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J. of Management Studies     Hybrid Journal   (Followers: 28, SJR: 3.806, h-index: 89)
J. of Marital and Family Therapy     Hybrid Journal   (Followers: 2, SJR: 1.107, h-index: 39)
J. of Marriage and Family     Hybrid Journal   (Followers: 17, SJR: 3.241, h-index: 98)
J. of Mass Spectrometry     Hybrid Journal   (Followers: 24, SJR: 1.207, h-index: 92)
J. of Medical Imaging and Radiation Oncology     Hybrid Journal   (Followers: 3, SJR: 0.513, h-index: 26)
J. of Medical Primatology     Hybrid Journal   (Followers: 1, SJR: 0.527, h-index: 30)
J. of Medical Radiation Sciences     Open Access   (Followers: 2)
J. of Medical Virology     Hybrid Journal   (Followers: 5, SJR: 1.058, h-index: 89)
J. of Metamorphic Geology     Hybrid Journal   (Followers: 6, SJR: 3.008, h-index: 75)
J. of Microscopy     Hybrid Journal   (Followers: 3, SJR: 0.765, h-index: 76)
J. of Midwifery & Women's Health     Hybrid Journal   (Followers: 25, SJR: 0.503, h-index: 36)
J. of Molecular Recognition     Hybrid Journal   (Followers: 2, SJR: 1.012, h-index: 60)
J. of Money, Credit and Banking     Hybrid Journal   (Followers: 26, SJR: 2.128, h-index: 61)
J. of Morphology     Hybrid Journal   (Followers: 3, SJR: 0.767, h-index: 49)
J. of Multi-Criteria Decision Analysis     Hybrid Journal   (Followers: 2)
J. of Multicultural Counseling and Development     Hybrid Journal   (Followers: 1, SJR: 0.267, h-index: 25)
J. of Muscle Foods     Hybrid Journal   (Followers: 3, SJR: 0.274, h-index: 24)
J. of Neurochemistry     Hybrid Journal   (SJR: 2.075, h-index: 172)
J. of Neuroendocrinology     Hybrid Journal   (Followers: 5, SJR: 1.417, h-index: 83)
J. of Neuroimaging     Hybrid Journal   (Followers: 1, SJR: 0.761, h-index: 43)
J. of Neuroscience Research     Hybrid Journal   (Followers: 8, SJR: 1.423, h-index: 120)
J. of Nursing and Healthcare of Chronic Illne Ss: An Intl. Interdisciplinary J.     Hybrid Journal   (Followers: 3)
J. of Nursing Management     Hybrid Journal   (Followers: 17, SJR: 1.185, h-index: 38)
J. of Nursing Scholarship     Hybrid Journal   (Followers: 3, SJR: 1.258, h-index: 49)
J. of Obstetric, Gynecologic, & Neonatal Nursing     Hybrid Journal   (Followers: 18, SJR: 0.647, h-index: 42)
J. of Obstetrics and Gynaecology Research     Hybrid Journal   (Followers: 13, SJR: 0.498, h-index: 32)
J. of Oral Pathology & Medicine     Hybrid Journal   (Followers: 3, SJR: 0.775, h-index: 58)
J. of Oral Rehabilitation     Hybrid Journal   (Followers: 2, SJR: 1.033, h-index: 57)
J. of Organizational Behavior     Hybrid Journal   (Followers: 30, SJR: 3.102, h-index: 95)
J. of Orthopaedic Research     Hybrid Journal   (Followers: 15, SJR: 1.505, h-index: 106)
J. of Paediatrics and Child Health     Hybrid Journal   (Followers: 16, SJR: 0.594, h-index: 51)
J. of Pathology     Hybrid Journal   (Followers: 8, SJR: 4.402, h-index: 131)
J. of Pathology : Clinical Research     Open Access  
J. of Peptide Science     Hybrid Journal   (Followers: 18, SJR: 0.641, h-index: 47)
J. of Periodontal Research     Hybrid Journal   (SJR: 0.781, h-index: 58)
J. of Personality     Hybrid Journal   (Followers: 12, SJR: 2.266, h-index: 83)
J. of Petroleum Geology     Hybrid Journal   (Followers: 5, SJR: 0.524, h-index: 24)
J. of Pharmaceutical Sciences     Hybrid Journal   (Followers: 296, SJR: 1.284, h-index: 113)
J. of Philosophy of Education     Hybrid Journal   (Followers: 8, SJR: 0.687, h-index: 20)
J. of Phycology     Hybrid Journal   (Followers: 6, SJR: 1.148, h-index: 84)
J. of Physical Organic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.64, h-index: 48)
J. of Phytopathology     Hybrid Journal   (Followers: 2, SJR: 0.503, h-index: 37)
J. of Pineal Research     Hybrid Journal   (Followers: 1, SJR: 2.189, h-index: 81)
J. of Plant Nutrition and Soil Science     Hybrid Journal   (Followers: 3, SJR: 0.846, h-index: 49)
J. of Policy Analysis and Management     Hybrid Journal   (Followers: 12, SJR: 1.531, h-index: 47)
J. of Policy and Practice In Intellectual Disabilities     Hybrid Journal   (Followers: 6, SJR: 0.62, h-index: 10)
J. of Political Philosophy     Hybrid Journal   (Followers: 29, SJR: 1.21, h-index: 31)
J. of Polymer Science Part A: Polymer Chemistry     Hybrid Journal   (Followers: 216, SJR: 1.211, h-index: 109)
J. of Polymer Science Part B: Polymer Physics     Hybrid Journal   (Followers: 22, SJR: 1.222, h-index: 96)
J. of Polymer Science Part C : Polymer Letters     Hybrid Journal   (Followers: 5)
J. of Popular Music Studies     Hybrid Journal   (Followers: 8, SJR: 0.199, h-index: 3)
J. of Product Innovation Management     Hybrid Journal   (Followers: 15, SJR: 2.115, h-index: 82)
J. of Prosthodontics     Hybrid Journal   (SJR: 0.44, h-index: 31)
J. of Psychiatric and Mental Health Nursing     Hybrid Journal   (Followers: 51, SJR: 0.529, h-index: 39)
J. of Psychological Issues in Organizational Culture     Hybrid Journal   (Followers: 3)
J. of Public Affairs     Hybrid Journal   (Followers: 2, SJR: 0.434, h-index: 7)
J. of Public Economic Theory     Hybrid Journal   (Followers: 4, SJR: 1.028, h-index: 21)
J. of Public Health Dentistry     Hybrid Journal   (Followers: 1, SJR: 0.757, h-index: 41)
J. of Quaternary Science     Hybrid Journal   (Followers: 23, SJR: 1.763, h-index: 65)
J. of Raman Spectroscopy     Hybrid Journal   (Followers: 11, SJR: 1.105, h-index: 69)
J. of Rapid Methods and Automation In Microbiology     Hybrid Journal   (Followers: 2)
J. of Regional Science     Hybrid Journal   (Followers: 10, SJR: 2.642, h-index: 42)
J. of Religious Ethics     Hybrid Journal   (Followers: 5, SJR: 0.2, h-index: 10)
J. of Religious History     Hybrid Journal   (Followers: 17, SJR: 0.179, h-index: 7)
J. of Renal Care     Hybrid Journal   (Followers: 1, SJR: 0.468, h-index: 13)
J. of Research In Reading     Hybrid Journal   (Followers: 10, SJR: 0.789, h-index: 23)
J. of Research in Science Teaching     Hybrid Journal   (Followers: 12, SJR: 4.717, h-index: 70)
J. of Research in Special Educational Needs     Hybrid Journal   (Followers: 3, SJR: 0.525, h-index: 10)
J. of Research on Adolescence     Hybrid Journal   (Followers: 6, SJR: 1.851, h-index: 55)
J. of Risk & Insurance     Hybrid Journal   (Followers: 11, SJR: 0.925, h-index: 36)
J. of School Health     Hybrid Journal   (Followers: 7, SJR: 1.099, h-index: 52)
J. of Sensory Studies     Hybrid Journal   (Followers: 3, SJR: 1.136, h-index: 30)
J. of Separation Science     Hybrid Journal   (Followers: 7, SJR: 1.148, h-index: 71)
J. of Sexual Medicine     Hybrid Journal   (Followers: 7, SJR: 1.403, h-index: 65)
J. of Sleep Research     Hybrid Journal   (Followers: 11, SJR: 1.259, h-index: 73)
J. of Small Animal Practice     Hybrid Journal   (Followers: 8, SJR: 0.71, h-index: 44)
J. of Small Business Management     Hybrid Journal   (Followers: 12, SJR: 1.117, h-index: 51)
J. of Social Issues     Hybrid Journal   (Followers: 17, SJR: 0.965, h-index: 72)
J. of Social Philosophy     Hybrid Journal   (Followers: 16, SJR: 0.156, h-index: 15)
J. of Sociolinguistics     Hybrid Journal   (Followers: 13, SJR: 1.11, h-index: 21)
J. of Software : Evolution and Process     Hybrid Journal   (Followers: 3, SJR: 0.209, h-index: 4)
J. of Supreme Court History     Hybrid Journal   (Followers: 7)
J. of Surgical Oncology     Hybrid Journal   (Followers: 1, SJR: 1.263, h-index: 75)
J. of Synthetic Lubrication     Hybrid Journal  
J. of Systematics Evolution     Open Access   (Followers: 4, SJR: 0.647, h-index: 22)
J. of Texture Studies     Hybrid Journal   (Followers: 2, SJR: 0.773, h-index: 33)
J. of the American Association of Nurse Practitioners     Partially Free   (Followers: 3, SJR: 0.46, h-index: 27)
J. of the American Ceramic Society     Hybrid Journal   (Followers: 23, SJR: 1.247, h-index: 129)
J. of the American Geriatrics Society     Hybrid Journal   (Followers: 23, SJR: 2.112, h-index: 151)
J. of the American Society for Information Science and Technology     Hybrid Journal   (Followers: 210, SJR: 1.745, h-index: 83)
J. of the American Water Resources Association     Hybrid Journal   (Followers: 18, SJR: 1.072, h-index: 61)
J. of the Association for Information Science and Technology     Hybrid Journal   (Followers: 5)
J. of the CardioMetabolic Syndrome     Hybrid Journal   (Followers: 1)
J. of the European Academy of Dermatology and Venereology     Hybrid Journal   (Followers: 9, SJR: 1.422, h-index: 58)
J. of the Experimental Analysis of Behavior     Hybrid Journal   (Followers: 3, SJR: 0.907, h-index: 36)
J. of the History of the Behavioral Sciences     Hybrid Journal   (Followers: 2, SJR: 0.316, h-index: 15)
J. of the Institute of Brewing     Free   (Followers: 1, SJR: 0.562, h-index: 28)
J. of the Peripheral Nervous System     Hybrid Journal   (Followers: 2, SJR: 1.335, h-index: 45)
J. of the Royal Anthropological Institute     Hybrid Journal   (Followers: 31, SJR: 0.741, h-index: 31)
J. of the Royal Statistical Society Series A (Statistics in Society)     Hybrid Journal   (Followers: 12, SJR: 1.59, h-index: 49)

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Journal Cover   BJU International
  [SJR: 1.812]   [H-I: 104]   [255 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1464-4096 - ISSN (Online) 1464-410X
   Published by John Wiley and Sons Homepage  [1611 journals]
  • Internet‐based treatment of stress urinary incontinence: 1‐
           and 2 years results of a randomised controlled trial with focus on pelvic
           floor muscle training
    • Authors: M Sjöström; G Umefjord, H Stenlund, P Carlbring, G Andersson, E Samuelsson
      Abstract: Objectives To evaluate the long‐term effects of two non‐face‐to‐face treatment programmes for stress urinary incontinence (SUI) based on pelvic floor muscle training (PFMT). Subjects and Methods Randomised controlled trial with online recruitment of 250 community‐dwelling women aged 18‐70 years with SUI ≥1/week. Diagnosis based on validated self‐assessed questionnaires, 2‐day bladder diary, and telephone interview with a urotherapist. Consecutive computer‐generated block‐randomisation with allocation by an independent administrator to 3 months of treatment with either an Internet‐based treatment programme (n=124) or a programme sent by post (n=126). Both interventions focused mainly on PFMT; the Internet group received continuous e‐mail support from a urotherapist, whereas the postal group trained on their own. Follow‐up was performed after 1 and 2 years via self‐assessed postal questionnaires. The primary outcomes were symptom severity (International Consultation on Incontinence Questionnaire Short Form, ICIQ‐UI SF) and condition‐specific quality of life (ICIQ‐Lower Urinary Tract Symptoms Quality of Life, ICIQ‐LUTSqol). Secondary outcomes were the Patient's Global Impression of Improvement, health‐specific quality of life (EQ‐Visual Analogue Scale), use of incontinence aids, and satisfaction with treatment. There was no face‐to‐face contact with the participants at any time. Analysis was based on intention‐to‐treat. Results We lost 32.4% (81/250) of participants to follow‐up after 1 year and 38.0% (95/250) after 2 years. With both interventions, we observed highly significant (p0.8) for symptoms and condition‐specific quality of life after 1 and 2 years, respectively. No significant differences were found between the groups. The mean changes (SD) in symptom score were 3.7 (3.3) for Internet and 3.2 (3.4) for postal (p=0.47) after 1 year, and 3.6 (3.5) for Internet and 3.4 (3.3) for postal (p=0.79) after 2 years. The mean changes (SD) of condition‐specific quality of life were 5.5 (6.5) for Internet and 4.7 for postal (6.5) (p=0.55) after 1 year, and 6.4 (6.0) for Internet and 4.8 (7.6) for postal (p=0.28) after 2 years. The proportions of participants perceiving they were much or very much improved were similar in both intervention groups after 1 year (Internet 31.9% (28/88), postal 33.8% (27/80) p=0.82), but after 2 years significantly more participants in the Internet group reported this level of improvement (39.2% (29/74) vs. 23.8% (19/80), p=0.03). Health‐specific quality of life improved significantly in the Internet group after 2 years (mean change EQ‐VAS 3.8 (11.4), p=0.005). We found no other significant improvements in this measure. One year after treatment, 69.8% (60/86) of participants in the Internet group and 60.5% (46/76) of participants in the postal group reported that they were still satisfied with the treatment result. After 2 years, the proportions were 64.9% (48/74) and 58.2% (46/79), respectively. Conclusion Non‐face‐to‐face treatment of SUI with PFMT provides significant and clinically relevant improvements in symptoms and condition‐specific quality of life 1 and 2 years after treatment. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-14T02:47:40.598066-05:
      DOI: 10.1111/bju.13091
  • Combination of multi‐parametric magnetic resonance imaging
           (mp‐MRI) and transperineal template‐guided mapping biopsy
           (TTMB) of the prostate to identify candidates for hemi‐ablative
           focal therapy
    • Authors: Minh Tran; James Thompson, Maret Böhm, Marley Pulbrook, Daniel Moses, Ron Shnier, Phillip Brenner, Warick Delprado, Anne‐Maree Haynes, Richard Savdie, Phillip D Stricker
      Abstract: Objective To evaluate the accuracy of combined multi‐parametric magnetic resonance imaging (mp‐MRI) and transperineal template‐guided mapping biopsy (TTMB) for identifying lobes with significant prostate cancer (PCa) for the application of hemi‐ablative focal therapy (FT). Patients and Methods From January 2012–January 2014, 89 consecutive patients aged ≥40 with PSA ≤15 underwent in sequential order: mp‐MRI, TTMB and radical prostatectomy (RP) at a single centre. Analysis was performed on 50 patients that met consensus guidelines for FT. Lobes were stratified into lobes with significant cancer (LSC), insignificant cancer (LIC) and no cancer (LNC). Using histopathology at RP, the predictive performance of combined mp‐MRI+TTMB in identifying LSC was evaluated. Results The sensitivity, specificity and positive predictive value (PPV) for mp‐MRI+TTMB for LSC was 97%, 61% and 83% respectively. The negative predictive value (NPV), the primary parameter of interest, for mp‐MRI+TTMB for LSC was 91%. Of the 50 patients, 21 had significant unilateral disease on mp‐MRI+TTMB. Two of these 21 patients had significant bilateral disease on RP not identified on mp‐MRI+TTMB. Conclusions In candidates for FT, mp‐MRI and TTMB provides a high NPV in the detection of lobes with significant cancer. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-14T02:47:32.861001-05:
      DOI: 10.1111/bju.13090
  • Telemetric monitoring of bladder function in female Göttingen
    • Authors: Nadine D Huppertz; Ruth Kirschner‐Hermanns, Rene H Tolba, Joachim O Grosse
      Abstract: Objectives To generate real‐time radio‐telemetric urodynamic reference data of maximum detrusor pressure (Pdet max), maximum flowrate (Qmax) and estimated grade of infravesical obstruction as well as for duration of detrusor contraction (DOC), in female Göttingen minipigs and to describe translational aspects of the use of Göttingen minipigs for urological research. Material and Methods In five female Göttingen minipigs, a telemetric transmitter was implanted and 24 h measurements in metabolic cages were performed. Through operator based analysis, synchronized real‐time radio‐telemetric cystometric data with flowmetric data and video sequences were used to determine voiding detrusor contractions (VC) and non‐voiding detrusor contractions (NVC). Furthermore data from telemetric natural filling cystometry from free‐moving and restricted maintenance were compared for potential difference. Results Median maximum detrusor pressure (Pdet max) of VC's was 120.6 cm H2O (21.0‐ 370.0 cm H2O) (median [range]) and, therefore, significantly different from Pdet max of NVC's (64.60 cm H2O [20.4 to 280.6 cmH2O]). Intra‐individual comparison of minipig data revealed great differences in voiding contractions. Effects of limited moving on VC's were analyzed and showed significantly higher Pdet max and lower DOC than in free‐moving maintenance. Conclusion The presented data can be used for the development of telecystometric implanted minipig models ‐ to investigate changes of detrusor function like under‐ or overactivity and might serve as model for bladder changes occurring with iatrogenic bladder outlet obstruction (BOO) or different therapeutical options for overactive bladder (OAB). Radio‐telemetric real‐time natural filling and voiding cystometries are feasible, reproducible in not anesthetized minipigs of free or limited moving and can give new insights in understanding circadian behaviour, physiological and pathological bladder function. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-13T22:44:32.04063-05:0
      DOI: 10.1111/bju.13089
  • Intravesical Gemcitabine in combination with Mitomycin C as salvage
           treatment in recurrent non‐muscle invasive bladder cancer
    • Authors: Patrick A. Cockerill; John J. Knoedler, Igor Frank, Robert Tarrell, R. Jeffrey Karnes
      Abstract: Objectives To evaluate oncologic outcomes after combination intravesical therapy with Gemcitabine (GC) and Mitomycin C (MMC), in the setting of recurrent non‐muscle invasive bladder cancer (NMIBC), after failure of prior intravesical therapy. Patients and Methods We retrospectively identified patients with recurrent NMIBC after prior intravesical therapy, who refused or were not candidates for cystectomy, between 2005 and 2011. GC and MMC were sequentially instilled weekly for six to eight weeks. Data was collected regarding patient demographics, bladder cancer history, and number and type of intravesical therapies prior to GC/MMC, Outcomes evaluated included time to recurrence and/or progression after GC/MMC. Recurrence free outcomes were estimated using the Kaplan Meier method, and cox proportional hazard regression models were used to test the association of clinicopathologic features with outcomes. Results 27 patients were identified, 23 with high risk (high grade or CIS) and four with intermediate risk (multifocal or recurrent low grade) disease. All patients received prior intravesical therapy, and 17 patients (63%) received multiple courses. Twenty four patients were treated with BCG. Median disease free survival of all patients was 15.2 months (1.7 months‐39.3 months). Seventeen patients (63%) developed recurrent bladder cancer, a median of 15.2 months after therapy. One patient progressed to muscle invasive disease five months after treatment, and one patient developed metastatic disease 22 months after treatment. Three patients went on to cystectomy. Ten patients (37%) had no evidence of disease at last follow up, with a median follow up of 22.1 months. Conclusion The combination of intravesical GC and MMC may offer durable recurrence free survival to some patients with recurrent NMIBC who are not candidates for, or refuse, cystectomy. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-13T22:44:19.687063-05:
      DOI: 10.1111/bju.13088
  • Does the Addition of Targeted Prostate Biopsies to Standard Systemic
           Biopsies Impact Treatment Management for Radiation Oncologists'
    • Authors: Mitchell Kamrava; John V. Hegde, Narine Abgaryan, Edward Chang, Jesse D. Le, Jason Wang, Patrick Kupelian, Leonard S. Marks
      Abstract: Objectives To study the management impact that MRI‐guided targeted prostate biopsies could provide relative to using only non‐targeted systematic biopsies in men with clinically‐localized prostate cancer (CaP). Subjects/Patients and Methods A consecutive series of untreated men undergoing Artemis (MRI‐ultrasound fusion) biopsies between March 2010 and June 2013 was evaluated in this retrospective, IRB‐approved study. Fusion biopsy included MRI targeted and systematic sampling at the same session. 3‐Tesla multiparametric MRI was performed at a median of 2 weeks prior to biopsy. Patients were included if > 1 systematic core revealed CaP. The impact of the information obtained from targeted versus systematic biopsies was studied on the following: Gleason Score (GS), NCCN risk reclassification, cancer core length, percent of core positive for tumor involvement, and percent positive biopsy cores. Results The study sample included 215 men (mean age=66 +/‐8 years). Median PSA was 6.0 (range = 0.7‐181 ng/ml). The mean number of total biopsy samples was 18 (12 systematic and 6 targeted samples). 34/215 men (16%) had a higher GS on targeted vs. systematic biopsy. 21/183 men (12%) were stratified into a higher NCCN risk group when incorporating targeted biopsy GS results. 18/101 men (18%) were upgraded to intermediate‐ or high‐risk from the low‐risk group. Among the 34 men whose cancer severity was upgraded, increases in cancer core length, percent involvement, and percent of cores involved were all statistically significant (p < 0.01). Conclusion Targeted prostate biopsy provided information about GS, NCCN risk, and tumor volume beyond that obtained in systematic biopsies, specifically increasing the proportions of intermediate‐ and high‐risk men. Such patients may be recommended for additional treatments (pelvic nodal irradiation or hormonal therapy). The appropriateness of changing treatment because of targeted biopsy results is still unclear. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-13T22:41:34.616952-05:
      DOI: 10.1111/bju.13082
  • The serum luteinizing hormone level is significantly associated with
           recovery of urinary function after radical prostatectomy
    • Authors: Shunichi Namiki; Koji Mitsuzuka, Yasuhiro Kaiho, Shigeyuki Yamada, Hisanobu Adachi, Shinichi Yamashita, Hideo Saito, Akihiro Ito, Haruo Nakagawa, Misa Takegami, Yoichi Arai
      Abstract: Objective To perform a longitudinal investigation of the correlation between functional recovery and sex hormone levels after radical prostatectomy (RP). Patients and methods A total of 72 consecutive men undergoing RP between January 2012 and June 2013were prospectively included and serially followed postoperatively for comparative analysis. They underwent measurements of luteinizing hormone (LH) and total testosterone (TT) levels prior to surgery and 3 and 12 months postoperatively. They filled out a health‐related quality of life questionnaire before and at 1, 3, 6, and 12 months after surgery. Results The mean LH level increased from 4.28 U/L at baseline to 5.53 U/L at 3 months and remained high at 12 months after RP (both p
      PubDate: 2015-02-13T22:41:24.308737-05:
      DOI: 10.1111/bju.13083
  • Outcomes of Robotic‐Assisted Laparoscopic Upper Urinary Tract
           Reconstruction: 250 Consecutive Patients
    • Authors: Tracy Marien; Marc Bjurlin, Blake Wynia, Matthew Bilbily, Gaurav Rao, Lee C. Zhao, Ojas Shah, Michael D. Stifelman
      Abstract: Objective To evaluate our long‐term outcomes of robotic assisted laparoscopic (RAL) upper urinary tract (UUT) reconstruction. Materials and Methods Data from 250 consecutive patients undergoing RAL UUT reconstruction including pyeloplasty with or without stone extraction, ureterolysis, ureteroureterostomy, ureterocalicostomy, ureteropyelostomy, ureteral reimplantation and buccal mucosa graft ureteroplasty was collected at a tertiary referral center between March 2003 and December 2013. The primary outcomes were symptomatic and radiographic improvement of obstruction and complication rate. The mean follow‐up was 17.1 months. Results Radiographic and symptomatic success rates ranged from 85% to 100% for each procedure with a 98% radiographic success rate and 97% symptomatic success rate for the entire series. There were a total of 34 complications; none greater than Clavien grade 3. Conclusion RAL UUT can be performed with few complications, with durable long‐term success, and is a reasonable alternative to the open procedure in experienced robotic surgeons. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-13T22:41:13.170724-05:
      DOI: 10.1111/bju.13086
  • Preoperative predictive model of recovery of urinary continence after
           radical prostatectomy
    • Authors: Kazuhito Matsushita; Matthew T. Kent, Andrew J. Vickers, Christian Bodman, Melanie Bernstein, Karim A. Touijer, Jonathan Coleman, Vincent Laudone, Peter T. Scardino, James A. Eastham, Oguz Akin, Jaspreet S. Sandhu
      Abstract: Objective To build a predictive model of urinary continence recovery following radical prostatectomy that incorporates magnetic resonance imaging parameters and clinical data. Patients and Methods We conducted a retrospective review of data from 2,849 patients who underwent pelvic staging magnetic resonance imaging prior to radical prostatectomy from November 2001 to June 2010. We used logistic regression to evaluate the association between each MRI variable and continence at 6 or 12 months, adjusting for age, body mass index (BMI), and American Society of Anesthesiologists (ASA) score and then used multivariable logistic regression to create our model. A nomogram was constructed using the multivariable logistic regression models. Results In total, 68% (n=1,742/2,559) and 82% (n=2,205/2,689) regained function at 6 and 12 months, respectively. In the base model, age, BMI, and ASA score were significant predictors of continence at 6 or 12 months on univariate analysis (p
      PubDate: 2015-02-13T22:41:05.1748-05:00
      DOI: 10.1111/bju.13087
  • The Utility and Significance of Ureteral Frozen Section Analysis During
           Radical Cystectomy
    • Authors: Raj Satkunasivam; Brian Hu, Charles Metcalfe, Saum B. Ghodoussipour, Manju Aron, Jie Cai, Gus Miranda, Inderbir Gill, Siamak Daneshmand
      Abstract: Objective To assess the utility of routine frozen section analysis (FSA) of ureters at the time of radical cystectomy (RC) for urothelial cancer (UC), and the long‐term outcomes of adverse ureteral pathology. Patients and Methods Pathological data on 2,047 patients undergoing RC for UC with routine FSA of ureters (01/1971 – 12/2009) were analyzed. Univariate and multivariable logistic and cox‐proportional hazards models were utilized to determine the risk of upper tract urothelial cancer (UTUC) recurrence, local recurrence and overall survival in those identified as having adverse pathology (severe atypia/CIS or UC) at time of FSA. Results Adverse pathology was identified by FSA in 178 patients (8.6%). FSA displayed poor sensitivity in identifying adverse pathology (59.1%), which was improved in patients with pre‐operative CIS (68.0%). After a median follow‐up of 12.4 years (IQR 1.9‐10.1 years), 28 patients (1.4%) developed UTUC recurrence. There were no uretero‐enteric anastomotic recurrences. Adverse pathology on FSA was associated with UTUC recurrence on univariate analysis (HR: 6.2, 95% CI: 2.9‐13.5), however, 54% (15 of 28) of patients with UTUC recurrence had benign ureteral FSA on initial sectioning. Adverse pathology on FSA was not independently associated with the risk of local recurrence (HR: 1.08, 95% CI: 0.61‐1.89) or overall survival (HR: 1.12, 95% CI: 0.94‐1.35) in multivariate models. Conclusions Ureteral FSA has poor sensitivity and may be marginally improved in pre‐existing CIS. UTUC recurrence is rare and can occur despite negative FSA. Our data question the utility of routine frozen section analysis of the distal ureteral margin at the time of radical cystectomy. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-13T22:31:32.812772-05:
      DOI: 10.1111/bju.13081
  • Guideline of Guidelines: Kidney Stones
    • Authors: Justin B. Ziemba; Brian R. Matlaga
      Abstract: Acute flank pain is a common presenting symptom with nephrolithiasis being the most frequent etiology.[1] The overall prevalence of kidney stones in the United States is estimated at approximately 9%.[2] Given the prevalence of this disease, it is frequently encountered in routine clinical practice. Therefore, several professional organizations have developed evidence‐based guidelines for the evaluation, surgical management, and medical treatment of patients with nephrolithiasis. The purpose of this article is to summarize these guidelines with references to the strength of evidence. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-13T22:31:23.297594-05:
      DOI: 10.1111/bju.13080
  • A review of detrusor overactivity and the overactive bladder after radical
           prostate cancer treatment
    • Authors: N Thiruchelvam; F Cruz, M Kirby, A Tubaro, C Chapple, K D Sievert
      Abstract: There are various forms of treatment for prostate cancer. In addition to oncologic outcomes, physicians and increasingly patients are focusing on functional and adverse outcomes. Symptoms of overactive bladder (OAB), including urinary frequency, urgency, and incontinence, can occur regardless of treatment modality. This article examines the prevalence, pathophysiology, and options for treatment of OAB after radical prostate cancer treatment. OAB seems to be more common and severe after radiation therapy than surgical therapy and even persisted longer with complications, suggesting an advantage for surgery over radiotherapy. Because OAB that occurs after radical prostate surgery or radiotherapy can be difficult to treat, it is important that patients are made aware of the potential development of OAB during counselling before decisions regarding treatment choice are made. To ensure a successful outcome of both treatments, it is imperative that clinicians and non‐specialists enquire about and document pre‐treatment urinary symptoms and carefully evaluate post‐treatment symptoms. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-13T10:16:11.054799-05:
      DOI: 10.1111/bju.13078
  • Patients with medical risk factors for chronic kidney disease are at
           increased risk of renal impairment despite the use of
           nephron‐sparing surgery
    • Authors: P Satasivam; F Reeves, K Rao, Z Ivey, M Basto, M Yip, H Roth, J Grummet, J Goad, D Moon, D Murphy, S Appu, N Lawrentschuk, D Bolton, J Kearsley, A Costello, M Frydenberg
      Abstract: Objective To determine whether patients with normal preoperative renal function, but who possess medical risk factors for CKD, experience poorer renal function post partial nephrectomy (PN) for renal cell carcinoma (RCC) compared to those without risk factors. Materials We investigated the effect of age, hypertension (HTN) and diabetes (DM) on estimated glomerular filtration rate (eGFR) in 488 consecutive operations for RCC performed between 2005 and 2012 at six Australian tertiary referral centres. 156 patients underwent PN and 332 patients underwent radical nephrectomy (RN). We used chi‐square and binary logistic regression to analyse new‐onset CKD, and multiple linear regression to investigate determinants of postoperative eGFR. Results The development of new‐onset eGFR
      PubDate: 2015-02-13T06:52:41.108309-05:
      DOI: 10.1111/bju.13075
  • Partial nephrectomy for the treatment of renal cell carcinoma (RCC) and
           the risk of end‐stage renal disease (ESRD)
    • Authors: Stanley A. Yap; Antonio Finelli, David R. Urbach, George A. Tomlinson, Shabbir M.H. Alibhai
      Abstract: Objective To assess whether radical nephrectomy (RN) compared with partial nephrectomy (PN) for the treatment of renal cell carcinoma (RCC) is associated with greater risk of end‐stage renal disease (ESRD). Patients and Methods We performed a population‐based, retrospective cohort study using linked administrative databases in the province of Ontario, Canada. We included individuals with pathologically confirmed RCC diagnosed between 1995 and 2010. Cox proportional hazards, propensity score, and competing risks models were used to assess the impact of treatment choice. The primary outcome was ESRD. Secondary outcomes included overall mortality, myocardial infarction, and new‐onset chronic kidney disease (CKD). A modern cohort of patients (2003–2010) was analysed separately. Results We included 11 937 patients, of whom 2107 (18%) underwent PN. The median follow‐up was 57 months. In the full cohort, type of surgery was not associated with the rate of ESRD, whereas PN was associated with a decreased likelihood of ESRD compared with RN in the modern cohort using a multivariable proportional hazards model [hazard ratio (HR) 0.44, 95% confidence interval (CI) 0.25–0.75) or propensity score modelling (HR 0.48, 95% CI 0.27–0.82). PN was also associated with a lower risk of new‐onset CKD (HR 0.48, 95% CI 0.41–0.57). Conclusions Although it is well‐known that RN is associated with more CKD than PN, we provide the first direct evidence that PN is associated with less ESRD requiring renal replacement therapy than RN in a modern cohort of patients with RCC.
      PubDate: 2015-02-05T02:25:56.450683-05:
      DOI: 10.1111/bju.12883
  • Pattern of invasion is the most important prognostic factor in patients
           with penile cancer submitted to lymph node dissection and pathological
           absence of lymph node metastasis (pN0)
    • Authors: Giuliano Aita; Walter Henriques Costa, Stenio Cassio Zequi, Isabela Werneck Cunha, Fernando Soares, Gustavo Cardoso Guimaraes, Ademar Lopes
      Abstract: Objectives Penile carcinoma (PC) is a rare neoplasm in European countries, of which the presence of lymph node metastasis is the most important prognostic factor. Few studies have examined PC patients with histologically negative nodes (pN0). The aim of this study was to identify the prognostic factors in a cohort of pN0 PC patients. Subjects and Methods One hundred one patients with PC met the inclusion criteria—47 (46.5%) patients underwent bilateral inguinal lymph node dissection, and 54 (53.5%) subjects underwent bilateral inguinopelvic lymph node dissection. Variables that had a prognostic impact on survival rates in the univariate analysis were selected for multivariate survival analysis. Results The cohort cancer‐specific survival (CSS) and overall survival (OS) rates were 88.1% and 52.5%, respectively. Histological grade and pattern of invasion were the only features to significantly impact survival rates in the univariate analysis. The CSS and OS rates in patients with pushing versus infiltrating patterns of invasion were 98.0% versus 78.4% (p=0.003) and 70.0% versus 35.3% (p=0.005), respectively. Pattern of invasion was the only independent predictor of survival. Patients with infiltrating invasion had a higher probability of death from cancer (HR 11.5, P = 0.019) and overall death (HR 2.3, P = 0.007) compared with those with a pushing invasion pattern. Conclusions The presence of an infiltrating pattern of invasion is the most important predictor of survival in PC patients. We encourage other centers to confirm our findings that the pattern of invasion is an important prognostic factor in patients with PC and pN0 disease.
      PubDate: 2015-01-30T03:59:28.647316-05:
      DOI: 10.1111/bju.13071
  • Final Quality of Life and Safety Data for patients with mCRPC treated with
           Cabazitaxel in the UK Early Access Programme (NCT01254279)
    • Authors: A Bahl; S Masson, Z Malik, AJ Birtle, S Sundar, RJ Jones, ND James, MD Mason, S Kumar, D Bottomley, A Lydon, S Chowdhury, J Wylie, JS Bono
      Abstract: Background Cabazitaxel is a novel taxoid developed to overcome resistance to other taxanes. The 2010 TROPIC trial demonstrated improved survival for cabazitaxel compared with mitoxantrone in metastatic castration resistant prostate cancer (mCRPC) after previous docetaxel chemotherapy. However, concerns regarding safety (particularly neutropenic and cardiac complications) remained and quality of life (QOL) was not assessed. Objective The UK Early Access Programme (EAP) was part of an international phase IIIb/IV trial set up to facilitate access to cabazitaxel and to record detailed safety data. In the UK a specific amendment enabled formal QOL evaluation. Design, Setting and Participants 112 patients participated at 12 UK Cancer Centres. All had mCRPC with disease progression during or after docetaxel. Intervention Patients received cabazitaxel 25mg/m2 every 3 weeks with prednisolone 10mg daily for up to 10 cycles. Safety assessments were performed prior to each cycle and QOL recorded at alternate cycles using the EQ5D‐3L questionnaire and visual analogue scale (VAS). Outcome measures and statistical analysis Safety profile was compiled following completion of the EAP and QOL measures analysed to record trends. No formal statistical analysis was carried out. Results and Limitations The incidences of neutropenic sepsis (6.3%), grade 3 and 4 diarrhoea (4.5%) and grade 3 and 4 cardiac toxicity (0%) were low. Neutropenic sepsis episodes though low occurred only in patients who did not receive prophylactic G‐CSF. There were trends to improved VAS and EQ5D‐3L pain scores during treatment. Conclusions The UK EAP experience indicates that cabazitaxel may improve QOL in mCRPC and represents an advance and useful addition to the armamentarium of treatment for patients whose disease has progressed during or after docetaxel. In view of the potential toxicity, careful patient selection is important. Patient Summary We recorded detailed information about side effects and quality of life in 112 patients with advanced prostate cancer receiving cabazitaxel chemotherapy. We found that side effects were less severe than expected and, importantly, many patients’ quality of life and pain symptoms improved during treatment.
      PubDate: 2015-01-30T03:59:19.676623-05:
      DOI: 10.1111/bju.13069
  • Safety and efficacy of mirabegron as add‐on therapy in patients with
           overactive bladder treated with solifenacin: a postmarketing,
           open‐label study in Japan (MILAI study)
    • Authors: Osamu Yamaguchi; Hidehiro Kakizaki, Yukio Homma, Yasuhiko Igawa, Masayuki Takeda, Osamu Nishizawa, Momokazu Gotoh, Masaki Yoshida, Osamu Yokoyama, Narihito Seki, Akira Okitsu, Takuya Hamada, Akiko Kobayashi, Kentarou Kuroishi
      Abstract: Objective To examine the safety and efficacy of mirabegron as add‐on therapy to solifenacin in patients with OAB. Patients and Methods This multicenter, open‐label, Phase IV study enrolled patients ≥20 years old with OAB, as determined by an overactive bladder symptom score (OABSS) total score of ≥3 points and a Question 3 OABSS of ≥2 points, who were being treated with solifenacin at a stable dose of 2.5 or 5 mg once daily for at least 4 weeks. Study duration was 18 weeks, comprising a 2‐week screening period and a 16‐week treatment period. Patients meeting eligibility criteria continued to receive solifenacin (2.5 or 5 mg once daily), and additional mirabegron (25 mg once daily) for 16 weeks. After 8 weeks of treatment, the mirabegron dose could be increased to 50 mg if the patient's symptom improvement was not sufficient, he/she was agreeable to the dose increase, and the investigator judged that there were no safety concerns. Safety assessments included adverse events (AEs), laboratory tests, vital signs, 12‐lead electrocardiogram (ECG), QT corrected for heart rate using Fridericia's correction (QTcF) interval and post‐void residual (PVR) volume. Efficacy endpoints were changes from baseline in OABSS total score, overactive bladder questionnaire short form (OAB‐q SF) score (symptom bother and total health‐related quality of life [HRQL] score), mean number of micturitions/24 h, mean number of urgency episodes/24 h, mean number of incontinence episodes/24 h, mean number of urgency incontinence episodes/24 h, mean volume voided/micturition, and mean number of nocturia episodes/night. Patients were instructed to complete the OABSS sheets at week –2, 0, 8 and 16 (or at discontinuation), OAB‐q SF sheets at week 0, 8 and 16 (or at discontinuation), and patient micturition diaries at week 0, 4,8,12 and 16 (or at discontinuation). Results Overall incidence of drug‐related TEAEs was 23.3%. Almost all TEAEs were mild or moderate. The most common TEAE was constipation, with similar incidence in the groups receiving a dose increase to that observed in the groups maintained on the original dose. Changes in post‐void residual volume, QTcF interval, pulse rate, and blood pressure were not considered to be clinically significant and there were no reports of urinary retention. Significant improvement was seen for changes in efficacy endpoints from baseline to end of treatment (EOT) in all groups (patients receiving solifenacin 2.5 or 5 mg + mirabegron 25 or 50 mg). Conclusions Add‐on therapy with mirabegron 25 mg once daily for 16 weeks, with an optional dose increase to 50 mg at week 8, was well tolerated in patients with OAB treated with solifenacin 2.5 mg or 5 mg once daily. Significant improvements from baseline to EOT in OAB symptoms were observed with combination therapy with mirabegron and solifenacin. Add‐on therapy with mirabgron and an antimuscarinic agent such as solifenacin may provide an attractive therapeutic option.
      PubDate: 2015-01-30T03:59:11.058056-05:
      DOI: 10.1111/bju.13068
  • Sensory evoked potentials of the bladder and urethra in middle‐aged
           women: the effect of age
    • Authors: Flavia Gregorini; Stephanie Knüpfer, Martina D. Liechti, Martin Schubert, Armin Curt, Thomas M. Kessler, Ulrich Mehnert
      Abstract: Objectives To investigate feasibility, reproducibility and age dependency of sensory evoked cortical potentials (SEPs) after electrical stimulation of different localizations in the lower urinary tract (LUT) in a cohort of middle‐aged healthy women. Subjects and methods In a group of ten healthy middle‐aged women (mean height: 165±5cm; mean age: 43±6 years), electrical stimulation (0.5 and 3Hz) was applied to bladder dome, trigone, proximal and distal urethra. SEPs were recorded at the Cz electrode with reference to Fz. All measurements were repeated three times with an interval of three to five weeks. Current perception thresholds (CPT), SEP latencies and amplitudes were analysed. Results were compared to a group of younger women published previously. Results LUT SEPs demonstrated 2 positive (P1, P2) and 1 negative peak (N1). The mean N1 latency was 108.9±7.8ms, 116.2±10.7ms, 113.2±13.4ms, and 131.3±35.6ms for bladder dome, trigone, proximal and distal urethra, respectively. N1 latencies – except for the distal urethra ‐ were significantly shorter compared to younger women. Taking all data, i.e. young and middle‐aged women, into account, there was a significant negative correlation between the variable age and CPT/dome (r = ‐0.462, p = 0.04) and N1 latency/dome (r = ‐0.605, p = 0.005) and a significant positive correlation between the variable age and N1P2 amplitude/dome (r = 0.542, p = 0.014). Conclusion LUT‐SEPs can be induced in middle‐aged women with reliable N1 responses. Unexpectedly, N1 responses reveal a shortening with increasing age particularly when compared to younger women. Changes in sensory afferents may be explained by age related qualitative reorganizations within the urothelium and suburothelium potentially altering afferent nerve excitability and may have an impact on the development of non‐neurological LUT disorders (e.g. overactive bladder) in women.
      PubDate: 2015-01-28T04:34:18.003162-05:
      DOI: 10.1111/bju.13066
  • Penile lengthening and widening without grafting according to a modified
           sliding technique
    • Authors: Paulo H. Egydio; Franklin E. Kuehhas
      Abstract: To present the feasibility and safety of penile length and girth restoration based on a modified “sliding technique” for patients suffering from severe ED, significant penile shortening with or without Peyronie's disease. Materials and Methods Between January 2013 and January 2014, 143 patients underwent our modified “sliding technique” for penile length and girth restoration and concomitant penile prosthesis implantation. It is based on three key elements: 1) the sliding maneuver for penile length restoration, 2) potential complementary longitudinal ventral and/or dorsal tunical incisions for girth restoration, and 3) closure of the newly created rectangular bow‐shaped tunical defects with Buck's fascia only. Results 143 patients underwent the procedure. The etiologies of penile shortening and narrowing were PD in 53.8%, severe ED with unsuccessful intracavernosal injection therapy in 21%, post‐radical prostatectomy 14.7%, androgen deprivation therapy, with or without brachytherapy or external radiotherapy, for prostate cancer in 7%, post‐penile fracture in 2.1%, post‐redo‐hypospadias repair 0.7%, and post‐priapism in 0.7%. In cases of ED and PD, the mean deviation of the penile axis was 45° (range, 0‐100°). The mean subjective penile shortening reported by patients was 3.4 cm (range, 1‐7 cm), and shaft constriction was present in 53.8%. Malleable penile prostheses were used in 133 patients and inflatable penile prostheses were inserted in 10 patients. The median follow‐up was 9.7 months (range, 6‐18 months). The mean penile length gain was 3.1 cm (range, 2‐7 cm). No penile prosthesis infection caused device explantation. The average IIEF score increased from 24 points at baseline to 60 points at the six‐month follow‐up. Conclusion Penile length and girth restoration based on our modified “sliding technique” is a safe and effective procedure. The elimination of grafting saves operative time and consequently, decreases infection risk and costs associated with surgery.
      PubDate: 2015-01-28T04:34:11.619848-05:
      DOI: 10.1111/bju.13065
  • Cigarette smoking during external beam radiation therapy for prostate
           cancer is associated with an increased risk of prostate
           cancer‐specific mortality and treatment‐related toxicity
    • Authors: Emily Steinberger; Marisa Kollmeier, Sean McBride, Caroline Novak, Xin Pei, Michael J. Zelefsky
      Pages: n/a - n/a
      Abstract: Objective To evaluate whether a history of smoking or smoking during therapy after external beam radiotherapy (EBRT) for clinically localised prostate cancer is associated with increased treatment‐related toxicity or disease progression. Patients and Methods Of 2358 patients receiving EBRT for prostate cancer between 1988 and 2005, 2156 had chart‐recorded smoking histories. Patients were classified as ‘never smokers’, ‘current smokers’, ‘former smokers’, and ‘current smoking unknown’. Variables considered included quantity of tobacco use in pack‐years, duration of smoking, and, for former smokers, how long before initiation of RT the patient quit smoking, when available. The median EBRT dose was 8100 Gy and the median follow‐up was 95 months. Toxicity was graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events. Results Current smoking significantly increased the risks of both prostate‐specific antigen relapse [hazard ratio (HR) 1.4, P = 0.02] and distant metastases (HR 2.37, P < 0.001), as well as prostate cancer‐specific death (HR 2.25, P < 0.001). Multivariate analysis showed that smoking was also associated with increased risk of EBRT‐related genitourinary toxicities (current smoker, HR 1.8, P = 0.02; former smoker, HR 1.45, P = 0.01). Smoking did not increase gastrointestinal toxicity. Conclusions Current smokers with prostate cancer are at increased risk of biochemical recurrence, distant metastasis, and prostate cancer‐related mortality after definitive RT to the prostate. Current and former smokers, regardless of duration and quantity of exposure, are at an increased risk of long‐term genitourinary toxicity after EBRT. Oncologists should encourage patients to participate in smoking‐cessation programmes before therapy to potentially lower their risk of relapsing disease and post‐treatment toxicities.
      PubDate: 2015-01-27T01:13:36.12883-05:0
      DOI: 10.1111/bju.12969
  • Identification of binding sites for C‐terminal
           pro‐gastrin‐releasing peptide (GRP)‐derived peptides in
           renal cell carcinoma: a potential target for future therapy
    • Authors: Joseph Ischia; Oneel Patel, Kapil Sethi, Marianne S. Nordlund, Damien Bolton, Arthur Shulkes, Graham S. Baldwin
      Pages: n/a - n/a
      Abstract: Objective To determine the expression and biology of the neuroendocrine growth factor gastrin‐releasing peptide (GRP) and other proGRP‐derived peptides in renal cancer. Materials and Methods Receptor binding studies, enzyme‐linked immunosorbent assay (ELISA) and radioimmunoassay, were used to quantitate the presence of proGRP‐derived peptide receptors and their ligands in renal cancer cell lines and human renal cancers. Biological activity of proGRP peptides was confirmed with proliferation, migration, and extracellular‐signal‐regulated kinases 1 and 2 (ERK1/2) activation assays in vitro. In vivo, ACHN renal cancer xenografts were treated with proGRP‐derived peptides to assess tumour size and necrosis. hypoxia‐inducible factor 1α (HIF1α) and vascular endothelial growth factor (VEGF) expression were investigated with Western blotting and ELISA respectively, to determine the possible contribution of the proGRP peptides to tumour viability. Results In ACHN cells that expressed both proGRP‐ and GRP‐receptors, the expression of proGRP binding sites was 80‐fold greater than the GRP‐receptor (GRPR). C‐terminal proGRP‐derived peptides stimulated the activation of ERK1/2, but with a different time course to GRP, consistent with the suggestion that these peptides may have unique cellular functions. Both GRP and proGRP47–68 stimulated proliferation and migration of ACHN cells in vitro, but only GRP reduced the extent of tumour necrosis in ACHN xenografts. GRP, but not proGRP47–68, was able to induce HIF1α and VEGF expression in ACHN cells. This may account in part for the reduction in necrosis after GRP treatment. C‐terminal proGRP‐derived peptides were present in all three renal cancer cell lines and a panel of human renal cancers, but mature amidated GRP was absent. Conclusion C‐terminal proGRP peptides are more abundant in renal cancers and their cell lines than the more extensively studied amidated peptide, GRP. These results suggest that C‐terminal proGRP‐derived peptides may be a better target for novel renal cancer treatments.
      PubDate: 2015-01-26T04:58:38.857083-05:
      DOI: 10.1111/bju.12886
  • Impact of surgeon volume on the morbidity and costs of radical cystectomy
           in the USA: a contemporary population‐based analysis
    • Authors: Jeffrey J. Leow; Stephen Reese, Quoc‐Dien Trinh, Joaquim Bellmunt, Benjamin I. Chung, Adam S. Kibel, Steven L. Chang
      Pages: n/a - n/a
      Abstract: Objectives To evaluate the relationship between surgeon volume of radical cystectomy (RC) and postoperative morbidity, and to assess the economic burden of bladder cancer in the USA. Methods We captured all patients who underwent RC (International Classification of Diseases, ninth revision, code 57.71) between 2003 and 2010, using a nationwide hospital discharge database. Patient, hospital and surgical characteristics were evaluated. The annual volume of RCs performed by the surgeons was divided into quintiles. Multivariable regression models were developed, adjusting for clustering and survey weighting, to evaluate the outcomes, including 90‐day major complications (Clavien grade III–V) and direct patient costs. We adjusted for clustering and weighting to achieve a nationally representative analysis. Results The weighted cohort included 49 792 patients who underwent RC, with an overall 90‐day major complication rate of 16.2%. Compared with surgeons performing one RC annually, surgeons performing ≥7 RCs each year had 45% lower odds of major complications (odds ratio [OR] 0.55; P < 0.001) and lower costs by $1690 (P = 0.02). Results were consistent when we analysed surgeon volume as a continuous variable and when we examined the surgeons with the highest volumes (≥28 cases annually), which showed markedly lower odds of major complications compared with the surgeons with the lowest volumes (OR 0.45, 95% CI 0.31–0.67; P < 0.001). Compared with patients who did not have any complications, those who had a major complication were associated with significantly higher 90‐day median direct hospital costs ($43 965 vs $24 341; P < 0.001). Conclusions We showed that there was an inverse relationship between surgeon volume and the development of postoperative 90‐day major complication rates as well as direct hospital costs. Centralisation of RC to surgeons with higher volumes may reduce the development of postoperative major complications, thereby decreasing the burden of bladder cancer on the healthcare system.
      PubDate: 2015-01-26T04:49:56.336423-05:
      DOI: 10.1111/bju.12749
  • The social media revolution is changing the conference experience:
           analytics and trends from eight international meetings
    • Authors: Sarah E. Wilkinson; Marnique Y. Basto, Greta Perovic, Nathan Lawrentschuk, Declan G. Murphy
      Pages: n/a - n/a
      Abstract: Objective To analyse the use of Twitter at urology conferences to enhance the social media conference experience. Materials and Methods We prospectively registered the hashtags of eight international urology conferences taking place in 2013, using the social media metrics website, In addition, we prospectively registered the hashtag for the European Association of Urology (EAU) Annual Congress for 3 consecutive years (2012–2014) to analyse the trend in the use of Twitter at a particular meeting. Metrics including number of ‘tweets’, number of participants, tweet traffic per day, and overall digital impressions, which were captured for 5 days before each conference, the conference itself, and the following 2 days. We also measured corresponding social media activity at a very large non‐urology meeting (the American Society of Clinical Oncology) for comparative purposes. Results Twitter activity was noted at all eight conferences in 2013. In all, 12 363 tweets were sent generating over 14 million impressions. The number of participants tweeting at each meeting varied from 80 (Congress of the Société Internationale d'Urologie, #SIU2013) to 573 (the American Urological Association, #AUA13). Overall, the AUA meeting (#AUA13) generated the most Twitter activity with >8.6 million impressions and a total of 4663 tweets over the peri‐conference period. It also had the most impressions and tweets per day over this period, at 717 000 and 389, respectively. The EAU Annual Congress 2013 (#EAU13) generated 1.74 million impressions from a total of 1762 tweets from 236 participants. For trends in Twitter use, there was a very sharp rise in Twitter activity at the EAU Annual Congress between 2012 and 2014. Over this 3‐year period, the number of participants increased almost 10‐fold, leading to an increase in the number of tweets from 347 to almost 6000. At #EAU14, digital impressions reached 7.35 million with 5903 tweets sent by 797 participants. Conclusions Urological conferences, to a varying extent, have adopted social media as a means of amplifying the conference experience to a wider audience, generating international engagement and global reach. Twitter is a very powerful tool that amplifies the content of scientific meetings, and conference organisers should put in place strategies to capitalise on this.
      PubDate: 2015-01-26T04:49:45.434893-05:
      DOI: 10.1111/bju.12910
  • Adjuvant cisplatin‐based combined chemotherapy for lymph node
           (LN)‐positive urothelial carcinoma of the bladder (UCB) after
           radical cystectomy (RC): a retrospective international study of >1500
    • Authors: Ilaria Lucca; Morgan Rouprêt, Luis Kluth, Michael Rink, Derya Tilki, Harun Fajkovic, Wassim Kassouf, Sebastian L. Hofbauer, Michela Martino, Pierre I. Karakiewicz, Alberto Briganti, Quoc‐dien Trinh, Christian Seitz, Hans‐Martin Fritsche, Maximilian Burger, Yair Lotan, Gero Kramer, Shahrokh F. Shariat, Tobias Klatte
      Pages: n/a - n/a
      Abstract: Objective To compare outcomes of patients with lymph node (LN)‐positive urothelial carcinoma of the bladder (UCB) treated with or without cisplatin‐based combined adjuvant chemotherapy (AC) after radical cystectomy (RC). Patients and Methods We retrospectively analysed 1523 patients with LN‐positive UCB, who underwent RC with bilateral pelvic LN dissection. All patients had no evidence of disease after RC. AC was administered within 3 months. Competing‐risks models were applied to compare UCB‐related mortality. Results Of the 1523 patients, 874 (57.4%) received AC. The cumulative 1‐, 2‐ and 5‐year UCB‐related mortality rates for all patients were 16%, 36% and 56%, respectively. Administration of AC was associated with an 18% relative reduction in the risk of UCB‐related death (subhazard ratio 0.82, P = 0.005). The absolute reduction in mortality was 3.5% at 5 years. The positive effect of AC was detectable in patients aged ≤70 years, in women, in pT3–4 disease, and in those with a higher LN density and lymphovascular invasion. This study is limited by its retrospective and non‐randomised design, selection bias, the absence of central pathological review and lack in standardisation of LN dissection and cisplatin‐based protocols. Conclusion AC seems to reduce UCB‐related mortality in patients with LN‐positive UCB after RC. Younger patients, women and those with high‐risk features such as pT3–4 disease, a higher LN density and lymphovascular invasion appear to benefit most. Appropriately powered prospective randomised trials are necessary to confirm these findings.
      PubDate: 2015-01-26T04:49:30.889846-05:
      DOI: 10.1111/bju.12829
  • Impact of the International Continence Society (ICS) report on the
           standardisation of terminology in nocturia on the quality of reports on
           nocturia and nocturnal polyuria: a systematic review
    • Authors: Ilse Hofmeester; Boudewijn J. Kollen, Martijn G. Steffens, J.L.H.Ruud Bosch, Marcus J. Drake, Jeffrey P. Weiss, Marco H. Blanker
      Pages: n/a - n/a
      Abstract: Objective To systematically review and evaluate the impact of the International Continence Society (ICS)‐2002 report on standardisation of terminology in nocturia, on publications reporting on nocturia and nocturnal polyuria (NP). In 2002, the ICS defined NP as a Nocturnal Polyuria Index (nocturnal urine volume/total 24‐h urine volume) of >0.2–0.33, depending on age. Materials and Methods In April 2013 the PubMed and Embase databases were searched for studies (in English, German, French or Dutch) based on original data and adult participants, investigating the relationship between nocturia and NP. A methodological quality assessment was performed, including scores on external validity, internal validity and informativeness. Quality scores of items were compared between studies published before and after the ICS‐2002 report. Results The search yielded 78 publications based on 66 studies. Quality scores of studies were generally high for internal validity (median 5, interquartile range [IQR] 4–6) but low for external validity. After publication of the ICS‐2002 report, external validity showed a significant change from 1 (IQR 1–2) to 2 (IQR 1–2.5; P = 0.019). Nocturia remained undefined in 12 studies. In all, 19 different definitions were used for NP, most often being the ICS (or similar) definition: this covered 52% (n = 11) of studies before and 66% (n = 27) after the ICS‐2002 report. Clear definitions of both nocturia and NP were identified in 67% and 76% before, and in 88% and 88% of the studies after the ICS‐2002 report, respectively. Conclusion The ICS‐2002 report on standardisation of terminology in nocturia appears to have had a beneficial impact on reporting definitions of nocturia and NP, enabling better interpretation of results and comparisons between research projects. Because the external validity of most of the 66 studies is considered a problem, the results of these studies may not be validly extrapolated to other populations. The ICS definition of NP is used most often. However, its discriminative value seems limited due to the estimated difference of 0.6 nocturnal voids between individuals with and without NP. Refinement of current definitions based on robust research is required. Based on pathophysiological reasoning, we argue that it may be more appropriate to define NP based on nocturnal urine production or nocturnal voided volumes, rather than on a diurnal urine production pattern.
      PubDate: 2015-01-26T04:48:32.887211-05:
      DOI: 10.1111/bju.12753
  • A lot of questions (and a few answers…) in retroperitoneal fibrosis
    • Authors: Archie Fernando; James Pattison, Catherine Horsfield, Matthew Bultitude, David D'Cruz, Tim O'Brien
      PubDate: 2015-01-23T01:25:45.61947-05:0
      DOI: 10.1111/bju.13061
  • Transrectal ultrasonography (TRUS)‐guided pelvic plexus block to
           reduce pain during prostate biopsy: a randomised controlled trial
    • Authors: Tarun Jindal; Subhabrata Mukherjee, Rajan K. Sinha, Mir R. Kamal, Nabankur Ghosh, Barun Saha, Nilanjan Mitra, Pramod K. Sharma, Soumendra N. Mandal, Dilip Karmakar
      Abstract: Objective To assess the role of pelvic plexus block (PPB) in reducing pain during transrectal ultrasonography(TRUS)‐guided prostate biopsy, compared with the conventional periprostatic nerve block (PNB). Patients and Methods A prospective, double‐blind observational study was conducted with patients being randomised into three groups. Group‐1 (47 patients) received intrarectal local anaesthesia (IRLA) with 10 mL 2% lignocaine jelly along with pelvic plexus block (PPB) with 2.5 mL 2% lignocaine injection bilaterally. Group‐2 (46 patients) received IRLA with periprostatic nerve block (PNB). Group‐3 (46 patients) received only IRLA without any type of nerve block. The patients were requested to rate the level of pain from 0 to 10 on a visual analogue scale (VAS) at two time points: VAS‐1: during biopsy procedure and VAS‐2: 30 min after the procedure. Results The mean age of the patients, mean volume of the prostates and mean serum PSA values were comparable among the three groups. The mean pain score during biopsy was significantly less in the PPB group [mean (range) sore of 2.91 (2–4)] compared with the PNB group [mean (range) score of 4 (3–5)], and both these groups were superior to the no nerve block group [mean score of 5.4 (3–7)]. There was no significant difference between the mean pain scores, 30 min after the procedure among the three groups with the mean (range) scores being 2.75 (2–4), 2.83 (2–4) and 2.85 (2–4), respectively. Conclusion PPB is superior to conventional periprostatic nerve block (PNB) for pain control during TRUS‐guided biopsy and both are in turn superior to no nerve block.
      PubDate: 2015-01-21T11:50:59.71916-05:0
      DOI: 10.1111/bju.12872
  • Short‐term pretreatment with a dual 5α‐reductase
           inhibitor before bipolar transurethral resection of the prostate
           (B‐TURP): evaluation of prostate vascularity and decreased surgical
           blood loss in large prostates
    • Authors: Gian Maria Busetto; Riccardo Giovannone, Gabriele Antonini, Antonella Rossi, Francesco Del Giudice, Stefano Tricarico, Giulia Ragonesi, Vincenzo Gentile, Ettore De Berardinis
      Abstract: Objective To investigate if short‐term treatment with dutasteride (8 weeks) before bipolar transurethral resection of the prostate (B‐TURP) can reduce intraoperative bleeding, as dutasteride a dual 5α‐reductase inhibitor (5‐ARI) blocks the conversion of testosterone into its active form dihydrotestosterone (DHT), and reduces prostate volume and prostate‐specific antigen (PSA) levels, while increasing urinary flow rate. Patients and Methods In all, 259 patients were enrolled and randomised to two groups: Group A, receiving placebo and Group B, receiving dutasteride (0.5 mg daily for 8 weeks). Blood samples were taken before and after B‐TURP for serum chemistry evaluation. In particular we evaluated blood parameters associated with blood loss [haemoglobin (Hb) and haematocrit (Ht)] and prostate vascularity [vascular endothelial growth factor (VEGF) immunoreactivity and microvessel density (MVD) using cluster of differentiation 34 (CD34) immunoreactivity]. Results Total testosterone, DHT, PSA level and prostate volume were evaluated and with the exception of DHT and PSA level there was no statistically significant differences between the groups. When comparing changes in Hb and Ht between Group A and Group B before and after B‐TURP, there was a statistically significant difference only in patients with large prostates of ≥50 mL (ΔHb 3.86 vs 2.05 g/dL and ΔHt 4.98 vs 2.64%, in Groups A and B, respectively). There was no significant difference in MVD and VEGF index in prostates of
      PubDate: 2015-01-21T11:50:47.942391-05:
      DOI: 10.1111/bju.12917
  • Transient receptor potential channel modulators as pharmacological
           treatments for lower urinary tract symptoms (LUTS): myth or reality'
    • Authors: Yves Deruyver; Thomas Voets, Dirk De Ridder, Wouter Everaerts
      Abstract: Transient receptor potential (TRP) channels belong to the most intensely pursued drug targets of the last decade. These ion channels are considered promising targets for the treatment of pain, hypersensitivity disorders and lower urinary tract symptoms (LUTS). The aim of the present review is to discuss to what extent TRP channels have adhered to their promise as new pharmacological targets in the lower urinary tract (LUT) and to outline the challenges that lie ahead. TRP vanilloid 1 (TRPV1) agonists have proven their efficacy in the treatment of neurogenic detrusor overactivity (DO), albeit at the expense of prolonged adverse effects as pelvic ‘burning’ pain, sensory urgency and haematuria. TRPV1 antagonists have been very successful in preclinical studies to treat pain and DO. However, clinical trials with the first generation TRPV1 antagonists were terminated early due to hyperthermia, a serious, on‐target, side‐effect. TRP vanilloid 4 (TRPV4), TRP ankyrin 1 (TRPA1) and TRP melastatin 8 (TRPM8) have important sensory functions in the LUT. Antagonists of these channels have shown their potential in pre‐clinical studies of LUT dysfunction and are awaiting clinical validation.
      PubDate: 2015-01-21T11:50:35.25774-05:0
      DOI: 10.1111/bju.12876
  • Radiation exposure to a pregnant urological surgeon – what is
    • Authors: Angela M. Birnie; Stephen R. Keoghane
      PubDate: 2015-01-21T11:50:21.313759-05:
      DOI: 10.1111/bju.12923
  • Ureteroscopy for stone disease in the paediatric population: a systematic
    • Authors: Hiro Ishii; Stephen Griffin, Bhaskar K. Somani
      Abstract: The aim of the present review was to look at the role of ureteroscopy (URS) for treatment of paediatric stone disease. We conducted a systematic review using studies identified by a literature search between January 1990 and May 2013. All English‐language articles reporting on a minimum of 50 patients aged ≤18 years treated with URS for stone disease were included. Two reviewers independently extracted the data from each study. A total of 14 studies (1718 procedures) were reported in patients with a mean (range) age of 7.8 (0.25–18.0) years. The mean (range) stone burden was 9.8 (1–30) mm and the mean (range) stone‐free rate (SFR) 87.5 (58–100)% with initial therapeutic URS. The majority of these stones were in the ureter (n = 1427, 83.4%). There were 180 (10.5%) Clavien I–III complications and 38 cases (2.2%) where there was a failure to complete the initial ureteroscopic procedure and an alternative procedure was performed. To assess the impact of age on failure rate and complications, studies were subcategorized into those that included children with either a mean age 6 years. (10 studies, 1377 procedures). A higher failure rate (4.4 vs 1.7%) and a higher complication rate (24.0 vs 7.1%) were observed in children whose mean age was
      PubDate: 2015-01-21T11:46:46.010589-05:
      DOI: 10.1111/bju.12927
  • Clinical utility of 18F‐fluorocholine positron‐emission
           tomography/computed tomography (PET/CT) in biochemical relapse of prostate
           cancer after radical treatment: results of a multicentre study
    • Authors: Sonia Rodado‐Marina; Mónica Coronado‐Poggio, Ana María García‐Vicente, Jose Ramón García‐Garzón, Aurora Crespo Jara, Antonio Maldonado‐Suárez, Antonio Rodríguez‐Fernández
      Abstract: Objective To evaluate 18F‐fluorocholine positron‐emission tomography (PET)/computed tomography (CT) in restaging patients with a history of prostate adenocarcinoma who have biochemical relapse after early radical treatment, and to correlate the technique's disease detection rate with a set of variables and clinical and pathological parameters. Patients and Methods This was a retrospective multicentre study that included 374 patients referred for choline‐PET/CT who had biochemical relapse. In all, 233 patients who met the following inclusion criteria were analysed: diagnosis of prostate cancer; early radical treatment; biochemical relapse; main clinical and pathological variables; and clinical, pathological and imaging data needed to validate the results. Criteria used to validate the PET/CT: findings from other imaging techniques, clinical follow‐up, treatment response and histological analysis. Different statistical tests were used depending on the distribution of the data to correlate the results of the choline‐PET/CT with qualitative [T stage, N stage, early radical prostatectomy (RP) vs other treatments, hormone therapy concomitant to choline‐PET/CT] and quantitative [age, Gleason score, prostate‐specific antigen (PSA) levels at diagnosis, PSA nadir, PSA level on the day of the choline‐PET/CT (Trigger PSA) and PSA doubling time (PSADT)] variables. We analysed whether there were independent predictive factors associated with positive PET/CT results. Results Choline‐PET/CT was positive in 111 of 233 patients (detection rate 47.6%) and negative in 122 (52.4%). Disease locations: prostate or prostate bed in 26 patients (23.4%); regional and/or distant lymph nodes in 52 (46.8%); and metastatic bone disease in 33 (29.7%). Positive findings were validated by: results from other imaging techniques in 35 patients (15.0%); at least 6 months of clinical follow‐up in 136 (58.4%); treatment response in 24 (10.3%); histological analysis of lesions in 17 (7.3%); and follow‐up plus imaging results in 21 (9.0%). The statistical analysis of qualitative variables, corresponding to patients' clinical characteristics, and the positive/negative final PET/CT results revealed that only whether or not early treatment with RP was done was statistically significant (P < 0.001), with the number of positive results higher in patients who did not undergo a RP. Among the quantitative variables, Gleason score, Trigger PSA and PSADT clearly differentiated the two patient groups (positive and negative choline‐PET/CT: P = 0.010, P = 0.001 and P = 0.025, respectively). A Gleason score of
      PubDate: 2015-01-21T11:46:33.860702-05:
      DOI: 10.1111/bju.12953
  • Brachytherapy for prostate cancer: feasible but oncological equivalence
    • Authors: Debasish Sundi; Misop Han
      PubDate: 2015-01-21T11:46:20.039366-05:
      DOI: 10.1111/bju.12837
  • Oncological outcomes of cryosurgery as primary treatment in T3 prostate
           cancer: experience of a single centre
    • Authors: Zhi Guo; Tongguo Si, Xueling Yang, Yan Xu
      Abstract: Objective To assess the oncological outcomes and determine prognostic factors for overall survival (OS), cancer‐specific survival (CSS), and biochemical progression‐free survival (BPFS) after cryosurgery for clinical stage T3 prostate cancer. Patients and Methods Between 2002 and 2007, 75 patients with clinical stage T3 prostate cancer received cryosurgery as primary treatment in our institution. No adjuvant treatment was provided until biochemical failure. After biochemical failure, hormone therapy was administered. Kaplan–Meier analysis was used to calculate the OS, CSS, and BPFS. Cox regression was used to identify factors predictive of survival. Results Clinical stage T3a (cT3a) was detected in 60% (45/75) of patients and cT3b detected in 40% (30/75). The 5‐year OS, CSS, and BPFS rates were 85.3%, 92.0%, and 48%, respectively. There was a significant difference when comparing the pT3a with the pT3b group for 5‐year OS (88.9% vs 80%, P = 0.02) and BPFS (55.6% vs 36.7%, P = 0.01), but there was no difference in CSS (93.3% vs 90%, P = 0.63). Stage, Gleason score, and nadir prostate‐specific antigen (PSA) were associated with BPFS, while Gleason score and nadir PSA were the most significant predictors for CSS. Conclusions Cryosurgery can offer good 5‐year OS, CSS, and BPFS rates for cT3 prostate cancer, and there was no difference between T3a and T3b for CSS. Gleason score and nadir PSA were the most significant predictors of survival. Further clinical trials are warranted for evaluating the role of cryosurgery for cT3 prostate cancer.
      PubDate: 2015-01-21T11:46:07.06379-05:0
      DOI: 10.1111/bju.12914
  • Extended pelvic lymph node dissection in patients with prostate cancer
           previously treated with surgery for lower urinary tract symptoms
    • Authors: Nicola Fossati; Daniel D. Sjoberg, Umberto Capitanio, Giorgio Gandaglia, Alessandro Larcher, Alessandro Nini, Vincenzo Mirone, Andrew J Vickers, Francesco Montorsi, Alberto Briganti
      Abstract: Objectives To evaluate the effect of previous prostate surgery performed for lower urinary tract symptoms (LUTS) on the ability to predict lymph node invasion (LNI) in patients subsequently diagnosed with prostate cancer, testing two widely used LNI predictive models. Patients and Methods From 1990 to 2012, we collected data on 4734 patients with prostate cancer treated with radical prostatectomy and extended pelvic LN dissection (ePLND). Of these, 4453 (94%) had no prior prostate surgery (‘naïve patients’), while 286 (6%) had previously undergone surgery for LUTS. Two LNI prediction models based on patients treated with ePLND were evaluated using the receiver operating characteristic‐derived area under the curve (AUC), the calibration plot method, and decision‐curve analyses. Results The rate of LNI was 12%, while the median number of LNs removed was 15 in both groups (P = 0.9). The two tested nomograms provided more accurate prediction in naïve patients than for those previously treated with prostate surgery for LUTS (AUC: 82% and 81% vs 68% and 71%, P = 0.01 and P = 0.04, respectively). In naïve patients the surgeon would have missed one LNI for every 53 and 34 avoided ePLND using the Briganti and Godoy nomograms, respectively; in patients previously treated with surgery for LUTS, a LNI would have been missed in 13 and 21 patients not undergoing ePLND. Conclusion The accuracy and the clinical net‐benefit of LNI prediction tools decrease significantly in patients with prior prostate surgery for LUTS. These models should be avoided in such patients, who should undergo routine ePLND.
      PubDate: 2015-01-21T11:43:02.903317-05:
      DOI: 10.1111/bju.12912
  • Pelvic recurrence after radical cystectomy: a call to arms
    • Authors: Stephen B. Williams; Ashish M. Kamat, Donald L. Lamm
      PubDate: 2015-01-21T11:42:55.308395-05:
      DOI: 10.1111/bju.12952
  • Cardiopulmonary reserve as determined by cardiopulmonary exercise testing
           correlates with length of stay and predicts complications after radical
    • Authors: Stephen Tolchard; Johanna Angell, Mark Pyke, Simon Lewis, Nicholas Dodds, Alia Darweish, Paul White, David Gillatt
      Abstract: Objective To investigate whether poor preoperative cardiopulmonary reserve and comorbid state dictate high‐risk status and can predict complications in patients undergoing radical cystectomy (RC). Patients and Methods In all, 105 consecutive patients with transitional cell carcinoma (TCC; stage T1–T3) undergoing robot‐assisted (38 patients) or open (67) RC in a single UK centre underwent preoperative cardiopulmonary exercise testing (CPET). Prospective primary outcome variables were all‐cause complications and postoperative length of stay (LOS). Binary logistic regression analysis identified potential predictive factor(s) and the predictive accuracy of CPET for all‐cause complications was examined using receiver operator characteristic (ROC) curve analysis. Correlations analysis employed Spearman's rank correlation and group comparison, the Mann–Whitney U‐test and Fisher's exact test. Any relationships were confirmed using the Mantel–Haenszel common odds ratio estimate, Kaplan–Meier analysis and the chi‐squared test. Results The anaerobic threshold (AT) was negatively (r = −206, P = 0.035), and the ventilatory equivalent for carbon dioxide (VE/VCO2) positively (r = 0.324, P = 0.001) correlated with complications and LOS. Logistic regression analysis identified low AT (50% of patients presenting for RC had significant heart failure, whereas preoperatively only very few (2%) had this diagnosis. Analysis using the Mann–Whitney test showed that a VE/VCO2 ≥33 was the most significant determinant of LOS (P = 0.004). Kaplan–Meier analysis showed that patients in this group had an additional median LOS of 4 days (P = 0.008). Finally, patients with an American Society of Anesthesiologists grade of 3 (ASA 3) and those on long‐term β‐blocker therapy were found to be at particular risk of myocardial infarction (MI) and death after RC with odds ratios of 4.0 (95% CI 1.05–15.2; P = 0.042) and 6.3 (95% CI 1.60–24.8; P = 0.008). Conclusion Patients with poor cardiopulmonary reserve and hypertension are at higher risk of postoperative complications and have increased LOS after RC. Heart failure is known to be a significant determinant of perioperative death and is significantly under diagnosed in this patient group.
      PubDate: 2015-01-21T11:41:27.703294-05:
      DOI: 10.1111/bju.12895
  • Risk stratification for bladder recurrence of upper urinary tract
           urothelial carcinoma after radical nephroureterectomy
    • Authors: Junichiro Ishioka; Kazutaka Saito, Toshiki Kijima, Yasukazu Nakanishi, Soichiro Yoshida, Minato Yokoyama, Yoh Matsuoka, Noboru Numao, Fumitaka Koga, Hitoshi Masuda, Yasuhisa Fujii, Yasuyuki Sakai, Chizuru Arisawa, Tetsuo Okuno, Katsuhi Nagahama, Shigeyoshi Kamata, Mizuaki Sakura, Junji Yonese, Shinji Morimoto, Akira Noro, Toshihiko Tsujii, Satoshi Kitahara, Shuichi Gotoh, Yotsuo Higashi, Kazunori Kihara
      Abstract: Objectives To identify risk factors and develop a model for predicting recurrence of upper urinary tract urothelial carcinoma (UTUC) in the bladder in patients without a history of bladder cancer after radical nephroureterectomy (RNU). Patients and Methods We retrospectively reviewed 754 patients with UTUC without prior or concurrent bladder cancer or distant metastasis at 13 institutions in Japan. Univariate and multivariate Fine and Gray competing risks proportional hazards models were used to examine the cumulative incidence of bladder recurrence of UTUC. A risk stratification model and a nomogram were constructed. Two prediction models were compared using the concordance index (c‐index) focusing on predictive accuracy and decision‐curve analysis, which indicate whether a model is appropriate for decision‐making and determining subsequent patient prognosis. Results The cumulative incidence rates of bladder UTUC recurrence at 1 and 5 years were 15 and 29%, respectively; the median time to bladder UTUC recurrence was 10 months. Multivariate analysis showed that papillary tumour architecture, absence of lymphovascular invasion and higher pathological T stage were both predictive factors for bladder cancer recurrence. The predictive accuracy of the risk stratification model and the nomogram for bladder cancer recurrence were not different (c‐index: 0.60 and 0.62). According to the decision‐curve analysis, the risk stratification was an acceptable model because the net benefit of the risk stratification was equivalent to that of the nomogram. The overall cumulative incidence rates of bladder cancer 5 years after RNU were 10, 26 and 44% in the low‐, intermediate‐ and high‐risk groups, respectively. Conclusions We identified risk factors and developed a risk stratification model for UTUC recurrence in the bladder after RNU. This model could be used to provide both an individualised strategy to prevent recurrence and a risk‐stratified surveillance protocol.
      PubDate: 2015-01-21T11:41:15.190423-05:
      DOI: 10.1111/bju.12707
  • Nomogram to predict the benefit from salvage systemic therapy for advanced
           urothelial carcinoma
    • Authors: Guru Sonpavde; Gregory R. Pond, Ronan Fougeray, Joaquim Bellmunt
      PubDate: 2015-01-21T11:41:02.504322-05:
      DOI: 10.1111/bju.12922
  • Causes of death in men with localised prostate cancer: a nationwide,
           population‐based study
    • Authors: Mieke Van Hemelrijck; Yasin Folkvaljon, Jan Adolfsson, Olof Akre, Lars Holmberg, Hans Garmo, Pär Stattin
      Abstract: Objective To detail the distribution of causes of death for localised prostate cancer (PCa). Patients and Methods PCBase Sweden links the Swedish National Prostate Cancer Register (NPCR) with other nation‐wide population‐based healthcare registers. We selected all 57,187 men diagnosed with localised PCa between 1997‐2009 and their 114,374 age‐ and county‐matched PCa‐free control men. Mortality was calculated using competing risk regression analyses, taking into account PCa risk category, age, and Charlson comorbidity index (CCI). Results In men with low risk PCa, all‐cause mortality was lower compared to corresponding PCa‐free men: 10‐year all‐cause mortality was 18% for men diagnosed at age 70 with CCI=0 and 21% among corresponding controls. 31% of these cases died of CVD compared to 37% of their controls. For men with low‐risk PCa, 10‐year PCa‐mortality was 0.4%, 1%, and 3% when diagnosed at age 50, 60, and 70, respectively. PCa was the third most common cause of death (18%), after CVD (31%) and other cancers (30%). In contrast, PCa was the most common cause of death in men with intermediate and high‐risk localised PCa. Conclusions Men with low‐risk PCa had lower all‐cause mortality than PCa‐free men due to lower cardiovascular mortality, driven by early detection selection. However, for men with intermediate or high‐risk disease, PCa death was substantial, irrespective of CCI, and this was even more pronounced for those diagnosed at age 50 or 60.
      PubDate: 2015-01-21T05:43:30.078348-05:
      DOI: 10.1111/bju.13059
  • Intermediate Analysis of A Phase Ii Trial Assessing Gemcitabine and
           Cisplatin in Locoregional or Metastatic Penile Squamous Cell Carcinoma
    • Authors: N. Houédé; L. Dupuy, A. Fléchon, P. Beuzeboc, G. Gravis, B. Laguerre, C. Théodore, S. Culine, T. Filleron, C. Chevreau
      Abstract: Objective Patients with squamous cell carcinoma of the penis and unresected loco‐regional lymph nodes and/or distant metastases have a poor prognostic with no standard of chemotherapy. We performed a phase II study evaluating the association of gemcitabine and cisplatin in this population. Patients and method Eligible patients had histological confirmed squamous cell carcinoma of the penis with unresected locoregional lymph nodes and/or distant metastases at initial diagnosis or at relapse, and measurable disease as defined by RECIST criteria. Patients were treated with the association of gemcitabine 1250 mg/m2 on day 1 over 30 minutes and cisplatin 50 mg/m2 on day 1 over 1 hour, every two weeks. Primary endpoint was the objective response rate; secondary endpoints were time to progression (TTP) and overall survival (OS). Results Twenty five patients were included in the first step of the study between February 2004 and January 2010 and received a median of 5 cycles. For ITT population, 2 patients (95%CI = [0.98 ;26.0]) presented an objective response. Thirteen patients had stable disease (52% 95%CI = [35.5‐76.8]). Median TTP is estimated at 5.48 months (95%CI = [2.40 ;11.73]). After a median follow up of 26.97 months (95%CI = [17.77 ; Not reached]), nine patients were still alive. OS median and 2 years OS rates are respectively estimated at 14.98 months (95%CI = [ 9.76 ;32.9]) and 39.32% (95%CI = [19.15 ; 59.03]). Eleven patients had a SAE (44%) within 24% were relied to chemotherapy. Conclusion The every two weeks administration of the combination of gemcitabine and cisplatin showed non‐significant responses in patients with unresected loco‐regional or metastatic penile squamous cell carcinoma. Despite manageable side effects, this combination cannot be recommended as a standard of care due to disappointing response rates observed in this negative study. Further regimens should be explored to improve the overall survival of these patients with poor prognosis.
      PubDate: 2015-01-20T02:13:49.107331-05:
      DOI: 10.1111/bju.13054
  • Increase of Framingham risk score is associated with severity of Lower
           urinary tract symptoms
    • Authors: Giorgio Ivan Russo; Tommaso Castelli, Salvatore Privitera, Eugenia Fragalà, Vincenzo Favilla, Giulio Reale, Daniele Urzì, Sandro La Vignera, Rosita Condorelli, Aldo E. Calogero, Sebastiano Cimino, Giuseppe Morgia
      Abstract: Objective To determine the relationship between LUTS/BPH and 10‐year risk of CVD assessed by the Framingham Cardiovascular Risk score in a cohort of patients without previous episodes of stroke and/or acute myocardial infarction. Patients and Methods Between September 2010 to September 2014, 336 consecutive patients with BPH related LUTS were prospectively enrolled. The general 10‐year cardiovascular disease Framingham risk score, expressed as a percent and assessing the risk of atherosclerotic cardiovascular disease (CVD) events was calculated for each patients. Respectively, individuals with low risk had 10% or less CVD risk at 10 years, with intermediate risk 10‐20%, and with high risk 20% or more. Logistic regression analyses were carried out to identify variables for predicting Framingham risk score ≥ 10% and moderate‐severe LUTS (IPSS≥ 8) adjusted for confounding factors. Results As category of Framingham risk score increased, we observed higher IPSS (18.0 vs. 18.50 vs. 19.0; p
      PubDate: 2015-01-20T02:13:41.303855-05:
      DOI: 10.1111/bju.13053
  • Sexually transmitted infections, benign prostatic hyperplasia and lower
           urinary tract symptom‐related outcomes: Results from the Prostate,
           Lung, Colorectal, and Ovarian Cancer Screening Trial
    • Authors: Benjamin N. Breyer; Wen‐Yi Huang, Charles S. Rabkin, John F. Alderete, Ratna Pakpahan, Tracey S. Beason, Stacey A. Kenfield, Jerome Mabie, Lawrence Ragard, Kathleen Y. Wolin, Robert L. Grubb III, Gerald L. Andriole, Siobhan Sutcliffe
      Abstract: Objectives The exact pathogenesis of benign prostatic hyperplasia (BPH) and related lower urinary tract symptoms (LUTS) remains unclear; however evidence supports a role of inflammation. One possible source of prostatic inflammation is sexually transmitted infections (STIs), which have been found to be positively related to LUTS in some mostly small case‐control studies or cross‐sectional surveys. The objective of our analysis is to examine whether a history of STIs or positive STI serology is associated with prevalent and incident BPH/LUTS‐related outcomes in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO). Methods Self‐reported history of STIs (gonorrhea, syphilis) was ascertained at baseline, and serological evidence of STIs (Chlamydia trachomatis, Trichomonas vaginalis, HPV‐16, HPV‐18, HSV‐2, HHV‐8, and CMV) was detected in baseline serum specimens. We used data collected on the baseline questionnaire, as well as results from the baseline PSA test and digital rectal exam (DRE), to define prevalent BPH/LUTS‐related outcomes as evidence of LUTS (self‐reported diagnosis of an enlarged prostate/BPH, BPH surgery, or nocturia (waking ≥2 times/night to urinate)) and evidence of prostate enlargement (PSA>1.4 ng/mL or prostate volume ≥30 cc) in men without prostate cancer. We created a similar definition of incident BPH using data from the follow‐up questionnaire completed 5‐13 years after enrollment (self‐reported diagnosis of an enlarged prostate/BPH or nocturia), data on finasteride use during follow‐up, and results from the follow‐up PSA tests and DREs. We used Poisson regression with robust variance estimation to calculate prevalence ratios (PRs) in our cross‐sectional analysis of self‐reported (n=32,900) and serologically‐detected STIs (n=1,143) with prevalent BPH/LUTS, and risk ratios in our prospective analysis of self‐reported STIs with incident BPH/LUTS (n=5,226). Results Generally null results were observed for a self‐reported history of STIs and positive STI serologies with prevalent and incident BPH/LUTS‐related outcomes, with the possible exception of T. vaginalis infection. This STI was positively associated with prevalent nocturia (PR 1.36, 95% confidence interval (CI): 1.18‐1.65), prevalent large prostate volume (PR 1.21 95% CI 1.02‐1.43), and any prevalent BPH/LUTS (PR 1.32 95% CI 1.09‐1.61); too few men had information on both STI serologies and incident BPH/LUTS to investigate associations between T. vaginalis infection and incident BPH/LUTS‐related outcomes. Conclusions Our findings do not support associations of several known STIs with BPH/LUTS‐related outcomes, although T. vaginalis infection may warrant further study.
      PubDate: 2015-01-20T02:13:30.543484-05:
      DOI: 10.1111/bju.13050
  • Complications following artificial urinary sphincter placement after
           radical prostatectomy and radiotherapy: A meta‐analysis
    • Authors: AS Bates; RM Martin, TR Terry
      Abstract: Objective To conduct a systematic review and meta‐analysis of AUS placement following radical prostatectomy (RP) and radiotherapy (EBRT). Materials and methods A systematic database search was conducted using keywords, according to PRISMA guidelines. Published series of AUS insertion were retrieved, according to the inclusion criteria. The Newcastle‐Ottawa Score was used to ascertain the quality of evidence for each study. Surgical results from each case series were extracted. Data were analysed using CMA® statistical software. Results There were 1886 patients available for analysis of surgical revision outcomes, and 949 for persistent urinary incontinence outcomes from 15 and 11 studies respectively. The mean age (SD) was 66.9 ± 1.4 years and the number of patients per study was 126.6 ± 41.7. Average follow up was 36.7 ± 3.9 months (range, 18 – 68). Artificial urinary sphincter revision was higher in RP + EBRT versus RP alone, with a random effects risk ratio of 1.56 (95% Confidence Interval [CI] 1.02 – 2.72; p
      PubDate: 2015-01-20T02:13:23.827974-05:
      DOI: 10.1111/bju.13048
  • Foxp3 expression serves as an early chronic inflammation marker of
           squamous cell differentiation and aggressive pathology of urothelial
           carcinomas in neurological patients
    • Authors: Véronique Phé; Morgan Rouprêt, Olivier Cussenot, Emmanuel Chartier‐Kastler, Xavier Gamé, Eva Compérat
      Abstract: Objective To establish whether the expression of Foxp3 provides specific diagnostic information about neurological patients with urothelial carcinoma of the bladder (UCB). Materials/methods UCB tissue samples from neurological patients were retrieved and compared to control samples. The expression of Foxp3 was analysed via immunohistochemistry of micro‐array tissue sections. The correlation between Foxp3 expression, histological parameters and tumour stage was assessed. Results Overall, 20 UCB tissue samples and 20 others without UCB from neurological patients, and 46 UCB tissue samples from non‐neurological patients were analysed. The distribution of pT of UCB in the neurological patients was as follows: 1 pTa low grade(5%), 3 pTa high grade(15%), 3 pT1(15%), 1 pT2(5%), 7 pT3(35%) and 5 pT4(25%). Squamous cell differentiation was observed in 9 UCB samples (45%). Foxp3 expression was detected in tumour tissues, including 1 pTa high grade, 1 pT1, 1 pT2, 5 pT3 and 5 pT4 tumours. Foxp3 was expressed in 11/13 muscle‐invasive tumours. All tumours displaying squamous cell differentiation expressed Foxp3. Foxp3 was not expressed in the pT3 tumours that displayed sarcomatoid and micropapillary properties. Among the bladder samples without UCB from neurological patients, no expression of Foxp3 was observed. Among the UCB samples from the non‐neurological patients, only 7 cases displayed squamous cell differentiation. All tumours that displayed squamous cell differentiation expressed Foxp3, including 1 pTa high grade, 4 pT3 and 2 pT4 tumours. Other tumours displaying urothelial differentiation did not express Foxp3. The expression of Foxp3 correlated to squamous cell differentiation in neurological(p=0.004) and non‐neurological UCB tissue(p
      PubDate: 2015-01-20T02:13:13.096347-05:
      DOI: 10.1111/bju.13044
  • Post‐operative Radiation Therapy for Patients at High‐risk of
           Recurrence after Radical Prostatectomy: Does Timing Matter'
    • Authors: Charles C. Hsu; Alan T. Paciorek, Matthew R. Cooperberg, Mack Roach, I‐Chow J. Hsu, Peter R. Carroll
      Abstract: Objective To evaluate among prostatectomy patients at high‐risk of recurrence whether the timing of post‐operative radiation therapy (adjuvant, early salvage with detectable post‐prostatectomy PSA, or “late” salvage with PSA>1.0) significantly is associated with overall, prostate‐cancer specific or metastasis‐free survival, in a longitudinal cohort. Patients and Methods Of 6176 prostatectomy patients in the Cancer of the Prostate Strategic Urologic Research Endeavor(CaPSURE), 305 patients with high‐risk pathologic features(margin positivity, Gleason Score(pGS) 8‐10, or pT3‐T4) who underwent post‐operative radiation were examined, either in the adjuvant(≤6 months from surgery with undetectable PSA, N=76) or salvage setting(>6 months after surgery or pre‐radiation PSA>0.1, N=229). Early (PSA≤1.0, N=180) or late salvage radiation(PSA>1.0, N=49) was based on post‐prostatectomy, pre‐radiation PSA. Multivariable Cox regression examined associations with all‐cause mortality and prostate cancer‐specific mortality or metastases(PCSMM). Results After a median of 74 months from prostatectomy, 65 men died(with 37 events of PCSMM). Adjuvant and salvage radiation patients had comparable high‐risk features. Compared to adjuvant, salvage radiation(early or late) had an increased association with all‐cause mortality(hazard ratio[HR] 2.7, p=0.018) and with PCSM(HR 4.0, p=0.015). PCSM‐free survival differed by further stratification of timing, with 10‐year estimates of 88%, 84%, and 71% for adjuvant, early salvage, and late salvage radiation, respectively(P=0.026). For PCSM‐ and overall‐survival, compared to adjuvant RT, late salvage RT had statistically significantly increased risk, however early salvage RT did not. Conclusion This analysis suggests that patients who underwent early salvage radiation with PSA1.0 is associated with worse clinical outcomes.
      PubDate: 2015-01-20T02:13:04.133915-05:
      DOI: 10.1111/bju.13043
  • External urethral sphincter electromyography in asymptomatic women and the
           influence of the menstrual cycle
    • Authors: C. Tawadros; K. Burnett, L.F. Derbyshire, T. Tawadros, N. W. Clarke, C.D. Betts
      Abstract: Objective To investigate by electromyography (EMG), the presence of complex repetitive discharges (CRDs) and decelerating bursts (DBs) in the striated external urethral sphincter during the menstrual cycle in female volunteers with no urinary symptoms and complete bladder emptying. Subjects and methods Healthy female volunteers aged 20‐40 years, with regular menstrual cycles and no urinary symptoms were recruited. Volunteers completed a menstruation chart, urinary symptom questionnaire, pregnancy test, urine dipstick, urinary free flow and post void ultrasound bladder scan. Exclusion criteria included current pregnancy, use of hormonal medication or contraception, body mass index greater than 35, incomplete voiding and a history of pelvic surgery. Eligible participants underwent an external urethral sphincter EMG, using a needle electrode, in the early follicular phase and the mid‐luteal phase of their menstrual cycles. Serum oestradiol and progesterone were measured at each EMG test. Results One hundred and nineteen women enquired about the research and following screening, 18 females were eligible to enter the study phase. Complete results were obtained in 15 women. Thirty EMG tests were undertaken in the 15 asymptomatic women. Sphincter EMG was positive for CRDs and DBs at one or both phases of the menstrual cycle in 8 (53%) of the female volunteers. Three had CRDs and DBs in both early follicular and midluteal phases. Five had normal EMG activity in the early follicular phase and CRDs and DBs in the midluteal phase. No woman had abnormal EMG activity in the early follicular phase and normal activity in the luteal phase. There was no relationship between EMG activity and age, parity or serum levels of oestradiol and progesterone. Conclusions CRDs and DB activity in the external striated urethral sphincter is present in a high proportion of asymptomatic young women. This abnormal EMG activity has been shown for the first time to change during the menstrual cycle in individual women. CRDs and DBs are more commonly found in the luteal phase of the menstrual cycle. The importance of CRDs and DBs in the aetiology of urinary retention in young women remains uncertain. The distribution and or quantity of abnormal EMG activity in the external urethral sphincter may be important. In a woman with urinary retention the finding of CRDs and DBs by needle EMG does not automatically establish Fowler's syndrome as the explanation for the bladder dysfunction. Urethral pressure profilometry may be helpful in establishing a diagnosis. Opiate use and psychological stress should be considered in young women with urinary retention.
      PubDate: 2015-01-20T02:12:55.634599-05:
      DOI: 10.1111/bju.13042
  • The accuracy of Magnetic Resonance Imaging (MRI) in predicting the
           invasion of the tunica albuginea and the urethra during the primary
           staging of Penile Cancer
    • Authors: Vishwanath Hanchanale; Lehana Yeo, Nawraj Subedi, Jonathan Smith, Tze Wah, Patricia Harnden, Selina Bhattarai, Sameer Chilka, Ian Eardley
      Abstract: Objectives Penile preserving surgery is increasingly offered to men with localised penile cancer and surgical margins of less than 10 mm appear to offer excellent oncological control. Invasion of the tunica albuginea (TA) and the urethra are important factors in determining the feasibility of such surgery. We assessed the accuracy of magnetic resonance imaging (MRI) in predicting the invasion of the tunica albuginea and the urethra during the primary staging of penile Cancer. Methods One hundred and four consecutive patients with clinical T1‐T3 penile cancer had a penile MRI as a part of local staging protocol. An artificial erection was induced by injecting alprostadil (prostaglandin E1). Four men with poor quality MRI images were excluded from the study. The preoperative MRI was compared to final histology to assess its accuracy in predicting the invasion of the tunica albuginea and urethral invasion. Results Data of one hunded patients who underwent penile MRI prior to definitive surgery for invasive penile carcinoma was available for analysis. The mean age was 65 years and number of patients with pathological stage T1, T2 and T3 were 32, 52 and 16 respectively. The sensitivity and specificity of MRI in predicting the invasion of tunica albuginea and urethra were 82.1%, 73.6% and 62.5%, 82.1% respectively. There were no MRI related complications. Conclusions This study shows that penile MRI is an accurate imaging modality in assessing the tunica albuginea invasion but is less sensitive in assessing urethral invasion. These results support the use of MRI in the local staging of penile cancer.
      PubDate: 2015-01-20T02:12:46.112717-05:
      DOI: 10.1111/bju.13041
  • Guideline of guidelines: A Review of Urologic Trauma Guidelines
    • Authors: Darren J. Bryk; Lee C. Zhao
      Abstract: Objective To review the guidelines released in the last decade by several organizations regarding the optimal evaluation and management of genitourinary injuries (renal, ureteral, bladder, urethral and genital). Materials and Methods This is a review of the genitourinary trauma guidelines from the European Association of Urology (EAU) and the American Urological Association (AUA) and renal trauma guidelines from the Societe Internationale D'Urologie (SIU). Results Most recommendations are guided by the American Association for the Surgery of Trauma (AAST) organ injury severity system. Grade A evidence is very rare in genitourinary trauma, and most recommendations are based on Grade C evidence. The findings of the most recent urologic trauma guidelines are summarized. All guidelines recommend conservative management for low‐grade injuries. The major difference is for high‐grade renal trauma, where the SIU and EAU recommended exploratory laparotomy for Grade 5 renal injuries, while the more recent AUA guideline recommends initial conservative management in hemodynamically stable patients. Conclusion There is generally consensus among the three guidelines. Recommendations are based on observational or retrospective studies as well as clinical principles and expert opinions. Large‐scale prospective studies can improve the quality of evidence, and direct more effective evaluation and management of urologic trauma.
      PubDate: 2015-01-20T02:12:38.105022-05:
      DOI: 10.1111/bju.13040
  • Management of sexual dysfunction due to central nervous system disorders:
           A systematic review
    • Authors: Giuseppe Lombardi; Stefania Musco, Thomas M. Kessler, Vincenzo Li Marzi, Michele Lanciotti, Giulio Del Popolo
      Abstract: Objective To systematically review the management of sexual dysfunction (SD) due to central nervous system disorders. Methods The review was done according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement. Studies were identified independently by two reviewers using electronic searches of MEDLINE and OVID (from January 2004 to August 2014) and hand searches of reference lists and review articles. Results In patients with central nervous system disorders, neuro‐urological assessment is recommended for both genders before starting any treatment for SD. For men, blood sexual hormones evaluation is the main investigation performed prior to phosphodiesterase type 5 inhibitors (PDE5Is) treatment, whereas there is no consensus on routine laboratory tests for women. PDE5Is are the first‐line medical treatment for men, with the most robust data derived from patients with spinal cord lesion assessed by validated questionnaires, mainly the International Index of Erectile Function‐15. There is no effective medical treatment for SD in women. Sacral neuromodulation for lower urinary tract dysfunction may improve SD in both genders. Conclusions Although SD is a major burden for patients with central nervous system disorders, high‐evidence level studies are rare and only available for PDE5Is treating erectile dysfunction. Well‐designed prospective studies are urgently needed for both genders.
      PubDate: 2015-01-19T23:08:33.713076-05:
      DOI: 10.1111/bju.13055
  • The current use of Active Surveillance in an Australian cohort of men: a
           pattern of care analysis from the Victorian Prostate Cancer Registry
    • Authors: Mahesha Weerakoon; Nathan Papa, Nathan Lawrentschuk, Sue Evans, Jeremy Millar, Mark Frydenberg, Damien Bolton, Declan G Murphy
      Abstract: Objectives To ascertain the treatment trends and patterns of care, for men with prostate cancer (PC) on Active Surveillance (AS) in Victoria, Australia. Material and Methods De‐identified data was obtained for 6424 men from the PCR. Men included in this study were diagnosed with prostate cancer from 2008 to August 2012 with a minimum of 12‐month follow‐up. Patients were stratified using the NCCN risk grouping system and those who were not actively treated were identified. Data was acquired to describe the trends and uptake of AS according to public vs. private hospital sector, and regional vs. metropolitan regions. Results A total of 1603/ 6424 (24.9%) of men received no treatment with curative intent at 12 months follow‐ up. This cohort included patients in whom the chosen management plan was AS (980/1603, 61.1%), watchful waiting (WW‐ 341/1603, 21.3%), or no management plan (282/1603, 17.6%) was recorded. From this, 980/6424(15.3%) of patients were recorded as being on AS across all NCCN categories at 12 months after diagnosis. This includes 653/1816 (35.9%) of very low and low‐risk men, and 251/2820 (8.9%) of intermediate‐risk men. Of our patients on AS, 169/980 (17.2%) progressed onto active treatment after 12 months. This was radical prostatectomy in 116 (68.6%), with 32 (18.9%) undergoing external beam radiation therapy (EBRT), 12 (7.1%) undergoing brachytherapy (BT) and 9 (5.3%) undergoing androgen deprivation therapy (ADT). Overall, 629/979 (64.2%) of AS patients were notified from a private hospital, with 350/979 (35.7%) of patients notified from a public hospital (1 patient unclassified). Of these, 202/652 (30.9%) of AS patients with very low/ low risk were managed in the public sector, vs. 450/652 (69%) of very low/ low risk AS patients being managed in the private sector. In our cohort, patients with very low and low risk disease, managed in a private hospital, were more likely to be on AS (p=0.005). AS patients in the private sector were also observed to have a median age 2.8 years younger (65.6 vs. 68.4, p
      PubDate: 2015-01-19T23:08:24.49189-05:0
      DOI: 10.1111/bju.13049
  • Patient reported “ever had” and “current” long
           term physical symptoms following prostate cancer treatments
    • Authors: Anna T Gavin; Frances J Drummond, Conan Donnelly, Eamonn O'Leary, Linda Sharp, Heather R Kinnear
      Abstract: Objective To document prostate cancer patient reported ‘ever experienced’ and ‘current’ prevalence of disease specific physical symptoms stratified by primary treatment received. Patients 3,348 prostate cancer survivors 2‐15 years post diagnosis. Methods Cross‐sectional, postal survey of 6,559 survivors diagnosed 2‐15 years ago with primary, invasive PCa (ICD10‐C61) identified via national, population based cancer registries in Northern Ireland and Republic of Ireland. Questions included symptoms at diagnosis, primary treatments and physical symptoms (impotence/urinary incontinence/bowel problems/breast changes/loss of libido/hot flashes/fatigue) experienced ‘ever’ and at questionnaire completion (“current”). Symptom proportions were weighted by age, country and time since diagnosis. Bonferroni corrections were applied for multiple comparisons. Results Adjusted response rate 54%; 75% reported at least one ‘current’ physical symptom (‘ever’:90%), with 29% reporting at least three. Prevalence varied by treatment; overall 57% reported current impotence; this was highest following radical prostatectomy (RP)76% followed by external beam radiotherapy with concurrent hormone therapy (HT); 64%. Urinary incontinence (overall ‘current’ 16%) was highest following RP (‘current'28%, ‘ever'70%). While 42% of brachytherapy patients reported no ‘current’ symptoms; 43% reported ‘current’ impotence and 8% ‘current’ incontinence. ‘Current’ hot flashes (41%), breast changes (18%) and fatigue (28%) were reported more often by patients on HT. Conclusion Symptoms following prostate cancer are common, often multiple, persist long‐term and vary by treatment. They represent a significant health burden. An estimated 1.6% of men over 45 is a prostate cancer survivor currently experiencing an adverse physical symptom. Recognition and treatment of physical symptoms should be prioritised in patient follow‐up. This information should facilitate men and clinicians when deciding about treatment as differences in survival between radical treatments is minimal.
      PubDate: 2015-01-18T23:02:52.137378-05:
      DOI: 10.1111/bju.13036
  • A novel urodynamic model for lower urinary tract assessment in awake rats
    • Authors: Marc P. Schneider; Francis M. Hughes, Anne K. Engmann, J. Todd Purves, Hansjörg Kasper, Marco Tedaldi, Laura S. Spruill, Miriam Gullo, Martin E. Schwab, Thomas M. Kessler
      Abstract: Objectives To develop a urodynamic model incorporating external urethral sphincter (EUS) electromyography (EMG) in awake rats. Materials and methods Bladder catheters and EUS EMG electrodes were implanted in female Sprague Dawley rats. Assessments were performed in awake, lightly restrained animals on postoperative day 12‐14. Measurements were repeated in the same animal on day 16 under urethane anesthesia. Urodynamics and EUS EMG were performed simultaneously. In addition, serum creatinine and bladder histology was assessed. Results No significant differences in urodynamic parameters were found between bladder catheter only versus bladder catheter and EUS EMG electrode groups. Urethane anesthesia evoked prominent changes in both urodynamic parameters and EUS EMG. Serum creatinine was within the normal limits in all animals. Bladder weight and bladder wall thickness were significantly increased in both the bladder catheter only and the bladder catheter and EUS EMG group compared to controls. Conclusions Our novel urodynamic model allows repetitive measurements of both bladder and EUS function at different time points in the same animal under fully awake conditions and opens promising avenues to investigate LUTD in a translational approach.
      PubDate: 2015-01-18T21:44:59.357815-05:
      DOI: 10.1111/bju.13039
  • Central obesity is predictive of persistent storage LUTS after surgery for
           Benign Prostatic Enlargement: results of a multicenter prospective study
    • Authors: M Gacci; A Sebastianelli, M Salvi, C De Nunzio, A Tubaro, L Vignozzi, G Corona, KT McVary, SA Kaplan, M Maggi, M Carini, S Serni
      Abstract: Objective Central obesity can be associated with the development of benign prostatic enlargement (BPE) and with the worsening of lower urinary tract symptoms (LUTS). The aim of our study was to evaluate the impact of components of Metabolic Syndrome (MetS) on urinary outcomes after surgical therapy for severe LUTS due to BPE. Materials and Methods A multicenter prospective study was conducted including 378 consecutive men surgically treated for large BPE with simple open prostatectomy (OP) or transurethral resection of the prostate (TURP), between January 2012 and October 2013. LUTS were measured by the International Prostate Symptom Score (IPSS), immediately before surgery and 6 to 12 months postoperatively. MetS was defined according the US National Cholesterol Education Program‐Adult Treatment Panel III. Results The improvement of total and storage IPSS postoperatively was related to diastolic blood pressure and waist circumference (WC). WC>102 cm was associated with a higher risk of an incomplete recovery of both total IPSS (OR: 0.343, p=0.001) and storage IPSS (OR: 0.208, p
      PubDate: 2015-01-18T21:44:26.97654-05:0
      DOI: 10.1111/bju.13038
  • Knowledge, Attitudes and Beliefs towards Management of Men with Locally
           Advanced Prostate Cancer following Radical Prostatectomy: An Australian
           Survey of Urologists
    • Authors: Bernadette (Bea) Brown; Jane Young, Andrew B Kneebone, Andrew J Brooks, Amanda Dominello, Mary Haines
      Abstract: Objective To investigate Australian urologists’ knowledge, attitudes and beliefs, and the association of these with treatment preferences relating to guideline‐recommended adjuvant radiotherapy for men with adverse pathologic features following radical prostatectomy. Subjects and methods A nationwide mailed and web‐based survey of Australian urologist members of the Urological Society of Australia and New Zealand (USANZ). Results 157 surveys were included in the analysis (45% response rate). Just over half of respondents (57%) were aware of national clinical practice guidelines for the management of prostate cancer. Urologists’ attitudes and beliefs towards the specific recommendation for post‐operative adjuvant radiotherapy for men with locally advanced prostate cancer were mixed. Just over half agreed the recommendation is based on a valid interpretation of the underpinning evidence (54.1%, 95% CI [46%, 62.2%]) but less than one third agreed adjuvant radiotherapy will lead to improved patient outcomes (30.2%, 95% CI [22.8%, 37.6%]). Treatment preferences were varied, demonstrating clinical equipoise. A positive attitude towards the clinical practice recommendation was significantly associated with treatment preference for adjuvant radiotherapy (rho = .520, p
      PubDate: 2015-01-14T03:53:29.770426-05:
      DOI: 10.1111/bju.13037
  • Efficacy and safety of a fixed‐dose combination of dutasteride and
           tamsulosin treatment (Duodart™) compared with watchful waiting with
           initiation of tamsulosin therapy if symptoms do not improve, both provided
           with lifestyle advice, in the management of treatment‐naïve men
           with moderately symptomatic benign prostatic hyperplasia: 2‐Year
           CONDUCT study results
    • Authors: Claus G Roehrborn; Igor Oyarzabal Perez, Erik PM Roos, Nicolae Calomfirescu, Betsy Brotherton, Fang Wang, Juan Manuel Palacios, Averyan Vasylyev, Michael J Manyak
      Abstract: Objective To investigate whether a fixed‐dose combination of 0.5 mg dutasteride and 0.4 mg tamsulosin (FDC) is more effective than watchful waiting with protocol‐defined initiation of tamsulosin therapy if symptoms did not improve (WW‐All) in treatment‐naïve men with moderately symptomatic benign prostatic hyperplasia (BPH) at risk of progression. Patients and methods This was a multicentre, randomised, open‐label, parallel‐group study (NCT01294592) in 742 men with an International Prostate Symptom Score (IPSS) of 8–19, prostate volume ≥30 cc and total serum PSA ≥1.5 ng/ml. Patients were randomised to FDC (n = 369) or WW‐All (n = 373) and followed for 24 months. All patients were given lifestyle advice. The primary endpoint was symptomatic improvement from baseline to 24 months, measured by IPSS. Secondary outcomes included BPH clinical progression, impact on quality of life (QoL), and safety. Results The change in IPSS at 24 months was significantly greater for FDC than WW‐All (–5.4 vs. –3.6 points, P < 0.001). With FDC, the risk of BPH progression was reduced by 43.1% (P < 0.001); 29% and 18% of men in the WW‐All and FDC groups had clinical progression, respectively, comprising symptomatic progression in most patients. Improvements in QoL (BPH Impact Index and question 8 of the IPSS) were observed in both groups but were significantly greater with FDC (P < 0.001). The safety profile of FDC was consistent with established profiles of dutasteride and tamsulosin. Conclusion FDC therapy with dutasteride and tamsulosin, plus lifestyle advice, caused rapid and sustained improvements in men with moderate BPH symptoms at risk of progression with significantly greater symptom and QoL improvements and a significantly reduced risk of BPH progression compared with WW plus initiation of tamsulosin as per protocol.
      PubDate: 2015-01-07T03:59:14.365763-05:
      DOI: 10.1111/bju.13033
  • Utilization of pre‐operative imaging for muscle‐invasive
           bladder cancer: a population‐based study
    • Authors: Matthew DF McInnes; D. Robert Siemens, William J. Mackillop, Yingwei Peng, Shelly Wei, Nicola Schieda, Christopher M. Booth
      Abstract: Objective To test the hypotheses that: a) use of pre‐operative imaging for muscle‐invasive bladder cancer (MIBC) conforms to practice guidelines; b) pre‐operative imaging, through more accurate staging is associated with improved outcomes. Materials & Methods In this population‐based cohort study, records of treatment were linked to the Ontario Cancer Registry to identify all patients with MIBC treated with cystectomy from 1994‐2008. Utilization of chest, abdomen‐pelvis and bone imaging were evaluated. Trends were evaluated over time. Logistic regression was used to analyze factors associated with utilization. Cox model analyses were used to explore associations between imaging and survival. Results 2802 patients with MIBC underwent cystectomy during 1994‐2008. Over the three 5‐year study periods, an increase in the proportion of patients having pre‐operative: chest x‐ray(CXR)(55%,64%,63%,p
      PubDate: 2015-01-05T05:55:30.542014-05:
      DOI: 10.1111/bju.13034
  • Transperineal biopsy prostate cancer detection in first biopsy and
           post‐negative TRUS biopsy settings: The Victorian Transperineal
           Biopsy Collaboration experience
    • Authors: Wee Loon Ong; Mahesha Weerakoon, Sean Huang, Eldho Paul, Nathan Lawrentschuk, Mark Frydenberg, Daniel Moon, Declan Murphy, Jeremy Grummet
      Abstract: Objectives To present the Victorian Transperineal Biopsy Collaboration (VTBC) experience in patients with no prior prostate cancer diagnosis, assessing the cancer detection rate, pathological outcomes and anatomical distribution of cancer within the prostate Patients and Methods VTBC was established through partnership between urologists performing transperineal biopsies of the prostate (TPB) at three institutions in Melbourne. Consecutive patients who had TPB, as first biopsy or repeat biopsy following previous negative TRUS biopsy, between September 2009 and September 2013 in the VTBC database were included in this study. Data for each patient was collected prospectively (except for TPB prior to 2011 in one institution), based on the minimum dataset published by the Ginsburg Study Group Univariate and multivariate analyses were performed to identify factors predictive of cancer detection on TPB Results 160 patients were included in the study, of these 57 patients had TPB as first biopsy while 103 had TPB as repeat biopsy after previous negative TRUS biopsies The median patient age at TPB was 63, with the repeat biopsy patients having higher median serum PSA level (5.8ng/ml for first biopsy, and 9.6ng/ml for repeat biopsy) and larger prostate volumes (40cc for first biopsy, and 51cc for repeat biopsy) Cancer was detected in 53% of first biopsy patients and 36% of repeat biopsy patients, of which 87% and 81%, respectively, were clinically significant cancers, defined as Gleason score of 7 or higher, or more than 3 positive cores of Gleason 6 75% of cancers detected in repeat biopsies involved the anterior region (based on the Ginsburg Study Group's recommended biopsy map), while 25% were confined exclusively within the anterior region; a lower proportion of only 5% of cancer detected in first biopsies were confined exclusively within the anterior region Age, serum PSA level and prostate volume were predictive of cancer detection in repeat biopsies, while only age was predictive of cancer detection in first biopsies Conclusions TPB is an alternative approach to TRUS biopsy of the prostate, offering a high rate of detection of clinically significant cancer TPB provides excellent sampling of the anterior region of the prostate, which is often under‐sampled using the TRUS approach, and should be considered an option for all men in whom a prostate biopsy is indicated.
      PubDate: 2015-01-05T05:55:22.283756-05:
      DOI: 10.1111/bju.13031
  • Effect of Surgical Approach on Erectile Function Recovery following
           Bilateral Nerve‐Sparing Radical Prostatectomy: An Evaluation
           Utilizing Data from a Randomized, Double‐Blind, Double‐Dummy
           Multicenter Trial of Tadalafil versus Placebo
    • Authors: Jens‐Uwe Stolzenburg; Markus Graefen, Christian Kriegel, Uwe Michl, Antonio Martin Morales, Peter J Pommerville, Martina Manning, Hartwig Büttner, Carsten Henneges, Martin Schostak
      Abstract: Objectives To report pre‐specified and exploratory results on the effect of different surgical approaches on erectile function (EF) after nerve‐sparing radical prostatectomy (nsRP) obtained from the multicenter, randomized, double‐blind, double‐dummy REACTT trial of tadalafil (once a day [OaD] or on‐demand [pro‐re‐nata, PRN]) versus placebo. Patients and Methods Patients
      PubDate: 2015-01-05T05:55:13.642995-05:
      DOI: 10.1111/bju.13030
  • Pathological factors associated with survival benefit from adjuvant
           chemotherapy (ACT): a population‐based study of bladder cancer
    • Authors: Christopher M. Booth; D. Robert Siemens, Xuejiao Wei, Yingwei Peng, David M. Berman, William J. Mackillop
      Pages: n/a - n/a
      Abstract: Objective To evaluate whether pathological factors are associated with differential effect of adjuvant chemotherapy (ACT). Patients and Methods In this population‐based retrospective cohort study, we linked electronic records of treatment and surgical pathology to the Ontario Cancer Registry. The study population included all patients with muscle‐invasive bladder cancer undergoing cystectomy in Ontario 1994–2008. Factors associated with overall (OS) and cancer‐specific survival (CSS) were evaluated using Cox proportional hazards. We tested for interaction between the following variables and ACT effect‐size: N‐stage, margin status, T‐stage, and lymphovascular invasion (LVI). Results The study population included 2802 patients; 19% were treated with ACT. Interaction terms with ACT for OS/CSS are: N‐stage (both P < 0.001); margin status (P = 0.054/P = 0.048); T‐stage (P = 0.509/P = 0.286); and LVI (P = 0.361/P = 0.405). Magnitude of effect for ACT was greater for patients with node‐positive disease [OS: hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.47–0.67; CSS: HR 0.60, 95% CI 0.49–0.72] than for patients with node‐negative disease (OS: HR 0.80, 95% CI 0.61–1.03; CSS: HR 0.79, 95% CI 0.59–1.07). ACT was also associated with greater effect among patients with involved margins (OS: HR 0.45, 95% CI 0.33–0.62; CSS: HR 0.40, 95% CI 0.28–0.57) compared with patients with negative margins (OS: HR 0.75, 95% CI 0.65–0.87; CSS: HR 0.79, 95% CI 0.67–0.93). Conclusions In this population‐based cohort study we observe evidence of interaction between ACT effect and nodal stage and surgical margin status. Our results suggest that patients at highest risk of disease recurrence may derive greatest benefit from ACT.
      PubDate: 2014-12-29T04:36:16.753374-05:
      DOI: 10.1111/bju.12913
  • Docetaxel rechallenge after an initial good response in patients with
           metastatic castration‐resistant prostate cancer
    • Authors: Stéphane Oudard; Gero Kramer, Orazio Caffo, Lorraine Creppy, Yohan Loriot, Steinbjoern Hansen, Mats Holmberg, Frederic Rolland, Jean‐Pascal Machiels, Michael Krainer
      Pages: n/a - n/a
      Abstract: Objective To evaluate the benefit of docetaxel rechallenge in patients with metastatic castration‐resistant prostate cancer (mCRPC) relapsing after an initial good response to first‐line docetaxel. Patients and Methods We retrospectively reviewed the records of consecutive patients with mCRPC with a good response to first‐line docetaxel [serum prostate specific antigen (PSA) decrease ≥50%; no clinical/radiological progression]. We analysed the impact of management at relapse (docetaxel rechallenge or non‐taxane‐based therapy) on PSA response, symptomatic response (performance status/pain/analgesic consumption), and overall survival (OS). We used multivariate stepwise logistic regression to analyse potential predictors of a favourable outcome. Results We identified 270 good responders to first‐line docetaxel. The median progression‐free interval (PFI) was 6 months from the last docetaxel dose. At relapse, 223 patients were rechallenged with docetaxel (82.5%) and 47 received non‐taxane‐based therapy. There was no significant difference in median OS {18.2 [95% confidence interval (CI) 16.1–22.00] and 16.8 [95%CI 13.4–21.5] months, respectively, P = 0.35}. However, good PSA response and symptom relief/stable disease were more frequent on docetaxel rechallenge (40.4% vs 10.6%, P < 0.001 for PSA). A PFI of >6 months and added estramustine predicted a good PSA response and symptomatic response on docetaxel rechallenge but only a PFI of >6 months predicted longer OS. Haemoglobin (6 months, but did not prolong survival. Potential benefits should be weighed against the risk of cumulative toxicity.
      PubDate: 2014-12-29T04:35:23.556419-05:
      DOI: 10.1111/bju.12845
  • Non‐steroidal antiandrogen monotherapy compared with luteinising
           hormone–releasing hormone agonists or surgical castration
           monotherapy for advanced prostate cancer: a Cochrane systematic review
    • Authors: Frank Kunath; Henrik R. Grobe, Gerta Rücker, Edith Motschall, Gerd Antes, Philipp Dahm, Bernd Wullich, Joerg J. Meerpohl
      Abstract: Objective ● To assess the effects of non‐steroidal antiandrogen monotherapy compared with luteinising hormone–releasing hormone agonists or surgical castration monotherapy for treating advanced hormone‐sensitive stages of prostate cancer. Materials and Methods ● We searched the Cochrane Prostatic Diseases and Urologic Cancers Group Specialized Register (PROSTATE), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Web of Science with Conference Proceedings, three trial registries and abstracts from three major conferences to 23 December 2013, together with reference lists, and contacted selected experts in the field and manufacturers. ● We included randomised controlled trials comparing non‐steroidal antiandrogen monotherapy with medical or surgical castration monotherapy for men in advanced hormone‐sensitive stages of prostate cancer. ● Two review authors independently examined full‐text reports, identified relevant studies, assessed the eligibility of studies for inclusion, extracted data and assessed risk of bias as well as quality of evidence according to GRADE. ● We used Review Manager 5.2 for data synthesis and used the fixed‐effect model as primary analysis (when heterogeneity low with I2 less than 50%); we used a random‐effects model when confronted with substantial or considerable heterogeneity (I2 ≥ 50%). Results ● Eleven studies involving 3060 randomly assigned participants were included in this review. Use of non‐steroidal antiandrogens decreased overall survival (hazard ratio (HR) 1.24, 95% confidence interval (CI) 1.05 to 1.48, six studies, 2712 participants) and increased clinical progression (one year: risk ratio (RR) 1.25, 95% CI 1.08 to 1.45, five studies, 2067 participants; 70 weeks: RR 1.26, 95% CI 1.08 to 1.45, six studies, 2373 participants; two years: RR 1.14, 95% CI 1.04 to 1.25, three studies, 1336 participants), as well as treatment failure (one year: RR 1.19, 95% CI 1.02 to 1.38, four studies, 1539 participants; 70 weeks: RR 1.27, 95% CI 1.05 to 1.52, five studies, 1845 participants; two years: RR 1.14, 95% CI 1.05 to 1.24, two studies, 808 participants), compared with medical or surgical castration. ● The quality of evidence for overall survival, clinical progression and treatment failure was rated as moderate according to GRADE. ● Use of non‐steroidal antiandrogens increased the risk for treatment discontinuation due to adverse events (RR 1.82, 95% CI 1.13 to 2.94, eight studies, 1559 participants), including events such as breast pain (RR 22.97, 95% CI 14.79 to 35.67, eight studies, 2670 participants) and gynaecomastia (RR 8.43, 95% CI 3.19 to 22.28, nine studies, 2774 participants) The risk of other adverse events, such as hot flashes (RR 0.23, 95% CI 0.19 to 0.27, nine studies, 2774 participants) was decreased when non‐steroidal antiandrogens were used. The quality of evidence for breast pain, gynaecomastia and hot flashes was rated as moderate according to GRADE. ● The effects of non‐steroidal antiandrogens on cancer‐specific survival and biochemical progression remained unclear. Conclusions ● Non‐steroidal antiandrogen monotherapy compared to medical or surgical castration monotherapy for advanced prostate cancer is less effective in terms of overall survival, clinical progression, treatment failure and treatment discontinuation due to adverse events. ● Evidence quality was rated as moderate according to GRADE; therefore further research is likely to have an important impact on results for patients with advanced but non‐metastatic prostate cancer treated with non‐steroidal antiandrogen monotherapy.
      PubDate: 2014-12-18T15:42:16.9154-05:00
      DOI: 10.1111/bju.13026
  • Patient experience and satisfaction with Onabotulinumtoxin A for
           refractory overactive bladder
    • Authors: S Malde; C Dowson, O Fraser, J Watkins, MS Khan, P Dasgupta, A Sahai
      Abstract: Objective ● To evaluate the patient experience of our dedicated botulinum toxin A (BTX‐A) service using a validated patient‐reported experience measure (PREM) and asses patient‐reported satisfaction with treatment. Materials and methods ● The first 100 patients who underwent BTX‐A treatment for refractory idiopathic detrusor overactivity (IDO) in our institution were contacted for telephone interview. They had all been assessed, injected and followed up in a dedicated BTX‐A clinic. ● Patients were asked to complete a validated PREM‐ the Client Satisfaction Questionnaire (CSQ‐8)‐ as well as a questionnaire developed in our department to assess satisfaction with the results of the treatment. ● The majority of patients received 200 U OnabotulinumtoxinA (Botox®) via an outpatient local anesthetic flexible cystoscopy technique. Results ● Complete data was available for 72 patients. Forty‐nine patients were continuing to receive BTX‐A treatment whilst 23 had opted for no further injections. ● The overall mean CSQ‐8 satisfaction score was 38.3 (SD 3.3) indicating a high level of patient satisfaction with the service offered in our institution. There was a significant difference in total satisfaction scores between those still receiving BTX‐A (mean score 29.8) and those who have discontinued treatment (mean score 25.1) (p
      PubDate: 2014-12-18T15:42:08.871009-05:
      DOI: 10.1111/bju.13025
  • Transperineal template‐guided prostate biopsy: 10 years of
    • Authors: Zhipeng Mai; Weigang Yan, Yi Zhou, Zhien Zhou, Jian Chen, Yu Xiao, Zhiyong Liang, Zhigang Ji, Hanzhong Li
      Abstract: Objective • To assess the efficacy and safety of transperineal template‐guided prostate biopsy. Materials and Methods • From December 2003 to December 2013, a total of 3007 patients (30‐91 years old, mean age 69.1) who met the inclusion criteria underwent 11‐region transrectal ultrasound‐guided transperineal template prostate biopsy. • The inclusion criteria included a prostate‐specific antigen (PSA) level of 4.0 ng/ml or greater and abnormal prostate gland findings on digital rectal examination, ultrasound, CT or MRI. The median PSA level was 11.0 ng/ml (range 0.2‐100 ng/ml). • The prostate cancer detection rate and prostate biopsy adverse effects, as well as prostate cancer spatial distribution were analyzed. Results • A mean of 19.3 cores (range 11 to 44) were obtained for each biopsy, and more cores were obtained in larger prostates than in smaller ones. • One to four cores were collected from each region. Prostate cancer was detected in 1067 of the 3007 patients (35.5%). The prostate cancer detection rates in groups with PSA levels of 0‐4.0 ng/ml, 4.1‐10.0 ng/ml, 10.1‐20.0 ng/ml, 20.1‐50.0 ng/ml, and 50.1‐100.0 ng/ml were 15.3% (27/176), 21.0% (248/1179), 32.6% (318/975), 56.0% (232/414), and 92.0% (241/262), respectively. • The mean positives for cancer in regions 1‐10 and region 11 (the apical region) were 46.7% vs. 52.0% (P=0.014). • Regarding adverse effects, 47.0% of the patients reported hematuria, 6.1% developed hemospermia, 1.9% required short‐term catheterization after biopsy because of acute urinary retention, and 0.03% (one patient) developed urosepsis. Conclusions • Transrectal ultrasound‐guided transperineal template prostate biopsy is safe and accurate. • The current study suggests that prostate carcinoma foci are more frequently localized in the apical region.
      PubDate: 2014-12-18T15:42:00.797458-05:
      DOI: 10.1111/bju.13024
  • Comparison of systematic transrectal biopsy to transperineal
           MRI/ultrasound‐fusion biopsy for the diagnosis of prostate cancer
    • Authors: Angelika Borkowetz; Ivan Platzek, Marieta Toma, Michael Laniado, Gustavo Baretton, Michael Froehner, Rainer Koch, Manfred Wirth, Stefan Zastrow
      Abstract: Objectives • To compare targeted, transperineal MRI/ultrasound‐fusion biopsy to systematic transrectal biopsy in patients with previous negative or first prostate biopsy. • To evaluate the gain in diagnostic information with systematic biopsies in addition to targeted MRI/ultrasound‐fusion biopsies. Patients and methods • 263 consecutive patients with suspicion of prostate cancer (PCa) were investigated. • All patients were evaluated by 3 Tesla multiparametric magnetic resonance imaging (mpMRI) applying the European Society of Urogenital Radiology (ESUR) criteria. • All patients underwent MRI/ultrasound‐fusion biopsy transperineally (mean nine cores) and additionally a systematic transrectal biopsy (mean 12 cores). Results • 195 patients underwent repeat biopsy and 68 patients underwent first biopsy. • Median age was 66yrs, median PSA‐level was 8.3ng/mL, median prostate volume was 50mL. Overall, PCa detection rate was 52% (137/263). • MRI/ultrasound‐fusion biopsy detected significantly more PCa than systematic prostate biopsy (44% (116/263) vs. 35% (91/263); p=0.0023). In repeat biopsy, the detection rate was 44% (85/195) in targeted and 32% (62/195) in systematic biopsy (p=0.0023). In first biopsy, the detection rate was 46% (31/68) in targeted and 43% (29/68) in systematic biopsy (p=0.5271). • 80% (110/137) of biopsy‐proven PCa were clinically significant. • Regarding the upgrading of Gleason Score (GS), 44% (32/72) more clinically significant PCa was detected by using additional targeted biopsy compared to systematic biopsy alone. Conversely, 12% (10/94) more clinically significant cancer was found by systematic biopsy additionally to targeted biopsy. Conclusions • MRI/ultrasound‐fusion biopsy was associated with a higher detection rate of clinically significant PCa while taking fewer cores both, especially in patients with prior negative biopsy. • Due to a high portion of additional tumours with GS ≥ 7 detected in addition to targeted biopsy, systematic biopsy should still be performed additionally to targeted biopsy.
      PubDate: 2014-12-18T15:39:59.56117-05:0
      DOI: 10.1111/bju.13023
  • The treatment of penile carcinoma in situ (CIS) within a UK
           supra‐regional network
    • Authors: Marc Lucky; Kusuma V.R. Murthy, Beverley Rogers, Stephen Jones, Maurice W. Lau, Vijay K. Sangar, Nigel J. Parr
      Abstract: Objectives To review outcomes of the treatment of carcinoma in situ (CIS) of the penis at a large supra‐regional penile cancer network, where centralisation has permitted greater experience with treatment outcomes, and suggest treatment strategies. Patients and Methods The network penile cancer database, which details presentation, treatment and complications was analysed from 2003 to 2010, identifying patients with CIS, with a minimum follow‐up of 2 years, looking at treatments administered and outcomes. Results In all, 57 patients with mean (range) age of 61 (34–91) years were identified. In all, 18 were treated by circumcision only, 20 by circumcision and local excision (LE) and 19 by circumcision and 5‐flurouracil (5‐FU). The mean (range) follow‐up was 3.5 (2–8) years. Of those treated by circumcision none subsequently developed CIS on the glans. For those who underwent circumcision + LE, five of 20 (25%) developed recurrence requiring further treatment. Of those treated by circumcision + 5‐FU, 14/19 (73.7%) completely responded. Of the five incomplete responders, two had focal invasive malignancy at repeat biopsy. One incomplete responder underwent glansectomy and four grafting. No complete responders relapsed. Complications of 5‐FU included significant inflammatory response in seven (36.8%), with two requiring hospital admission and one neo‐phimosis (5.3%). Conclusion This study suggests that patients undergoing circumcision for isolated CIS and complete responders to 5‐FU may require only short‐term follow‐up, as recurrence is unlikely, whereas longer follow up is required for all other patients. However, numbers in this study are small and larger studies are needed to support this. An incomplete response to 5‐FU dictates immediate re‐biopsy, as it carries a significant chance of previously undetected invasive disease.
      PubDate: 2014-12-15T21:59:54.564311-05:
      DOI: 10.1111/bju.12878
  • Does cumulative prostate cancer length (CCL) in prostate biopsies improve
           prediction of clinically insignificant cancer at radical prostatectomy in
           patients eligible for active surveillance'
    • Authors: Derrick J. Chen; Sara M. Falzarano, Jesse K. McKenney, Chris G. Przybycin, Jordan P. Reynolds, Andres Roma, J. Stephen Jones, Andrew Stephenson, Eric Klein, Cristina Magi‐Galluzzi
      Abstract: Objectives To evaluate if cumulative prostate cancer length (CCL) on prostate needle biopsy divided by the number of biopsy cores (CCL/core) could improve prediction of insignificant cancer on radical prostatectomy (RP) in patients with prostate cancer eligible for active surveillance (AS). Patients and Methods Patients diagnosed with prostate cancer on extended (≥10 cores) biopsy with an initial prostate‐specific antigen (iPSA) level of
      PubDate: 2014-12-15T21:59:39.989825-05:
      DOI: 10.1111/bju.12880
  • Modified transurethral resection of the prostate (TURP) for men with
           moderate lower urinary tract symptoms (LUTS) before brachytherapy is safe
           and feasible
    • Authors: Philip Brousil; Muddassar Hussain, Mark Lynch, Robert W. Laing, Stephen E.M. Langley
      Abstract: Objective To report the urinary toxicity outcomes for patients at greater risk of voiding symptoms and retention who received a modified limited transurethral resection of the prostate (TURP) before low‐dose rate (LDR) brachytherapy. Patients and Method Data were analysed from patients receiving the above procedures between 2006 to present, taken from the prospective brachytherapy database of 2000 patients at the St. Luke's Cancer Centre. The limited TURP (TURPBXT) was performed at a median (range) of 64 (25–205) days before seed implantation with a median resection weight of 1.15 g. Selection criteria were based on patients with moderate lower urinary tract symptoms, poor flow or post‐void residual urine volume (PVR), or a prominent middle lobe or high bladder neck on transrectal ultrasonography. Baseline prostate cancer characteristics, uroflowmetry, International Prostate Symptom Score (IPSS) and quality‐of‐life QoL scores were collected and compared with follow‐up IPSS and QoL scores. Results Data for 112 patients was gathered from the database. The TURPBXT resulted in statistically significant improvements before LDR brachytherapy in maximum urinary flow rate (Qmax) and PVR, IPSS and QoL scores (the mean Qmax before vs after the TURPBXT was 11.3 vs 16.7 mL/s). The IPSS and QoL scores at 6 months after seed implantation were increased compared with baseline values before the TURPBXT (mean IPSS at 6 months 11.7 vs 9.2 before TURPBXT), but no difference at 1 year (mean IPSS 9), and improved scores at 2, 3, 4 and 5 years follow‐up (mean IPSS of 7.9, 5.6, 5.3 and 7.4, respectively). Conclusion The present study suggests patients at increased risk of deteriorating voiding symptoms, including urinary retention, are no longer contraindicated against LDR brachytherapy if they receive a modified TURP before seed implantation. This procedure does not appear to carry the risk of urinary incontinence thought to be associated with a conventional TURP before LDR brachytherapy.
      PubDate: 2014-12-15T21:59:26.44602-05:0
      DOI: 10.1111/bju.12798
  • Extraprostatic extension (EPE) of prostatic carcinoma: is its proximity to
           the surgical margin or Gleason score important'
    • Authors: Ruta Gupta; Rachel O'Connell, Anne‐Maree Haynes, Phillip D. Stricker, Wade Barrett, Jennifer J. Turner, Warick Delprado, Lisa G. Horvath, James G. Kench
      Abstract: Objective To examine the association between histopathological factors of extraprostatic prostate cancer and outcome. Patients and Methods Patients with extraprostatic extension (EPE) without positive margins, seminal vesicle or lymph node involvement were analysed from a consecutive radical prostatectomy cohort of 1136 (2002–2006) for: (i) distance of EPE from the margin; (ii) Gleason score of the EPE; and (iii) extent of EPE. Log‐rank, Kaplan–Meier, and Cox regression analyses were performed. Results The study included 194 pT3a, pN0, R0 patients with a median follow‐up of 5.4 years, with 37 (19%) patients experiencing biochemical relapse (BCR). On univariable analysis, patients with a Gleason score of ≥8 in the extraprostatic portion showed increased incidence of BCR compared with those with Gleason scores of ≤7 (P = 0.03). The proximity of the EPE to the margin (0.01–7.5 mm) did not correlate with BCR. On multivariable analysis, the extent of EPE, the Gleason score of the dominant nodule or of the EPE portion did not correlate with BCR. Conclusion Data from this study using current International Society of Urological Pathology Gleason scoring and EPE criteria indicate that close proximity of EPE to the margin is not associated with recurrence. Gleason score ≥8 within EPE is associated with an increased BCR risk on univariable analysis, but larger studies are required to confirm whether extensive Gleason pattern 4 in an EPE indicates increased risk in an otherwise overall Gleason score 7 cancer.
      PubDate: 2014-12-15T21:57:05.449175-05:
      DOI: 10.1111/bju.12911
  • Comparison of magnetic resonance imaging and ultrasound (MRI‐US)
           fusion‐guided prostate biopsies obtained from axial and sagittal
    • Authors: Cheng W. Hong; Soroush Rais‐Bahrami, Annerleim Walton‐Diaz, Nabeel Shakir, Daniel Su, Arvin K. George, Maria J. Merino, Baris Turkbey, Peter L. Choyke, Bradford J. Wood, Peter A. Pinto
      Abstract: Objective To compare cancer detection rates and concordance between magnetic resonance imaging and ultrasound (MRI‐US) fusion‐guided prostate biopsy cores obtained from axial and sagittal approaches. Patients and Methods Institutional records of MRI‐US fusion‐guided biopsy were reviewed. Detection rates for all cancers, Gleason ≥3 + 4 cancers, and Gleason ≥4 + 3 cancers were computed. Agreement between axial and sagittal cores for cancer detection, and frequency where one was upgraded the other was computed on a per‐target and per‐patient basis. Results In all, 893 encounters from 791 patients that underwent MRI‐US fusion‐guided biopsy in 2007–2013 were reviewed, yielding 4688 biopsy cores from 2344 targets for analysis. The mean age and PSA level at each encounter was 61.8 years and 9.7 ng/mL (median 6.45 ng/mL). Detection rates for all cancers, ≥3 + 4 cancers, and ≥4 + 3 cancers were 25.9%, 17.2%, and 8.1% for axial cores, and 26.1%, 17.6%, and 8.6% for sagittal cores. Per‐target agreement was 88.6%, 93.0%, and 96.5%, respectively. On a per‐target basis, the rates at which one core upgraded or detected a cancer missed on the other were 8.3% and 8.6% for axial and sagittal cores, respectively. Even with the inclusion of systematic biopsies, omission of axial or sagittal cores would have resulted in missed detection or under‐characterisation of cancer in 4.7% or 5.2% of patients, respectively. Conclusion Cancer detection rates, Gleason scores, and core involvement from axial and sagittal cores are similar, but significant cancer may be missed if only one core is obtained for each target. Discordance between axial and sagittal cores is greatest in intermediate‐risk scenarios, where obtaining multiple cores may improve tissue characterisation.
      PubDate: 2014-12-15T21:56:08.7013-05:00
      DOI: 10.1111/bju.12871
  • Hypoalbuminaemia is associated with mortality in patients undergoing
           cytoreductive nephrectomy
    • Authors: Anthony T. Corcoran; Samuel D. Kaffenberger, Peter E. Clark, John Walton, Elizabeth Handorf, Zack Piotrowski, Jeffery J. Tomaszewski, Serge Ginzburg, Reza Mehrazin, Elizabeth Plimack, David Y.T. Chen, Marc C. Smaldone, Robert G. Uzzo, Todd M. Morgan, Alexander Kutikov
      Abstract: Objective To evaluate whether poor nutrition is associated with mortality in patients undergoing cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC). Patients and Methods A multi‐institutional review of prospective databases identified 246 patients meeting inclusion criteria who underwent CN for mRCC from 1993 to 2012. Nutritional markers evaluated were: body mass index
      PubDate: 2014-12-15T21:43:22.446871-05:
      DOI: 10.1111/bju.12897
  • Effectiveness of hexaminolevulinate fluorescence cystoscopy for the
           diagnosis of non‐muscle‐invasive bladder cancer in daily
           clinical practice: a Spanish multicentre observational study
    • Authors: J Palou; C Hernández, E Solsona, R ABascal, JP Burgués, C Rioja, JA Cabrera, C Gutiérrez, O Rodríguez, I Iborra, F Herranz, JM Abascal, G Conde, J Oliva
      Abstract: Objective To assess the sensitivity and specificity of blue‐light cystoscopy (BLC) with hexaminolevulinate as an adjunct to white‐light cystoscopy (WLC) versus WLC alone for the detection of non‐muscle‐invasive bladder cancer (NMIBC), in routine clinical practice in Spain. Material and Methods An intra‐patient comparative, multicentre, prospective, observational study. Adult patients with suspected or documented primary or recurrent NMIBC at eight Spanish centres were included in the study. All patients were examined with WLC followed by BLC with hexaminolevulinate. We evaluated the detection rate of bladder cancer lesions by WLC and BLC with hexaminolevulinate, overall and by tumour stage and compared with histological examination of the biopsied lesions. Sensitivity and specificity was calculated. Results 1,569 lesions were identified from 283 patients: 621 were tumour lesions according to histology and 948 were false‐positives. Of the 621 tumour lesions, 475 were detected by WLC (sensitivity 76.5%; 95% CI 73.2–79.8) and 579 were detected by BLC (sensitivity 93.2%; 95% CI 91.0–95.1; p
      PubDate: 2014-12-15T06:10:49.570807-05:
      DOI: 10.1111/bju.13020
  • A trial of devices for urinary incontinence following treatment for
           prostate cancer
    • Authors: M Macaulay; J Broadbridge, H Gage, P Williams, B Birch, K N Moore, A Cottenden, M J Fader
      Abstract: Objective •  To compare performance of three continence management devices and absorbent pads used by men with persistent urinary incontinence (> 1yr) post treatment for prostate cancer. •  Patients and Methods •  Randomised, controlled trial of 56 men with one year follow up. •  Three devices were tested for three weeks each: sheath drainage system, body‐worn urinal, penile clamp. Device and pad performance were assessed. •  Quality of life (QOL) was measured at baseline and follow‐up with the King's Health Questionnaire. •  Stated (intended use) and revealed (actual use) preference for products was assessed •  Value‐for‐money was gathered. Results Substantial and significant differences in performance were found: •  Sheath: good for extended use (e.g. golf and travel) when pad changing is difficult. Good for keeping skin dry, not leaking, not smelling and convenient for storage and travel; •  Body‐worn urinal: generally rated worse than the sheath and was mainly used for similar activities but by men who could not use a sheath (e.g. retracted penis); not good for seated activities. •  Clamp: good for short vigorous activities like swimming/exercise. Most secure, least likely to leak, most discreet but almost all men described it as uncomfortable or painful. •  Pads: good for everyday activities and best for night‐time use. Most easy to use, comfortable when dry but most likely to leak and most uncomfortable when wet. •  A preference for having a mixture of products to meet daytime needs; around two thirds of men were using a combination of pads and devices after testing compared to baseline. Conclusions •  This is the first trial to systematically compare different continence management devices for men •  Pads and devices have different strengths which make them particularly suited to certain circumstances and activities. •  Most men prefer to use pads at night but would choose a mixture of pads and devices during the day. •  Device limitations were important but may be overcome by better design.
      PubDate: 2014-12-11T06:36:36.134753-05:
      DOI: 10.1111/bju.13016
  • Emerging trends in prostate cancer literature: medical progress or
           marketing hype'
    • Authors: Jonathan Lo; Nathan Papa, Damien M Bolton, Declan Murphy, Nathan Lawrentschuk
      Abstract: Objectives •  To review emerging trends in prostate cancer (PC) literature with a focus on the marketing and implementation of new technologies, and the use of PC terms Methods •  Literature search of MEDLINE for external‐beam radiotherapy, prostatectomy, deferred intervention and focal therapy articles pertaining to PC •  Observational trends of PC literature relating to the marketing of new technologies and the use of standardised language Results •  PC literature has proliferated across all treatment modalities, particularly in the research of new technologies (robot‐assisted prostatectomy, image‐guided radiotherapy and focal therapy) •  Marketing and implementation of new technologies has occurred in some instances before effectiveness and adverse effects have been determined •  Inconsistent use of terminology exists in the PC literature Conclusion •  There is an ever‐present need for editors and researchers to maintain integrity and relevance in PC research •  We advocate a standardised language in PC and inclusion of active surveillance and robot‐assisted prostatectomy as MeSH indexing to reflect current trends and needs in PC research
      PubDate: 2014-12-11T06:36:27.616729-05:
      DOI: 10.1111/bju.13015
  • Clinical and Genomic Analysis of Metastatic Prostate Cancer Progression in
           a Background of Post‐Operative Biochemical Recurrence
    • Authors: Mohammed Alshalalfa; Anamaria Crisan, Ismael A. Vergara, Mercedeh Ghadessi, Christine Buerki, Nicholas Erho, Kasra Yousefi, Thomas Sierocinski, Zaid Haddad, Peter C. Black, R. Jeffrey Karnes, Robert B. Jenkins, Elai Davicioni
      Pages: n/a - n/a
      Abstract: Objective Biochemical recurrence (BCR) is a widely used surrogate for disease progression in the post‐operative setting. Of the men that experience BCR after surgery, only a minority will experience progression to lethal prostate cancer in their lifetime. In order to improve treatment decisions, we sought to better characterize the genomics of patients with BCR who have metastatic disease progression. Methods and Material The expression profiles of three clinical outcome groups after radical prostatectomy (RP) were compared: NED (no evidence of disease, n = 108); BCR (PSA without metastasis, n = 163); and MET (metastasis, n = 192). The patients were profiled using Human Exon 1.0 ST microarrays and outcomes were supported by a median 18 years of follow‐up. A MET signature was defined and verified in an independent RP cohort to ensure the robustness of the signature. Furthermore, bioinformatics characterization of the signature was conducted to decipher its biology. Results Minimal gene expression differences were observed between adjuvant treatment naïve NED patients and BCR patients without metastasis. More than 95% of the differentially expressed genes (MET signature) were found in comparisons between primary tumors of MET patients and the two other outcome groups. The MET signature was validated in an independent cohort and was significantly associated with cell cycle genes, ubiquitin‐mediated proteolysis, DNA repair, androgen, G‐protein coupled and NOTCH signal transduction pathways. Conclusion This study shows that metastasis development after BCR is associated with a distinct transcriptional program that can be detected in the primary tumor. NED and BCR patients have highly similar transcriptional profiles, suggesting that measurement of PSA on its own is a poor surrogate for a lethal disease. Use of genomic testing in radical prostatectomy patients with initial PSA rise may be useful to improved secondary therapy decision‐making.
      PubDate: 2014-12-08T13:21:17.723908-05:
      DOI: 10.1111/bju.13013
  • Am I normal? A systematic review and construction of nomograms for
           flaccid and erect penis length and circumference in up to 15,521 men
    • Authors: D Veale; S Miles, S Bramley, G Muir, J Hodsoll
      Pages: n/a - n/a
      Abstract: Objectives To systematically review and create nomograms on flaccid and erect penile size measurements. Methods Study key eligibility criteria: measurement of penis size by a health professional using a standard procedure; a minimum of 50 participants per sample Exclusion criteria were samples with a congenital or acquired penile abnormality. previous surgery, complaint of small penis size or erectile dysfunction Synthesis methods: Calculation of a weighted mean and pooled standard deviation and simulation of 20,000 observations from the normal distribution to generate nomograms of penis size. Results Nomograms for flaccid pendulous (n = 10,704, mean 9.16cm, sd 1.57) and stretched length (n=14,160, mean 13.24cm, sd 1.89), erect length (n = 692, mean 13.12cm, sd 1.66), flaccid circumference (n = 9,407, mean 9.31cm, sd 0.90); and erect circumference (n = 381, mean 11.66cm, sd 1.10) were constructed. Consistent and strongest significant correlation was between flaccid stretched or erect length and height, which ranged from r = 0.2 to 0.6. Conclusions penis size nomograms may be useful in clinical and therapeutic settings to counsel men and for academic research. Limitations: a relatively small number of erect measurements were conducted in a clinical setting and the greatest variability between studies was with flaccid stretched length.
      PubDate: 2014-12-08T13:20:51.201708-05:
      DOI: 10.1111/bju.13010
  • Validation of the GreenLight™ Simulator and development of a
           training curriculum for photoselective vaporisation of the prostate
    • Authors: Abdullatif Aydin; Gordon H. Muir, Manuela E. Graziano, Muhammad Shamim Khan, Prokar Dasgupta, Kamran Ahmed
      Pages: n/a - n/a
      Abstract: Objectives To assess face, content and construct validity, and feasibility and acceptability of the GreenLight™ Simulator as a training tool for photoselective vaporisation of the prostate (PVP), and to establish learning curves and develop an evidence‐based training curriculum. Subjects and Methods This prospective, observational and comparative study, recruited novice (25 participants), intermediate (14) and expert‐level urologists (seven) from the UK and Europe at the 28th European Association of Urological Surgeons Annual Meeting 2013. A group of novices (12 participants) performed 10 sessions of subtask training modules followed by a long operative case, whereas a second group (13) performed five sessions of a given case module. Intermediate and expert groups performed all training modules once, followed by one operative case. The outcome measures for learning curves and construct validity were time to task, coagulation time, vaporisation time, average sweep speed, average laser distance, blood loss, operative errors, and instrument cost. Face and content validity, feasibility and acceptability were addressed through a quantitative survey. Results Construct validity was demonstrated in two of five training modules (P = 0.038; P = 0.018) and in a considerable number of case metrics (P = 0.034). Learning curves were seen in all five training modules (P < 0.001) and significant reduction in case operative time (P < 0.001) and error (P = 0.017) were seen. An evidence‐based training curriculum, to help trainees acquire transferable skills, was produced using the results. Conclusion This study has shown the GreenLight Simulator to be a valid and useful training tool for PVP. It is hoped that by using the training curriculum for the GreenLight Simulator, novice trainees can acquire skills and knowledge to a predetermined level of proficiency.
      PubDate: 2014-12-07T20:21:26.579515-05:
      DOI: 10.1111/bju.12842
  • Ipsilateral renal function preservation after robot‐assisted partial
           nephrectomy (RAPN): an objective analysis using
           mercapto‐acetyltriglycine (MAG3) renal scan data and volumetric
    • Authors: Homayoun Zargar; Oktay Akca, Riccardo Autorino, Luis Felipe Brandao, Humberto Laydner, Jayram Krishnan, Dinesh Samarasekera, Robert J. Stein, Jihad H. Kaouk
      Pages: n/a - n/a
      Abstract: Objective To objectively assess ipsilateral renal function (IRF) preservation and factors influencing it after robot‐assisted partial nephrectomy (RAPN). Patients and Methods Our database was queried to identify patients who had undergone RAPN from 2007 to 2013 and had complete pre‐ and postoperative mercapto‐acetyltriglycine (MAG3) renal scan assessment. The estimated glomerular filtration rate (eGFR) for the operated kidney was calculated by multiplying the percentage of contribution from the renal scan by the total eGFR. IRF preservation was defined as a ratio of the postoperative eGFR for the operated kidney to the preoperative eGFR for the operated kidney. The percentage of total eGFR preservation was calculated in the same manner (postoperative eGFR/preoperative eGFR × 100). The amount of healthy rim of renal parenchyma removed was assessed by deducting the volume of tumour from the volume of the PN specimen assessed on pathology. Multivariable linear regression was used for analysis. Results In all, 99 patients were included in the analysis. The overall median (interquartile range) total eGFR preservation and IRF preservation for the operated kidney was 83.83 (75.2–94.1)% and 72 (60.3–81)%, respectively (P < 0.01). On multivariable analysis, volume of healthy rim of renal parenchyma removed, warm ischaemia time (WIT) > 30 min, body mass index (BMI) and operated kidney preoperative eGFR were predictive of IRF preservation. Conclusions Using total eGFR tends to overestimate the degree of renal function preservation after RAPN. This is particularly relevant when studying factors affecting functional outcomes after nephron‐sparing surgery. IRF may be a more precise assessment method in this setting. Operated kidney baseline renal function, BMI, WIT >30 min, and amount of resected healthy renal parenchyma represent the factors with a significant impact on the IRF preservation. RAPN provides significant preservation of renal function as shown by objective assessment criteria.
      PubDate: 2014-12-07T20:19:36.446816-05:
      DOI: 10.1111/bju.12825
  • Transperineal prostate biopsy: template‐guided or freehand?
    • Authors: Philip E. Dundee; Jeremy P. Grummet, Declan G. Murphy
      Pages: n/a - n/a
      PubDate: 2014-12-07T20:12:37.939299-05:
      DOI: 10.1111/bju.12860
  • Clinical significance of prognosis using the neutrophil–lymphocyte
           ratio and erythrocyte sedimentation rate in patients undergoing radical
           nephroureterectomy for upper urinary tract urothelial carcinoma
    • Authors: Hyun Hwan Sung; Hwang Gyun Jeon, Byong Chang Jeong, Seong Il Seo, Seong Soo Jeon, Han‐Yong Choi, Hyun Moo Lee
      Pages: n/a - n/a
      Abstract: Objectives To evaluate the clinical significance of preoperative erythrocyte sedimentation rate (ESR) and neutrophil–lymphocyte ratio (NLR) as prognostic factors in patients undergoing radical nephroureterectomy for upper tract urothelial carcinoma (UTUC). Patients and Methods A total of 410 patients were retrospectively reviewed. An elevated NLR was defined as ≥2.5 and a normal ESR was considered to be in the range of 0–22 mm/h in men and 0–27 mm/h in women. Patients were divided into three groups: those with ESR and NLR in the normal range (group 0, n = 168), those with either elevated ESR or elevated NLR (group I, n = 169), and those with both elevated ESR and elevated NLR (group II, n = 73). Results The median patient age was 64 years and the median follow‐up duration was 40.2 months. In all, 35.6 and 41.2% of patients had elevated NLRs and ESRs, respectively. Group II was associated with advanced tumour status in terms of size, grade, stage, lymph node and margin status (P < 0.05). Preoperative ESR (hazard ratio [HR] 1.784, 95% confidence interval [CI] 1.173–2.712), NLR (HR 1.704, 95% CI 1.136–2.556), and prognostic grouping (HR 2.285, 95% CI 1.397–3.737 for group I; HR 2.962, 95% CI 1.719–5.102 for group II) were independent predictors of progression‐free survival (PFS) in the multivariate model (P < 0.05). Prognostic grouping was also an independent prognostic factor for cancer‐specific survival (CSS) and overall survival (OS). Time‐dependent area under the receiver‐operating characteristic curves showed that NLR plus ESR had a greater diagnostic value than NLR alone regarding oncological outcomes (P < 0.05). Conclusions Prognostic grouping using ESR and NLR was identified as an independent prognostic marker in patients with UTUC. The addition of ESR improved the prognostic value of NLR alone in predicting oncological outcomes. The combination of preoperative ESR and NLR might be a new prediction tool in patients with UTUC after radical nephroureterectomy.
      PubDate: 2014-12-07T19:52:07.428341-05:
      DOI: 10.1111/bju.12846
  • Incidence of urethral stricture after bipolar transurethral resection of
           the prostate using TURis: results from a randomised trial
    • Authors: Kazumasa Komura; Teruo Inamoto, Tomoaki Takai, Taizo Uchimoto, Kenkichi Saito, Naoki Tanda, Koichiro Minami, Rintaro Oide, Hirofumi Uehara, Kiyoshi Takahara, Hajime Hirano, Hayahito Nomi, Satoshi Kiyama, Toshikazu Watsuji, Haruhito Azuma
      Abstract: Objectives To assess whether bipolar transurethral resection of the prostate (B‐TURP) using the TURis® system has a similar level of efficacy and safety to that of the traditional monopolar transurethral resection of the prostate (M‐TURP), and to evaluate the impact of the TURis system on postoperative urethral stricture rates over a 36‐month follow‐up period. Patients and Methods A total of 136 patients with benign prostatic obstruction were randomised to undergo either B‐TURP using the TURis system or conventional M‐TURP, and were regularly followed for 36 months after surgery. The primary endpoint was safety, which included the long‐term complication rates of postoperative urethral stricture. The secondary endpoint was the follow‐up measurement of efficacy. Results In peri‐operative findings, no patient in either treatment group presented with transurethral resection syndrome, and the decline in levels of haemoglobin and hematocrit were similar. The mean operation time was significantly extended in the TURis treatment group compared with the M‐TURP group (79.5 vs 68.6 min; P = 0.032) and postoperative clot retention was more likely to be seen after M‐TURP (P = 0.044). Similar efficacy findings were maintained throughout 36 months, but a significant difference in postoperative urethral stricture rates between groups was detected (6.6% in M‐TURP vs 19.0% in TURis; P = 0.022). After stratifying patients according to prostate volume, there was no significant difference between the two treatment groups with regard to urethral stricture rates in patients with a prostate volume ≤ 70 mL (3.8% in M‐TURP vs 3.8% in TURis), but in the TURis group there was a significantly higher urethral stricture rate compared with the M‐TURP group in patients with a prostate volume >70 mL (20% in TURis vs 2.2% in M‐TURP; P = 0.012). Furthermore, the mean operation time for TURis was significantly longer than for M‐TURP for the subgroup of patients with a prostate volume > 70 mL (99.6 vs 77.2 min; P = 0.011), but not for the subgroup of patients with a prostate volume ≤ 70 mL. Conclusion The TURis system seems to be as efficacious and safe as conventional M‐TURP except that there was a higher incidence of urethral stricture in patients with larger preoperative prostate volumes.
      PubDate: 2014-10-24T01:55:28.518382-05:
      DOI: 10.1111/bju.12831
  • Cytotoxic chemotherapy in the contemporary management of metastatic
           castration‐resistant prostate cancer (mCRPC)
    • Authors: Guru Sonpavde; Christopher G. Wang, Matthew D. Galsky, William K. Oh, Andrew J. Armstrong
      Abstract: For several years, docetaxel was the only treatment shown to improve survival of patients with metastatic castration‐resistant prostate cancer (mCRPC). There are now several novel agents available, although chemotherapy with docetaxel and cabazitaxel continues to play an important role. However, the increasing number of available agents will inevitably affect the timing of chemotherapy and therefore it may be important to offer this approach before declining performance status renders patients ineligible for chemotherapy. Patient selection is also important to optimise treatment benefit. The role of predictive biomarkers has assumed greater importance due to the development of multiple agents and resistance to available agents. In addition, the optimal sequence of treatments remains undefined and requires further study in order to maximize long‐term outcomes. We provide an overview of the clinical data supporting the role of chemotherapy in the treatment of mCRPC and the emerging role in metastatic castration‐sensitive prostate cancer. We review the key issues in the management of patients including selection of patients for chemotherapy, when to start chemotherapy, and how best to sequence treatments to maximise outcomes. In addition, we briefly summarise the promising new chemotherapeutic agents in development in the context of emerging therapies.
      PubDate: 2014-10-23T21:58:29.773493-05:
      DOI: 10.1111/bju.12867
  • Medium‐term oncological outcomes for extended vs saturation biopsy
           and transrectal vs transperineal biopsy in active surveillance for
           prostate cancer
    • Authors: James E. Thompson; Andrew Hayen, Adam Landau, Anne‐Maree Haynes, Arveen Kalapara, Joseph Ischia, Jayne Matthews, Mark Frydenberg, Phillip D. Stricker
      Abstract: Objective To assess, in men undergoing active surveillance (AS) for low‐risk prostate cancer, whether saturation or transperineal biopsy altered oncological outcomes, compared with standard transrectal biopsy. Patients and Methods Retrospective analysis of prospectively collected data from two cohorts with localised prostate cancer (1998–2012) undergoing AS. Prostate cancer‐specific, metastasis‐free and treatment‐free survival, unfavourable disease and significant cancer at radical prostatectomy (RP) were compared for standard (12 core, median 16), and transrectal vs transperineal biopsy, using multivariate analysis. Results In all, 650 men were included in the analysis with a median (mean) follow‐up of 55 (67) months. Prostate cancer‐specific, metastasis‐free and biochemical recurrence‐free survival were 100%, 100% and 99% respectively. Radical treatment‐free survival at 5 and 10 years were 57% and 45% respectively (median time to treatment 7.5 years). On Kaplan–Meier analysis, saturation biopsy was associated with increased objective biopsy progression requiring treatment (log‐rank P = 0.01). On multivariate Cox proportional hazards analysis, saturation biopsy (hazard ratio 1.68, P < 0.01) but not transperineal approach (P = 0.89) was associated with increased objective biopsy progression requiring treatment. On logistic regression analysis of 179 men who underwent RP for objective progression, transperineal biopsy was associated with lower likelihood of unfavourable RP pathology (odds ratio 0.42, P = 0.03) but saturation biopsy did not alter the likelihood (P = 0.25). Neither transperineal nor saturation biopsy altered the likelihood of significant vs insignificant cancer at RP (P = 0.19 and P = 0.41, respectively). Conclusions AS achieved satisfactory oncological outcomes. Saturation biopsy increased progression to treatment on AS; longer follow‐up is needed to determine if this represents beneficial earlier detection of significant disease or over‐treatment. Transperineal biopsy reduced the likelihood of unfavourable disease at RP, possibly due to earlier detection of anterior tumours.
      PubDate: 2014-10-23T21:29:37.142058-05:
      DOI: 10.1111/bju.12858
  • Targeted local therapy in oligometastatic prostate cancer: a promising
           potential opportunity after failed primary treatment
    • Authors: Fairleigh Reeves; Declan Murphy, Christopher Evans, Patrick Bowden, Anthony Costello
      PubDate: 2014-10-13T02:39:55.11755-05:0
      DOI: 10.1111/bju.12957
  • Long‐Term Analysis of Oncologic Outcomes After Laparoscopic Radical
           Cystectomy in Europe: Results from a Multicentric Study of
           Eau‐Section of Uro‐Technology
    • Authors: Simone Albisinni; Jens Rassweiler, Clement‐Claude Abbou, Xavier Cathelineau, Piotr Chlosta, Laurent Fossion, Franco Gaboardi, Peter Rimington, Laurent Salomon, Rafael Sanchez‐Salas, Jens‐Uwe Stolzenburg, Dogu Teber, Roland Velthoven
      Abstract: Objective To report long‐term outcomes of laparoscopic radical cystectomy (LRC) in a multi‐centric European cohort, and explore feasibility and safety of the procedure. Patients and Methods This study was coordinated by EAU‐section of Uro‐technology (ESUT) with nine centers enrolling 503 patients undergoing LRC for bladder cancer prospectively between 2000 and 2013. Data were retrospectively analyzed. Descriptive statistics were used to explore peri‐ and post‐operative characteristics of the cohort. Kaplan‐Meier curves were constructed to evaluate recurrence free survival (RFS), cancer specific survival (CSS) and overall survival (OS). Outcomes were also stratified according to tumour stage, node involvement and surgical margin status. Results Minor complications (Clavien I‐II) occurred in 39% and major (IIIa‐IVb) in 17%. 10 (2%) post‐operative deaths were recorded. Median lymph node retrieval was 14 (IQR 9‐17) and positive surgical margins were detected in 29 (5.8%) patients. Median follow‐up was 50 months (mean 60, IQR 19‐90), during which 134 (27%) recurrences were detected. Actuarial RFS, CSS and OS rates were 66%, 75% and 62% at 5years and 62%, 55%, 38% at 10 years. Significant differences in RFS, CSS and OS were found according to tumour stage, node involvement and margin status (log‐rank p
      PubDate: 2014-10-07T22:55:55.992849-05:
      DOI: 10.1111/bju.12947
  • Association between metabolic syndrome and severity of lower urinary tract
           symptoms: observational study in a 4,666 European men cohort
    • Authors: Pourya Pashootan; Guillaume Ploussard, Arnaud Cocaul, Armaury De Gouvello, François Desgrandchamps
      Pages: n/a - n/a
      Abstract: Objectives To evaluate the relationship between metabolic syndrome (MS) and the frequency and severity of lower urinary tract symptoms (LUTS) Patients and Methods 4,666 male patients from 55 to 100 years old consulting a general practitioner (GP) on a 12‐days period in December 2009 have been included into an observational study. LUTS were defined according to the I‐PSS score and metabolic syndrome with the NECP/ATP III definition. We studied the correlation between MS and its individual component, and the severity of LUTS (I‐PSS and treatment for LUTS). Analyses were adjusted on BMI, age, and PSA level. Results MS was reported in 51.5 % of the patients and 47% were treated for LUTS. There was a significant link between MS and treated LUTS (p
      PubDate: 2014-09-17T04:13:12.936292-05:
      DOI: 10.1111/bju.12931
  • Association of Androgen Deprivation Therapy with Excess
           Cardiac‐Specific Mortality in Men with Prostate Cancer
    • Authors: David R. Ziehr; Ming‐Hui Chen, Danjie Zhang, Michelle H. Braccioforte, Brian J. Moran, Brandon A. Mahal, Andrew S. Hyatt, Shehzad S. Basaria, Clair J. Beard, Joshua A. Beckman, Toni K. Choueiri, Anthony V. D'Amico, Karen E. Hoffman, Jim C. Hu, Neil E. Martin, Christopher J. Sweeney, Quoc‐Dien Trinh, Paul L Nguyen
      Abstract: Objectives To determine if androgen deprivation therapy (ADT) is associated with excess cardiac‐specific mortality (CSM) in men with prostate cancer and no cardiovascular comorbidity, coronary artery disease risk factors, or congestive heart failure (CHF) or past myocardial infarction (MI). Subjects/patients and methods Five thousand seventy‐seven men (median age, 69.5 years) with cT1c‐T3N0M0 prostate cancer were treated with brachytherapy with or without neoadjuvant ADT (median duration, four months) between 1997 and 2006. Fine and Gray's competing risks analysis evaluated the association of ADT with CSM, adjusting for age, year of brachytherapy, and ADT treatment propensity score among men in groups defined by cardiac comorbidity. Results After a median follow‐up of 4.8 years, no association was detected between ADT and CSM in men with no cardiac risk factors (1.08% at 5 years for ADT vs 1.27% at five years for no ADT, adjusted hazard ratio (AHR) 0.83; 95% confidence interval (CI), 0.39‐1.78; P=0.64; n=2653) or in men with diabetes mellitus, hypertension, or hypercholesterolemia (2.09% vs 1.97%, AHR, 1.33; 95% CI, 0.70‐2.53; P=0.39; n=2168). However, ADT was associated with significantly increased CSM in men with CHF or MI (AHR 3.28; 95% CI 1.01‐10.64; P=0.048; n=256). In this subgroup, the five‐year cumulative incidence of CSM was 7.01% (95% CI 2.82‐13.82%) for ADT vs 2.01% (95% CI 0.38‐6.45%) for no ADT. Conclusion ADT was associated with a five percent absolute excess risk of CSM at five years in men with CHF or prior MI, suggesting that administering ADT to 20 men in this potentially vulnerable subgroup could result in one cardiac death.
      PubDate: 2014-08-15T01:55:07.623913-05:
      DOI: 10.1111/bju.12905
  • Multicenter prospective evaluation of the learning curve of the holmium
           laser enucleation of the prostate (HoLEP)
    • Abstract: Objectives To describe the step‐by‐step learning curve of Holmium Laser Enucleation (HoLEP) surgical technique. Patients and methods A prospective, multicentrer observational study was conducted, involving surgeons experienced in transurethral resection of the prostate and open prostatectomy, never having performed HoLEP were included. The main judgment criterion was the ability of the surgeon to perform four consecutive successful procedures, defined by the following: complete enucleation and morcellation, within less than 90 minutes, without any conversion to standard TURP, with acceptable stress, and with acceptable difficulty (evaluated by Likert scales). Each surgeon included 20 consecutive cases. Results Of nine centers, three abandoned the procedure before the end of the study due to complications, and one was excluded for treating patients off protocol. Only one centre achieved the main judgment criterion of four consecutive successful procedures. Overall, the procedures were successfully performed in 43.6% of cases. Reasons for unsuccessful procedures were mainly operative time longer than 90 minutes (n=51), followed by conversion to TURP (n=14), incomplete morcellation (n=8), significant stress (n=9), or difficulty (n=14) during procedure. Ignoring operating time, 64% of procedures were successful and four out of five centers did 4 consecutive successful cases. Of the five centers who completed the study, four chose to continue HoLEP. Conclusion Even in a prospective training structure, HoLEP has a steep learning curve exceeding 20 cases, with almost half of our centres choosing to abandon or not to continue with the technique. Operating time and difficulty of the enucleation seem the most important problems for a beginner. A more intensely mentored and structured mentorship programme might allow safer adoption of the operation. This article is protected by copyright. All rights reserved.
  • Podium Presentation Abstracts
  • Poster & Podium Poster Abstracts
  • Author Index
  • Comparative effectiveness and safety of various treatment procedures for
           lower pole renal calculi: a systematic review and network
    • Abstract: Objective To compare the effectiveness of various treatments used for lower pole renal calculi. Methods We searched PubMed, EMBASE, CINAHL, the Cochrane Collaboration's Database of Systematic Reviews, the Cochrane Collaboration Central Register of Controlled Clinical Trials as well as for reports up to 1 April 2014. The search was supplemented with abstract reports from various urology conferences. All randomised, ‘blinded’ clinical studies including patients treated for lower pole renal calculi of
  • A novel interface for the telementoring of robotic surgery
    • Abstract: Objective To prospectively evaluate the feasibility and safety of a novel, second‐generation telementoring interface (Connect™; Intuitive Surgical Inc., Sunnyvale, CA, USA) for the da Vinci robot. Materials and Methods Robotic surgery trainees were mentored during portions of robot‐assisted prostatectomy and renal surgery cases. Cases were assigned as traditional in‐room mentoring or remote mentoring using Connect. While viewing two‐dimensional, real‐time video of the surgical field, remote mentors delivered verbal and visual counsel, using two‐way audio and telestration (drawing) capabilities. Perioperative and technical data were recorded. Trainee robotic performance was rated using a validated assessment tool by both mentors and trainees. The mentoring interface was rated using a multi‐factorial Likert‐based survey. The Mann–Whitney and t‐tests were used to determine statistical differences. Results We enrolled 55 mentored surgical cases (29 in‐room, 26 remote). Perioperative variables of operative time and blood loss were similar between in‐room and remote mentored cases. Robotic skills assessment showed no significant difference (P > 0.05). Mentors preferred remote over in‐room telestration (P = 0.05); otherwise no significant difference existed in evaluation of the interfaces. Remote cases using wired (vs wireless) connections had lower latency and better data transfer (P = 0.005). Three of 18 (17%) wireless sessions were disrupted; one was converted to wired, one continued after restarting Connect, and the third was aborted. A bipolar injury to the colon occurred during one (3%) in‐room mentored case; no intraoperative injuries were reported during remote sessions. Conclusion In a tightly controlled environment, the Connect interface allows trainee robotic surgeons to be telementored in a safe and effective manner while performing basic surgical techniques. Significant steps remain prior to widespread use of this technology.
  • Psychosocial interventions for men with prostate cancer: a Cochrane
           systematic review
    • Abstract: To evaluate the effectiveness of psychosocial interventions for men with prostate cancer in improving quality of life (QoL), self‐efficacy and knowledge and in reducing distress, uncertainty and depression. We searched for trials using a range of electronic databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsycINFO to October 2013, together with hand searching of journals and reference lists. Randomised controlled trials were eligible if they included psychosocial interventions that explicitly used one or a combination of the following approaches: cognitive behavioural, psycho‐educational, supportive and counselling. Interventions had to be delivered or facilitated by trained or lay personnel. Our outcomes were an improvement in QoL, self‐efficacy and knowledge and a reduction in distress, uncertainty and depression. Pairs of review authors independently extracted data and assessed risk of bias. We analysed data using standardised mean differences (SMDs), random‐effects models and 95% confidence intervals (CIs). In all, 19 studies with a total of 3 204 men, with a diagnosis of prostate cancer, comparing psychosocial interventions vs usual care were included in this review. Men in the psychosocial intervention group had a small, statistically significant improvement in the physical component of general health‐related QoL (GHQoL) at end of intervention (SMD 0.12, 95% CI 0.01–0.22) based on low quality evidence. There was no clear evidence of benefit associated with psychosocial interventions for the mental component of GHQoL at end of intervention (SMD −0.04, 95% CI −0.15 to 0.06) based on moderate quality evidence. At end of intervention, cancer‐related QoL showed a small improvement after psychosocial interventions (SMD 0.21, 95% CI 0.04–0.39). For prostate cancer‐specific and symptom‐related QoL, the differences between intervention and control groups were not significant. There was no clear evidence that psychosocial interventions were beneficial in improving self‐efficacy at end of intervention (SMD 0.16, 95% CI −0.05 to 0.38) based on very low quality evidence. Men in the psychosocial intervention group had a moderate increase in prostate cancer knowledge at end of intervention (SMD 0.51, 95% CI 0.32–0.71) based on very low quality evidence. A small increase in knowledge with psychosocial interventions was noted at 3 months after intervention (SMD 0.31, 95% CI 0.04–0.58). The results for uncertainty (SMD −0.05, 95% CI −0.35 to 0.26) and distress (SMD 0.02, 95% CI −0.11 to 0.15) at end of intervention were compatible with both benefit and harm based on very low quality evidence. Finally, there was no clear evidence of benefit associated with psychosocial interventions for depression at end of intervention (SMD −0.18, 95% CI −0.51 to 0.15) based on very low quality evidence. The overall risk of bias in the included studies was unclear or high, primarily as the result of performance bias. No data about stage of disease or treatment with androgen‐deprivation therapy were extractable for subgroup analysis. Only one study addressed adverse effects. Overall, this review shows that psychosocial interventions may have small, short‐term beneficial effects on certain domains of wellbeing, as measured by the physical component of GHQoL and cancer‐related QoL when compared with usual care. Prostate cancer knowledge was also increased. However, this review failed to show a statistically significant effect on other domains such as symptom‐related QoL, self‐efficacy, uncertainty, distress or depression. Moreover, when beneficial effects were seen, it remained uncertain whether the magnitude of effect was large enough to be considered clinically important. The quality of evidence for most outcomes was rated as very low according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, reflecting study limitations, loss to follow‐up, study heterogeneity and small sample sizes. We were unable to perform meaningful subgroup analyses based on disease stage or treatment method. Although some findings of this review are encouraging, they do not provide sufficiently strong evidence to permit meaningful conclusions about the effects of these interventions in men with prostate cancer. Additional well executed and transparently reported research studies are necessary to establish the role of psychosocial interventions in men with prostate cancer.
  • Targeted microbubbles: a novel application for the treatment of kidney
    • Abstract: Kidney stone disease is endemic. Extracorporeal shockwave lithotripsy was the first major technological breakthrough where focused shockwaves were used to fragment stones in the kidney or ureter. The shockwaves induced the formation of cavitation bubbles, whose collapse released energy at the stone, and the energy fragmented the kidney stones into pieces small enough to be passed spontaneously. Can the concept of microbubbles be used without the bulky machine' The logical progression was to manufacture these powerful microbubbles ex vivo and inject these bubbles directly into the collecting system. An external source can be used to induce cavitation once the microbubbles are at their target; the key is targeting these microbubbles to specifically bind to kidney stones. Two important observations have been established: (i) bisphosphonates attach to hydroxyapatite crystals with high affinity; and (ii) there is substantial hydroxyapatite in most kidney stones. The microbubbles can be equipped with bisphosphonate tags to specifically target kidney stones. These bubbles will preferentially bind to the stone and not surrounding tissue, reducing collateral damage. Ultrasound or another suitable form of energy is then applied causing the microbubbles to induce cavitation and fragment the stones. This can be used as an adjunct to ureteroscopy or percutaneous lithotripsy to aid in fragmentation. Randall's plaques, which also contain hydroxyapatite crystals, can also be targeted to pre‐emptively destroy these stone precursors. Additionally, targeted microbubbles can aid in kidney stone diagnostics by virtue of being used as an adjunct to traditional imaging methods, especially useful in high‐risk patient populations. This novel application of targeted microbubble technology not only represents the next frontier in minimally invasive stone surgery, but a platform technology for other areas of medicine.
  • A Comparative Analysis of Robotic versus Laparoscopic Retroperitoneal
           Lymph Node Dissection for Testicular Cancer
    • Abstract: Objective To compare the safety and perioperative outcomes of robotic versus laparoscopic retroperitoneal lymph node dissection (RPLND). Patients and Methods Our institutional review board approved retrospective testicular cancer registry was queried for patients who underwent a primary unilateral robotic (R‐RPLND) or laparoscopic (L‐RPLND) RPLND by a single surgeon for a stage I testicular nonseminomatous germ cell tumor. Groups were compared for differences in baseline and outcomes variables. Results Between July 2006 and July 2014, a total of 16 R‐RPLND and 21 L‐RPLND cases were performed by a single surgeon. Intra‐ and perioperative outcomes including operative time, estimated blood loss, lymph node yield, complicate rate and ejaculatory status were similar between groups (all p > 0.1). Conclusions As an early checkpoint, R‐RPLND appears comparable to the laparoscopic approach in terms of safety and perioperative outcomes. It remains unclear if R‐RPLND offers any tangible benefits over standard laparoscopy. This article is protected by copyright. All rights reserved.
  • Impact of stage migration and practice changes on high risk prostate
           cancer: results from patients treated with radical prostatectomy over the
           last two decades
    • Abstract: Background Phenotype of prostate cancer at diagnosis has changed through the years. We aim to evaluate the impact of year of surgery on clinical, pathologic and oncologic outcomes of high‐risk prostate cancer patients. Patients and methods We evaluated 1,033 clinically high‐risk patients, defined as the presence of at least one of the following risk factors: pre‐operative prostate specific antigen (PSA) level >20 ng/ml, and/or clinical stage ≥T3, and/or biopsy Gleason score ≥8. Patients were treated between 1990 and 2013 at a single Institution. Year‐per‐year trends of clinical and pathologic characteristics were examined. Multivariable Cox regression analysis was used to test the relationship between year of surgery and oncologic outcomes. Results We observed a decrease over time in the proportion of high‐risk patients with a pre‐operative PSA level >20 ng/ml or clinical stage cT3. An opposite trend was seen for biopsy Gleason score ≥8. We observed a considerable increase in the median number of lymph nodes removed that was associated with an increased rate of LNI. At multivariable Cox regression analysis, year of surgery was associated with a reduced risk of biochemical recurrence (HR per 5‐year: 0.90; 95% CI: 0.84–0.96; p=0.01) and distant metastasis (HR per 5‐year: 0.91; 95% CI: 0.83–0.99; p=0.039), after adjusting for age, pre‐operative PSA, pathologic stage, lymph node invasion, surgical margin status, and pathological Gleason score. Conclusions In this single center study, an increased diagnosis of localized and less extensive high‐grade prostate cancer was observed over the last two decades. High‐risk patients selected for radical prostatectomy showed better cancer control over time. Better definitions of what constitutes high‐risk prostate cancer among contemporary patients are needed. This article is protected by copyright. All rights reserved.
  • Histopathological characteristics of microfocal prostate cancer detected
           during systematic prostate biopsy
    • Abstract: Objective To evaluate the prevalence of adverse pathological features and the percentage of multifocal and/or bilateral disease in a series of patients who underwent radical prostatectomy (RP) for unique, microfocal prostate cancer (miPCa) detected on prostate biopsy in the pre‐active surveillance (AS) era. Patients and Methods In this retrospective, multi‐institutional study, we analysed the clinical records of 131 consecutive patients who underwent either retropubic or robot‐assisted RP for miPCa at two referral centres from January 2000 to December 2011. miPCa was defined as a neoplastic lesion present in ≤10% of core with biopsy Gleason score not applicable or biopsy Gleason score 6. Results There were 17 (13%) pT3–4 prostate cancers and a single case (0.8%) of pN+ tumour. Moreover, 31 (24.1%) patients had a Gleason score of >6 in the RP specimen. Therefore, unfavourable pathological features (pT3–4/N+ and/or Gleason score >6) were present in 40 (30.5%) patients. The median (interquartile range) prostate‐specific antigen (PSA) density was 0.11 (0.09–0.17) and 0.16 (0.11–0.24) ng/mL/mL in patients with favourable and unfavourable pathological characteristics, respectively (P = 0.003). The receiver operating characteristic curve had an area under the curve value of 0.67 (95% confidence interval 0.56–0.77) for PSA density to predict the risk of unfavourable pathological features. Conclusion Patients with miPCa who are candidates for an AS protocol should be adequately informed that in ≈30% of cases the cancer might be locally advanced and/or with a Gleason score of >6. Those unfavourable pathological characteristics could be predicted by the PSA density value. Further studies should investigate the role of a more extensive biopsy sampling to reduce the risk of under‐staging and/or under‐grading in patients with an initial diagnosis of miPCa.
  • The genetic diversity of cystinuria in a UK population of patients
    • Abstract: Objective To examine the genetic mutations in the first UK cohort of patients with cystinuria with preliminary genotype/phenotype correlation. Patients and Methods DNA sequencing and multiplex ligation‐dependent probe amplification (MLPA) were used to identify the mutations in 74 patients in a specialist cystinuria clinic in the UK. Patients with type A cystinuria were classified into two groups: Group M patients had at least one missense mutation and Group N patients had two alleles of all other types of mutations including frameshift, splice site, nonsense, deletions and duplications. The levels of urinary dibasic amino acids, age at presentation of disease, number of stone episodes and interventions were compared between patients in the two groups using the Mann–Whitney U‐test. Results In all, 41 patients had type A cystinuria, including one patient with a variant of unknown significance and 23 patients had type B cystinuria, including six patients with variants of unknown significance. One patient had three sequence variants in SLC7A9; however, two are of unknown significance. Three patients had type AB cystinuria. Three had a single mutation in SLC7A9. No identified mutations were found in three patients in either gene. There were a total of 88 mutations in SLC3A1 and 55 mutations in SLC7A9. There were 23 pathogenic mutations identified in our UK cohort of patients not previously published. In patients with type A cystinuria, the presence of a missense mutation correlated to lower levels of urinary lysine (mean [se] 611.9 [22.65] vs 752.3 [46.39] millimoles per mole of creatinine [mm/MC]; P=0.02), arginine (194.8 [24.83] vs 397.7 [15.32] mm/MC; P
  • Mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney: a
           detailed study of radiological, pathological and clinical outcomes
    • Abstract: Objective To characterise the clinical, radiological and histological features of mucinous tubular and spindle cell carcinoma (MTSCC), as well as oncological outcomes. Patients and methods This is a single institution retrospective analysis of all patients with MTSCC from 2002 to 2011. Patients were excluded if MTSCC could not be confirmed on pathology re‐review (four patients). Clinical characteristics, pathology, imaging, and outcomes were reviewed for the 19 included patients. Results The median (range) age at diagnosis was 59 (17–71) years with a female predominance (78.9%). On contrast‐enhanced computed tomography, MTSCC enhanced less than the cortex during the corticomedullary phase. The mean (range) tumour attenuation was 36 (24–48), 67 (41–133), 89 (49–152), and 76 (52–106) Hounsfield units in the pre‐contrast, corticomedullary, nephrographic and excretory phases, respectively. In all, 16 patients were treated with partial (five patients) or radical nephrectomy (11) for pT1 (62.5%), pT2 (31.3%), and pT3a disease (6.3%). One patient underwent active surveillance. Of three patients (13.0%) managed with energy ablation, there was one recurrence that was treated with salvage surgery. One patient (5.3%) had metastatic disease at diagnosis and died from disease 64.7 months later. A patient with a pT2bN0M0 MTSCC with sarcomatoid dedifferentiation developed bone metastases 9.5 months after diagnosis and was alive at 19.0 months. The remainder were free of recurrence or progression. Conclusion MTSCC is a rare renal cell carcinoma (RCC) variant. In this largest series to date, MTSCC presented at a broad range of ages and displayed a female predilection. Imaging and pathological features of MTSCC display some overlap with papillary RCC. MTSCC is associated with excellent outcomes overall, but is not universally indolent.
  • Full immersion simulation: validation of a distributed simulation
           environment for technical and non‐technical skills training in
    • Abstract: Objective To evaluate the face, content and construct validity of the distributed simulation (DS) environment for technical and non‐technical skills training in endourology. To evaluate the educational impact of DS for urology training. Subjects and Methods DS offers a portable, low‐cost simulated operating room environment that can be set up in any open space. A prospective mixed methods design using established validation methodology was conducted in this simulated environment with 10 experienced and 10 trainee urologists. All participants performed a simulated prostate resection in the DS environment. Outcome measures included surveys to evaluate the DS, as well as comparative analyses of experienced and trainee urologist's performance using real‐time and ‘blinded’ video analysis and validated performance metrics. Non‐parametric statistical methods were used to compare differences between groups. Results The DS environment demonstrated face, content and construct validity for both non‐technical and technical skills. Kirkpatrick level 1 evidence for the educational impact of the DS environment was shown. Further studies are needed to evaluate the effect of simulated operating room training on real operating room performance. Conclusions This study has shown the validity of the DS environment for non‐technical, as well as technical skills training. DS‐based simulation appears to be a valuable addition to traditional classroom‐based simulation training.
  • The changing reality of urothelial bladder cancer: should
           non‐squamous variant histology be managed as a distinct clinical
    • Abstract: Objectives To assess the effect of non‐squamous differentiation (non‐SQD) variant histology on survival in muscle‐invasive bladder urothelial cancer (UC). Patients and Methods A cohort of 411 radical cystectomy (RC) cases performed with curative intent for muscle‐invasive primary UC was identified between 2008 and June 2013. Survival analysis was evaluated using Kaplan–Meier methodology comparing non‐variant (NV) + SQD histology to non‐SQD variant histology (non‐SQD variants). Multivariable cox proportional hazards regression assessed all‐cause and disease‐specific mortality. Results Of the 411 RC cases, 77 (19%) had non‐SQD variant histology. The median overall survival (OS) for non‐SQD variant histology was 28 months, whereas the NV+SQD group had not reached the median OS at 74 months (log‐rank test P < 0.001). After adjusting for sex, age, pathological stage, and any systemic chemotherapy, patients with non‐SQD variant histology at RC had a 1.57‐times increased adjusted risk of all‐cause mortality (P = 0.027) and 1.69‐times increased risk of disease‐specific mortality (P = 0.030) compared with NV+SQD patients. Conclusions While SQD behaves similarly to NV, non‐SQD variant histology portends worse OS and disease‐specific survival regardless of neoadjuvant or adjuvant chemotherapy and pathological stage. Non‐SQD variants of UC could perhaps be considered a distinct clinical entity in UC with goals for developing new treatment algorithms through novel clinical trials.
  • Disease‐specific death and metastasis do not occur in patients with
           Gleason score ≤6 at radical prostatectomy
    • Abstract: Objectives To assess the metastasis‐free survival (MFS) and disease‐specific survival (DSS) in men with Gleason score ≤6 prostate cancer at radical prostatectomy (RP). Patients and Methods We included 1101 consecutive RP patients operated between March 1985 to July 2013 at a single institution. The outcome variables were MFS and DSS. The postoperative survival was estimated by the Kaplan–Meier method. Results The Gleason score distribution of the study population (1101 patients) was Gleason score ≤6 (449, 41%), Gleason score 3 + 4 = 7 (436, 40%), Gleason score 4 + 3 = 7 (99, 9%) and Gleason score 8–10 (117, 11%). The median (interquartile range) postoperative follow‐up was 100 (48–150) months. During follow‐up 197 men (18%) died, of whom 42 (3.8%) died from prostate cancer‐related causes. In all, 19/1101 patients (1.7%) had documented lymph node metastasis at the time of RP: none with Gleason score ≤6, seven with Gleason score 3 + 4 = 7 (1.6%), six with Gleason score 4 + 3 = 7 (6.1%) and six with Gleason score 8–10 (5.1%). Distant metastasis occurred in 56/1101 patients (5.1%): none with Gleason score ≤6, 23 with Gleason score 3 + 4 = 7 (5.3%), 17 with Gleason score 4 + 3 = 7 (17%) and 16 with Gleason score 8–10 (14%). Disease‐specific death, stratified per Gleason‐score group was: none in ≤6, 16 (3.7%) in 3 + 4 = 7, 16 (16%) in 4 + 3 = 7 and 10 (8.5%) in 8–10 group. Conclusion No metastasis or disease‐specific death were seen in men with Gleason score ≤6 prostate cancer at RP, showing the negligible potential to metastasise in this large subgroup of patients with prostate cancer.
  • The role of adjuvant chemotherapy for lymph node‐positive upper
           tract urothelial carcinoma following radical nephroureterectomy: a
           retrospective study
    • Abstract: Objective To evaluate the effect of adjuvant chemotherapy (AC) on mortality after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) with positive lymph nodes (LNs) and to identify patient subgroups that are most likely to benefit from AC. Patients and methods We retrospectively analysed data of 263 patients with LN‐positive UTUC, who underwent full surgical resection. In all, 107 patients (41%) received three to six cycles of AC, while 156 (59.3%) were treated with RNU alone. UTUC‐related mortality was evaluated using competing‐risks regression models. Results In all patients (Tall N+), administration of AC had no significant impact on UTUC‐related mortality on univariable (P = 0.49) and multivariable (P = 0.11) analysis. Further stratified analyses showed that only N+ patients with pT3–4 disease benefited from AC. In this subgroup, AC reduced UTUC‐related mortality by 34% (P = 0.019). The absolute difference in mortality was 10% after the first year and increased to 23% after 5 years. On multivariable analysis, administration of AC was associated with significantly reduced UTUC‐related mortality (subhazard ratio 0.67, P = 0.022). Limitations of this study are the retrospective non‐randomised design, selection bias, absence of a central pathological review and different AC protocols. Conclusions AC seems to reduce mortality in patients with pT3–4 LN‐positive UTUC after RNU. This subgroup of LN‐positive patients could serve as target population for an AC prospective randomised trial.
  • Upper limit of cancer extent on biopsy defining very low‐risk
           prostate cancer
    • Abstract: Objective To investigate how much Gleason pattern 3 cancer prostate biopsy specimens may contain without an increased risk of undetected more aggressive cancer, compared with the risk for cancers fulfilling the National Comprehensive Cancer Network (NCCN) criteria for very low‐risk prostate cancer. Patients and Methods We identified 1286 men aged
  • Risk of acute myocardial infarction after androgen‐deprivation
           therapy for prostate cancer in a Chinese population
    • Abstract: Objective To investigate the risk of acute myocardial infarction (AMI) after androgen‐deprivation therapy (ADT) for prostate cancer in a Chinese population. Patients and methods All Chinese patients with prostate cancer who were treated primarily with radical prostatectomy or radiotherapy, with or without further ADT at our hospital from the year 2000 to 2009 were retrospectively reviewed. We compared the risk of AMI in the patients who were given further ADT (ADT group) with those who were not given any ADT (non‐ADT group). Potential risk factors of AMI including age, diabetes mellitus, hypertension, hyperlipidaemia, history of stroke, ischaemic heart disease, Eastern Cooperative Oncology Group Performance Status (ECOG PS) and duration of ADT were reviewed. The risk of AMI after ADT was first analysed using the Kaplan–Meier method, followed by Cox regression analyses including the potential risk factors mentioned. Results In all, 452 patients were included, with 200 patients in the non‐ADT group and 252 patients in the ADT group. The mean (sd) age was 68.2 (5.9) years in the non‐ADT group and 69.5 (6.5) years in the ADT group, and the difference was statistically significant (P = 0.031). There were no significant differences in their pre‐existing medical conditions or ECOG PS. The ADT group was associated with an increased risk of AMI when compared with the non‐ADT group (P = 0.004) upon Kaplan‐Meier analysis. Upon multivariate Cox regression analysis, hyperlipidaemia, poor ECOG PS and the use of ADT were the only three significant factors that were associated with increased risk of developing new AMI. Conclusions There was increased risk of AMI after ADT for prostate cancer in a Chinese population. Hyperlipidaemia and poor ECOG PS were also significant risk factors for developing AMI. The risk of AMI should be considered when deciding on ADT, especially in patients with history of hyperlipidaemia and relatively poor ECOG PS.
  • The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer
           Trials Group – a new co‐operative cancer trials group in
           genitourinary oncology
  • Hypogonadal symptoms in young men are associated with a serum total
           testosterone threshold of 400 ng/dL
    • Abstract: Objective To investigate the association between hypogonadal symptoms and serum total testosterone (TT) levels in young men (aged
  • Proportion of tadalafil‐treated patients with clinically meaningful
           improvement in lower urinary tract symptoms associated with benign
           prostatic hyperplasia – integrated data from 1 499 study
    • Abstract: Objectives To evaluate the proportion of patients achieving clinically meaningful improvement of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH‐LUTS) with tadalafil using two definitions of response. Patients and Methods Post hoc integrated analysis of four placebo‐controlled studies in men (aged ≥45 years; International Prostate Symptom Score [IPSS] of ≥13; maximum urinary flow rate [Qmax] of ≥4 to ≤15 mL/s) with BPH‐LUTS randomised to tadalafil 5 mg (752 patients) or placebo (747) for 12 weeks after a 4‐week placebo run‐in. Responders were defined as having a total IPSS improvement of ≥3 points or ≥25% from randomisation to endpoint (Week 12). Response status was calculated per patient, and relative benefit and odds ratio (OR) with 95% confidence interval (CI) of tadalafil vs placebo was calculated using a logistic Generalised Mixed Model for Repeated Measures. Results Tadalafil 5 mg once daily resulted in a significantly greater proportion of patients achieving a ≥3‐point IPSS improvement (71.1% and 56.0% for tadalafil and placebo patients, respectively [OR 1.9, 95% CI 1.5, 2.4; P < 0.001]) and achieving a ≥25% improvement in total IPSS randomisation to endpoint (61.7% and 45.5% for tadalafil and placebo patients, respectively [OR 2.0, 95% CI 1.6, 2.5; P < 0.001]). Conclusion About two‐thirds of tadalafil‐treated patients achieve a clinically meaningful improvement in BPH‐LUTS symptoms, based on two different definitions of responder status.
  • Contrast Enhanced Ultrasound Parametric Imaging for the detection of
           Prostate Cancer
    • Abstract: Objective To investigate the value of Dynamic Contrast Enhanced‐Ultrasound (DCE‐US) and software‐generated parametric maps in predicting biopsy outcome and their potential to reduce the amount of negative biopsy cores. Patients and methods For 651 prostate biopsy locations (82 consecutive patients) we correlated the interpretation of DCE‐US recordings with and without parametric maps with biopsy results. The parametric maps were generated by software that extracts perfusion parameters that differentiate benign from malignant tissue form DCE‐US recordings. We performed a stringent analysis (all tumours) and a clinical analysis (clinically significant tumours). We calculated the potential reduction in biopsies (benign on imaging) and the resultant missed positive biopsies (false negatives). Additionally, we evaluated the performance in terms of sensitivity, specificity NPV, and PPV on the per‐prostate level. Results Based on DCE‐US, 470/651 (72.2%) of biopsy locations appeared benign resulting in 40 false negatives (8.5%) regarding clinically significant tumour only. Including parametric maps, 411/651 (63.1%) of the biopsy locations appeared benign, resulting in 23 false negatives (5.6%). In the per‐prostate clinical analysis, DCE‐US classified 38/82 prostates as benign, missing 8 diagnoses. Including parametric maps, 31/82 prostates appeared benign, missing 3 diagnoses. Sensitivity, specificity, PPV and NPV were 73%, 58%, 50% and 79% for DCE‐US alone and 91%, 56%, 57% and 90% with parametric maps, respectively. Conclusion DCE‐US interpretation with parametric maps allows good prediction of biopsy outcome. A two‐thirds reduction in biopsy cores seems feasible with only a modest decrease in cancer diagnosis. This article is protected by copyright. All rights reserved.
  • Temporary implantable nitinol device (TIND): a novel, minimally invasive
           treatment for relief of lower urinary tract symptoms (LUTS) related to
           benign prostatic hyperplasia (BPH): feasibility, safety and functional
           results at 1 year of follow‐up
    • Abstract: Objectives To report the first clinical experience with a temporary implantable nitinol device (TIND; Medi‐Tate®) for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Patients and Methods In all, 32 patients with LUTS were enrolled in this prospective study, which was approved by our Institutional Ethics Committee. Inclusion criteria were: age >50 years, International Prostate Symptom Score (IPSS) of ≥10, maximum urinary flow rate (Qmax) of ≤12 mL/s, and prostate volume of
  • The Diminishing Returns of Robotic Diffusion: Complications Following
           Robot‐Assisted Radical Prostatectomy
    • Abstract: In the United States, robot‐assisted radical prostatectomy (RARP) is the most common approach for the operative management of prostate cancer (PCa). Patients pursue robotic surgery based on perceived benefit, but fail to take into account the importance of institution and surgeon volume on outcomes. Therefore, we examined the Nationwide Inpatient Sample (NIS) to elucidate the extent of robotic diffusion for PCa surgery, and to explore the effects of wider robotic adoption on prostatectomy complication rates. NIS patients who underwent RARP between 2009 and 2011 were included. Hospital volume was calculated and complications were recorded. The effect of hospital volume quintile was assessed with ordinal logistic regression fitted with generalized estimating equations to control for hospital clustering and was adjusted for various confounders. Results show median hospital volume fell sharply after 2009. Overall postoperative complication rates at very‐low volume institutions (14.7%) versus very‐high volume institutions (5.7%) were significant, and patients treated at very‐high volume hospitals were less than half as likely to experience a complication (OR: 0.40; 95% CI: 0.29‐0.54). In conclusion, migration of patients away from very‐high volume institutions is likely jeopardizing patient care, and a renewed focus on the benefits of centralization of care is warranted. This article is protected by copyright. All rights reserved.
  • Biodistribution of Evans blue in an orthotopic AY‐27 rat bladder
           urothelial cell carcinoma model: implication for the improved diagnosis of
           non‐muscle‐invasive bladder cancer (NMIBC) using
           dye‐guided white‐light cystoscopy
    • Abstract: Objectives To investigate the possibility of using Evans blue (EB) as a novel diagnostic tool to detect bladder tumors with white‐light (WL) cystoscopy, in this preclinical study we examined the biodistribution of the compound in the different layers (urothelium, submucosa, muscle) of a normal rat bladder and a rat bladder bearing a malignant urothelium composed of syngeneic AY‐27 tumor cells. Materials and methods EB was instilled into both normal as well as tumor‐bearing rat bladders. Following instillation, bladders were removed and snap frozen in liquid nitrogen. The distribution of EB in the different layers was quantified using fluorescence microscopy. To gain more insight into the mechanism underlying the selective accumulation of EB in tumor tissue, bladder sections were prepared for ultrastructural investigations by means of transmission electron microscopy (TEM). Besides, we also examined the expression of E‐cadherin, claudin‐1 and desmoglein‐1 by immunohistochemistry to study the integrity of the bladder wall as these molecules are key constituents of adherens junctions, tight junctions and desmosomes, respectively. Results In most cases the accumulation of EB in malignant bladders was substantially higher than in healthy bladders, at least when 1 mM EB instillations were used. In case of a 1 mM EB instillation for 2 hrs, the EB‐associated fluorescence in malignant urothelial tissue was 55 times higher as compared to the fluorescence found in normal urothelium. Ultrastructurally, malignant tissue displayed wider intercellular spaces and a decreased number of cell junction components as compared to normal tissue, pointing to defects in the urothelial barrier. No differences in expression of E‐cadherin were found, whereas desmoglein‐1 staining was stronger in the membranes of healthy bladder urothelium compared to tumor tissue. Claudin‐1 expression was negative in all samples tested. Conclusion EB is selectively taken up by tumor tissue after intravesical instillations in rats bearing bladder tumors. The lower expression of desmoglein‐1 in tumor samples, together with the decreased presence of desmosomes observed with TEM, likely imply that desmosomes play an important role in the ultrastructural differences between healthy rat urothelium and tumor tissue, and secondary to that, to the differential uptake of EB in both tissues. We believe that our findings can be useful for future clinical developments in the field of diagnostics for bladder cancer. This article is protected by copyright. All rights reserved.
  • Observations on transatlantic renal cell cancer surgery outcomes
    • Abstract: Kidney cancer surgeons from North America have provided technological innovation and demonstrated excellent clinical outcomes from high‐volume centres. The results presented by high‐volume US centres provide a benchmark standard for those practicing in other settings. However, the aim of this comment is to make observations regarding the care that the majority of patients undergoing renal cancer surgery receive in USA and contrast these with outcomes following nephrectomy in the UK. Observations are made using large published US database series and the British Association of Urological Surgeons (BAUS) nephrectomy data, which has become the first set of individual British urologist level data to be made publically available This article is protected by copyright. All rights reserved.
  • Partial versus Radical Nephrectomy for T1 renal tumours:An analysis from
           the British Association of Urological Surgeons Nephrectomy Audit
    • Abstract: Introduction and objectives The increasing incidence of small localised renal tumours has changed practice towards nephron‐sparing and minimally invasive techniques. This has prompted assessment of current practice. The objective was to analyse and compare data from The British Association of Urological Surgeons Nephrectomy Audit for outcomes of partial and radical nephrectomy for T1 renal tumours. Materials and Methods UK consultants were invited to submit data on all patients undergoing nephrectomy between 1st January and 31st December 2012 to a nationally established database using a standard proforma. Analysis was made on patient demographics, operative technique and perioperative data/outcome between partial and radical nephrectomy for T1 tumours. Results Overall, data from 6,042 nephrectomies were reported of which 1,768 were performed for T1 renal tumours. Of these, 1,082 (61.2%) were radical nephrectomies (RN) and 686 (38.8%) were partial nephrectomies (PN). The mean age of patients undergoing PN was lower (PN 59 vs RN 64; p
  • Clinical Efficacy of Collagenase Clostridium Histolyticum in the Treatment
           of Peyronie's Disease by Subgroups: Results From Two Large,
    • Abstract: Objectives To examine the efficacy of intralesional collagenase clostridium histolyticum (CCH) in defined subgroups of subjects with Peyronie's disease (PD). Subjects and Methods The efficacy of CCH compared with placebo from baseline to week 52 was examined in subgroups of subjects from the Investigation for Maximal Peyronie's Reduction Efficacy and Safety Studies (IMPRESS) I and II, defined by: severity of penile curvature deformity at baseline (30°‐60° [n=492] and 61°‐90° [n=120]); PD duration (1 to ≤2 [n=201], >2 to ≤4 [n=212], and >4 years [n=199]); degree of plaque calcification (no calcification [n=447], noncontiguous stippling [n=103], and contiguous calcification that did not interfere with the injection [n=62]); and baseline erectile function (International Index of Erectile Function [IIEF] 1‐5 [n=22], 6‐16 [n=106], and ≥17 [n=480]). Results Reductions in penile curvature deformity and PD symptom bother were observed in all subgroups. Penile curvature deformity reductions were significantly greater for CCH vs placebo for: baseline penile curvature 30°‐60° and 61°‐90°; disease duration >2 to ≤4 years and >4 years; no calcification; and IIEF ≥17 (high IIEF erectile function) (P < .05 for all). PD symptom bother reductions were significantly greater in the CCH group for: penile curvature 30°‐60°; disease duration >4 years; no calcification; and IIEF 1‐5 (no sexual activity) and ≥17 (P < .05 for all). Conclusions In this analysis, the clinical efficacy of CCH treatment for reducing penile curvature deformity and PD symptom bother was demonstrated across subgroups. In the IMPRESS I and II studies overall, AEs were typically mild or moderate, although treatment‐related serious AEs, including corporal rupture or penile hematoma, occurred. Future studies could be considered to directly assess the efficacy and safety of CCH treatment in defined subgroups of PD patients, with the goal of identifying predictors of optimal treatment success. This article is protected by copyright. All rights reserved.
  • The Relationship Between Illness Uncertainty, Anxiety, Fear of
           Progression, and Quality of Life in Men With Favorable Risk Prostate
           Cancer Undergoing Active Surveillance
    • Abstract: Objectives To evaluate prospectively the associations between illness uncertainty, anxiety, fear of progression, and general and disease‐specific quality of life (QOL) in men with favorable risk prostate cancer undergoing active surveillance (AS). Patients and Methods After meeting stringent enrollment criteria for an AS cohort study at a single tertiary care cancer center, 180 men with favorable‐risk prostate cancer completed questionnaires at enrollment and every 6 months for up to 30 months. Questionnaires assessed illness uncertainty, anxiety, prostate‐specific (Expanded Prostate Cancer Index Composite; EPIC) and general QOL (Short Form 12; SF‐12) and fear of progression. We used linear mixed model analyses and multilevel mediation analyses. Results EPIC sexual scores significantly declined over time (P
  • Significance of time interval between first and second transurethral
           resection on recurrence and progression rates in patients with high risk
           non muscle invasive bladder cancer treated with maintenance intravesical
           Bacillus Calmette‐Guerin
    • Abstract: Objectives To evaluate the effect of time lapse between the initial and second transurethral resection (TUR) on the outcome of patients with high risk nonmuscle invasive bladder cancer (NMIBC) treated with maintenance intravesical Bacillus Calmette‐Guerin (BCG) therapy. Materials and Methods We reviewed the data of patients from ten centers treated for high risk NMIBCbetween 2005 and 2012.Patients without a diagnosis of muscle invasive cancer on second TUR performed within 90 days after a complete first TUR, and received at least one year of maintenance BCG were included in this study.Time interval between first and second TUR in addition to other parameters were recorded.Multivariate logistic regression analysis was performed to identify predictors of recurrence and progression. Results A total of 242 patients were included in this study. The mean follow‐up period was 29.4±22.2 months (range 12‐96).The 3‐year recurrenceand progression free survival rates of patients who underwent second TUR between 14‐42 days and 43‐90 days were 73.6% vs. 46.2%(p=0.0001) and 89.1% vs. 79.1%(p=0.006), respectively. On multivariate analysis, time lapse to second TUR was found to be a predictor of both recurrence (OR 3.598, 95% CI 1.885–8.137, p =0.001) and progression (OR 2.144, 95% CI 1.447–5.137, p=0.003). Conclusions The time interval between first and second TUR should be≤ 42 days in order to obtain lower recurrence and progression rates. To our knowledge, this is the first study demonstrating the effect of time lapse between first and second TUR on patient outcomes. This article is protected by copyright. All rights reserved.
  • Diagnosis and treatment of chronic bacterial prostatitis and chronic
           prostatitis/chronic pelvic pain syndrome: a consensus guideline
    • Abstract: Objectives To improve awareness and recognition of these conditions among non‐specialists and patients. To provide guidance to healthcare professionals treating patients with CBP and CP/CPPS, in both non‐specialist and specialist settings. To promote efficient referral of care between non‐specialists and specialists and the involvement of the multidisciplinary team (MDT). Patients and Methods The guideline population were men with CBP or CP/CPPS (persistent or recurrent symptoms and no other urogenital pathology for ≥3 of the previous 6 months). Consensus recommendations for the guidelines were based on a search to identify literature on the diagnosis and management of CBP and CP/CPPS (published between 1999 and February 2014). A Delphi panel process was used where high‐quality, published evidence was lacking. Results CBP and CP/CPPS can present with a wide range of clinical manifestations. The 4 main symptom domains are urogenital pain, lower urinary tract symptoms (LUTS ‐ voiding or storage symptoms), psychological issues and sexual dysfunction. Patients should be managed according to their individual symptom pattern. Options for first‐line treatment include antibiotics, alpha‐adrenergic antagonists (if voiding LUTS are present) and simple analgesics. Repeated use of antibiotics such as quinolones should be avoided if there is no obvious symptomatic benefit from infection control or cultures do not support an infectious cause. Early use of treatments targeting neuropathic pain and/or referral to specialist services should be considered for patients who do not respond to initial measures. An MDT approach (urologists, pain specialists, nurse specialists, specialist physiotherapists, GPs, cognitive behavioural therapists/psychologists, sexual health specialists) is recommended. Patients should be fully informed about the possible underlying causes and treatment options, including an explanation of the chronic pain cycle. Conclusion Chronic prostatitis can present with a wide variety of signs and symptoms. Identification of individual symptom patterns and a symptom‐based treatment approach are recommended. Further research is required to evaluate management options for CBP and CP/CPPS. This article is protected by copyright. All rights reserved.
  • Guideline of Guidelines: Prostate Cancer Imaging
    • Abstract: In the era before the widespread adoption of PSA screening for prostate cancer, most incident cases were already advanced stage. Because treatment options such as surgery or radiation are thought mainly to benefit patients with localized disease, prostate cancer imaging was necessary prior to treatment of almost all patients. In the PSA era, however, over 90% of incident cases are localized, making the need for routine imaging with CT, MRI, or bone scan obsolete [1]. Numerous studies show a relatively low rate of positive staging imaging in low‐ and intermediate‐ risk patients. Recognizing these trends, several professional societies issued prostate cancer imaging guidelines in the mid‐1990s in an effort to curb the overuse of imaging. This article is protected by copyright. All rights reserved.
  • Salvage Radical Prostatectomy for recurrent Prostate Cancer: Verification
           of EAU guideline criteria
    • Abstract: Objective To analyze oncological and functional outcomes of salvage radical prostatectomy (SRP) in patients with recurrent prostate cancer (PCa) and to compare outcomes of patients within and outside the EAU guideline criteria (organ‐confined PCa ≤ T2b, Gleason score ≤ 7 and preoperative PSA < 10 ng/mL) for SRP. Patients and Methods A total of 55 patients who underwent SRP from January 2007 to December 2012 were retrospectively analyzed. Kaplan‐Meier curves assessed time to biochemical recurrence (BCR), metastasis‐free survival (MFS) and cancer specific survival (CSS). Cox regressions addressed factors influencing BCR and MFS. BCR was defined as PSA>0.2 ng/ml and rising, continence as the use of 0‐1 safety pad per day and potency as an IIEF‐5 score ≥18. Results Median follow‐up was 36 months. Following SRP 42.0% of the patients experienced BCR, 15.9% developed metastasis and 5.5% died from PCa. Patients fulfilling EAU guideline criteria were less likely to have positive lymph nodes and had significantly better BCR‐free survival (5‐year BCR‐free survival 73.9% vs. 11.6% (p=0.001), respectively). In multivariate analysis, LDR‐brachytherapy as primary treatment (p=0.03) and presence of positive lymph nodes at SRP (p=0.02) were significantly associated with worse BCR‐free survival. The presence of positive lymph nodes or Gleason score > 7 at SRP were independently associated with metastasis. Urinary continence‐rate 1 year after SRP was 74%. Seven patients (12.7%) experienced complications ≥III (Clavien grade). Conclusion Salvage radical prostatectomy is a safe procedure providing good cancer control and reasonable urinary continence. Oncologic outcomes are significantly better in patients who met EAU guideline recommendations. This article is protected by copyright. All rights reserved.
  • Sampling of the anterior apical region results in increased cancer
           detection and upgrading in transrectal repeat saturation biopsy of the
    • Abstract: Detection of clinically suspected prostate cancer using ultrasound‐guided transrectal biopsy is standard of care [1]. The relatively high probability of missing clinically significant cancers during initial sextant biopsies led to the introduction of extended 10‐12 core biopsy and subsequently to 20+ core saturation biopsy strategies [1–9]. Nevertheless, underdiagnosis of high risk prostate cancer even in patients with low PSA levels still occurs in 25‐30% [10,11].Anteriorly located prostate cancer contributes to these high rates and data from magnetic resonance imaging (MRI) studies underlines these considerations [12–14]. This article is protected by copyright. All rights reserved.
  • Pharmacological characterization of the relaxation induced by the soluble
           guanylate cyclase activator, BAY 60‐2770 in rabbit corpus cavernosum
    • Abstract: Objective To characterize the relaxation induced by the soluble guanylate cyclase (sGC) activator, BAY 60‐2770 in rabbit corpus cavernosum. Material and Methods Penis from male New Zealand rabbits were removed and fours strips of corpus cavernosum (CC) were obtained. Concentration‐response curves to BAY 60‐2770 were carried out in the absence and presence of inhibitors of nitric oxide synthase, L‐NAME (100 μM), sGC, ODQ (10 μM) and phosphodiestarase type 5, tadalafil (0.1 μM). The potency (pEC50) and maximal response (Emax) values were determined. Second, electrical‐field stimulation (EFS)‐induced contraction or relaxation was realized in the absence and presence of BAY 60‐2770 (0.1 or 1 μM) alone or in combination of ODQ (10 μM). In the case of EFS‐induced relaxation two protocols were realized: 1) ODQ (10 μM) was first incubated for 20 min and then BAY 60‐2770 (1 μM) was added for another 20 min (ODQ + BAY 60‐2770). In different CC strips, BAY 60‐2770 was incubated for 20 min followed by another 20 min with ODQ (BAY 60‐2770 + ODQ). The intracellular levels of cyclic guanosine monophosphate (cGMP) were also determined. Results BAY 60‐2770 potently relaxed rabbit CC with pEC50 and Emax values of 7.58 ± 0.19 and 81 ± 4%, respectively. The inhibitors ODQ (n=7) or tadalafil (n=7) produced 4.2‐ and 6.3‐leftward shifts, respectively in BAY 60‐2770‐induced relaxation without interfering on the Emax values. The intracellular levels of cGMP were augmented after stimulation with BAY 60‐2770 (1 μM) alone, whereas its co‐incubation with ODQ produced even higher levels of cGMP. The EFS‐induced contraction was reduced in the presence of BAY 60‐2770 (1 μM) and this inhibition was even greater when BAY 60‐2770 was co‐incubated with ODQ. The nitrergic stimulation induced CC relaxation, which was abolished in the presence of ODQ. BAY 60‐2770 alone increased the amplitude of relaxation. Co‐incubation of ODQ and BAY 60‐2770 did not alter the relaxation in comparison with ODQ alone. Interestingly, when BAY 60‐2770 was incubated prior to ODQ, EFS‐induced relaxation was partly restored in comparison with ODQ alone or ODQ + BAY 60‐2770. Conclusions Considering that the relaxation induced by the sGC activator, BAY 60‐2770 was increased after sGC oxidation and unaltered in the absence of nitric oxide, these class of substances are advantageous over sGC stimulators or PDE5 inhibitors for the treatment in those patients with erectile dysfunction and high endothelial damage. This article is protected by copyright. All rights reserved.
  • Continence outcomes of robot assisted radical prostatectomy in patients
           with adverse urinary continence risk factors
    • Abstract: Objective To analyze the continence outcomes of robot assisted radical prostatectomy (RARP) in suboptimal patients that have challenging continence recovery factors: enlarged prostates, elderly patients, higher Body Mass Index (BMI), salvage prostatectomy and bladder neck procedures prior to RARP Material & Methods From January 2008 through November 2012, 4023 patients underwent RARP by a single surgeon at our institution. Retrospective analysis of prospectively collected data identified 3362 men who had minimum of one year of follow‐up. This cohort of patients was stratified into six groups: Group I, age 70 and over (n=451); Group II, BMI 35 and over (n=197); Group III, prior bladder neck procedures (n=103); Group IV, prostate weight 80 g and over (n=280); and Group V, salvage prostatectomy patients (n=41). Group VI consisted of patients (n=2447) with none of these risk factors. Continence outcomes at follow‐up were analyzed for all groups. Results The continence rate at 1 year and mean time to continence in different groups were for patients ≥70 years 85.6% and 3.2 ± 4.5 months; BMI ≥35 years 87.8% and 3.1 ± 4.5 months; prior bladder neck treatment 82.4% and 3.4 ± 4.7 months; prostate weight ≥80 g 85.8% and 3.3 ± 4.4 months; salvage procedures 51.3% and 6.6 ± 8.3 months and in Group VI, 95.1% and 2.4 ± 3.2 months. The continence rate was significantly higher in group VI in comparison to salvage group at different time intervals (p
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