Tranexamic acid during radical cystectomy: a randomized clinical trial.

Croghan SM, O’Meara S, Cunnane EM, Purtill H, Walsh MT, O’Brien FJ et al.

Br J Surg 2024; 111: znae137.

Variable intrarenal pressure during endorenal (stone) surgery may affect renal function adversely. An automatic pressurized pump was compared with manual hand-pump irrigation in 38 patients. The automatic pump gave lower (mean 38 versus 62 mmHg, P=0.005) and more consistent intrarenal pressure, and a better view for the surgeon.

Comment: Machine beats human.

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Kimball AB, Jemec GBE, Sayed CJ, Kirby JS, Prens E, Ingram JR et al.

Lancet 2024;  403: 2504-2519.

These two RCTs included over 1000 patients randomized to different doses of bimekizumab for up to 48 months. Responder rates were superior in those who received bimekizumab in both trials over placebo (I – 48 versus 29 per cent, P=0.006; II – 52 versus 32 per cent, P=0.0032). Side effects were infrequent.

Comment: At last, a meaningful treatment compared with surgery. Now for the direct comparison?

Mueller C, Kehl V, Dimpel R, Blankenstein C, Egert-Schwender SE, Strudthoff J, Lock JF et al, for the IOWISI Study Group.

JAMA Surg. 2024;159: 484-492.

This three armed RCT included 689 patients randomized to saline, polyhexanide or no wound irrigation. Respective wound infection rates were 12.5, 10.6 and 12.8 per cent. Compared to controls, polyhexanide did not reduce infection rates: hazard rate 1.23, 95 per cent confidence interval 0.64 to 2.36.

Comment: Wound irrigation remains controversial, and unproven.