedure remains relatively low. We summarize our 5 years experience, so prospective patients may be informed of the effects and potential complications of intraves...
Journal of Clinical Urology, 2013
Objective: To compare the clinical pathways of patients referred under the two-week rule (2WR) wi... more Objective: To compare the clinical pathways of patients referred under the two-week rule (2WR) with those referred in a standard manner and subsequently diagnosed as having urological cancer. Patients and methods: A retrospective case note review was undertaken of 209 patients coded as having urological cancer over a six-month period. Patients that were not referred through either pathway, who had no symptoms or signs suspicious of cancer or who did not have a newly-diagnosed cancer during this period were excluded. The dates of relevant clinical events within each patient pathway were recorded and compared (e.g. dates of referral, first clinic appointment, diagnosis and first treatment). Results: Of the 209 cases reviewed, 58 cases were excluded. Eighty-two cases were referred through the standard referral pathway and 69 by the 2WR. Overall, patients referred through the 2WR pathway were seen sooner, had their cancer diagnosed earlier and received treatment more quickly than those ...
Journal of Clinical Oncology, 2016
396 Background: Cystectomy has become one of the standard forms of therapy for patients with musc... more 396 Background: Cystectomy has become one of the standard forms of therapy for patients with muscle invasive bladder cancer with long term follow-up data supporting radical surgical management. Methods: Data are collected retrospectively on patients who underwent cystectomy at the Royal Liverpool University Hospital. The aim was to document the overall survival of patients undergoing cystectomy at this centre. Results: Data were collected on 147 patients between September 2007 and June 2013. Median patient age was 66 (IQR: 61, 72) with 33 (23%) females. 107 (73%) patients had muscle invasive TCC, 13 (9%) had recurrent non-muscle invasice disease, 9 (6%) had salvage surgery following radical radiotherapy and 6 (4%) had persistent carcinoma in situ. 28 patients (20%) had hydronephrosis. 34 (23%) patients underwent neo-adjuvant chemotherapy. 2 (1%) patients had Combined synchronous urethrectomy and 5 (3%) had Combined synchronous nephroureterectomy. Post operatively positive lymph node...
Journal of Clinical Urology, 2013
Aims: To evaluate the medium and long-term results of abobotulinumtoxinA (aboBTX-A) injection tre... more Aims: To evaluate the medium and long-term results of abobotulinumtoxinA (aboBTX-A) injection treatment in the management of refractory overactive bladder (OAB) symptoms owing to idiopathic detrusor overactivity. Methods: Prospective data were collected from consecutive patients who underwent intravesical injection of 250 units of aboBTX-A under general anaesthetic for OAB symptoms that were refractory to antimuscarinic therapy. Overactive bladder symptom scores (OABSS), Likhart quality of life (QoL) indices and post-void residual volumes (PVR) were compared before and 6 weeks after treatment. The Wilcoxon Signed Ranks test was used to compare changes in OABSS, QoL and PVR from baseline scores. Results: Seventy-three patients received 93 aboBTX-A injection treatments over a 5-year period. Overall, OABSS and QoL improved by a mean of 3.7 + 4.17 ( p<0.001) and 2.1 + 2.06 ( p<0.001), respectively. An improvement in the combined OABSS and QoL scores of two or more points was obser...
European Journal of Cardio-Thoracic Surgery, 2010
Background: Both cancer patients and patients undergoing surgery are thought to be at an increase... more Background: Both cancer patients and patients undergoing surgery are thought to be at an increased risk of thrombo-embolic events. Consequently, low-molecular-weight heparin (LMWH) is administered to all such patients perioperatively. There is a lack of consensus in guidelines regarding the timing of administration and the dosage of thromboprophylactic agents. Studies have shown that thrombo-elastography (TEG) is a useful test in assessing global haemostatic function, and has been validated in monitoring the dosage of LMWH. In this study, we assess the coagulation status of patients undergoing thoracic surgery with TEG, and the effectiveness of administered LMWH for thromboprophylaxis. Methods: Thirty patients with primary lung cancer (LC) and 30 with benign lung disease (BL) were studied prospectively. Patients were randomised to receive subcutaneous LMWH 40 mg once or twice per day perioperatively. Their coagulation status was monitored with TEG preoperatively and postoperatively for 3 consecutive days. Results: Preoperative TEG parameters (k time, alpha angle and maximum amplitude (MA)) were within the normal range in both the LC and BL groups. Preoperative r time was prolonged in both the groups, but with no significant difference between the two groups (p > 0.05). Postoperatively, r time was prolonged in some patients receiving LMWH twice daily, suggesting a possible adequate thromboprophylaxis in these patients only. Conclusion: This study demonstrates that the majority of patients with LC are not hypercoagulable. We also showed that LMWH once or twice a day might not provide sufficient thromboprophylaxis. We advocate screening for patients demonstrating hypercoagulable states and ensuring adequate thromboprophylaxis in this group of patients with careful monitoring.