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TOPIRAMATE AND THE RISK OF UROLITHIASIS

In summary, the 5% cut-off for TURP involvement is flawed: firstly, the method of pathological assessment is insufficiently rigorously defined and secondly, it overestimates the number of patients that require radical therapy. It seems self-evident that the simpler method of chip assessment should be used, although I would speculate that few clinicians are aware which method is in use on their diagnostic reports. The TNM classification is long overdue for revision. Although stratification into four groups to give detailed information on risk is attractive, for simplicity a simpler raising of the threshold to 10% chip involvement would be the more attractive option. While relatively few patients are diagnosed on TURP chippings in the current era, there remains a persistent minority of cases that require treatment decisions. Increased uniformity and revision of TNM classification will improve treatment decisions, and abolish a universally used cutoff, established 30 years ago on very flimsy evidence.