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J. of Mass Spectrometry     Hybrid Journal   (Followers: 23, 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: 6, 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: 26, 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: 19, 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: 31, 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: 308, SJR: 1.284, h-index: 113)
J. of Philosophy of Education     Hybrid Journal   (Followers: 9, 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: 31, SJR: 1.21, h-index: 31)
J. of Polymer Science Part A: Polymer Chemistry     Hybrid Journal   (Followers: 220, 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: 50, 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: 18, 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: 14, 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: 8)
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: 22, SJR: 2.112, h-index: 151)
J. of the American Society for Information Science and Technology     Hybrid Journal   (Followers: 218, 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: 6)
J. of the CardioMetabolic Syndrome     Hybrid Journal   (Followers: 1)
J. of the European Academy of Dermatology and Venereology     Hybrid Journal   (Followers: 10, 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: 3, 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: 13, SJR: 1.59, h-index: 49)
J. of the Royal Statistical Society Series B (Statistical Methodology)     Hybrid Journal   (Followers: 26, SJR: 7.863, h-index: 82)
J. of the Royal Statistical Society Series C (Applied Statistics)     Hybrid Journal   (Followers: 17, SJR: 1.435, h-index: 51)
J. of the Science of Food and Agriculture     Hybrid Journal   (Followers: 21, SJR: 0.846, h-index: 88)

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Journal Cover   BJU International
  [SJR: 1.812]   [H-I: 104]   [267 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  [1607 journals]
  • Long‐term oncological outcomes of a phase II trial of neoadjuvant
           chemohormonal therapy followed by radical prostatectomy for patients with
           clinically localised, high‐risk prostate cancer
    • Authors: Jonathan L. Silberstein; Stephen A. Poon, Daniel D. Sjoberg, Alexandra C. Maschino, Andrew J. Vickers, Aaron Bernie, Badrinath R. Konety, W. Kevin Kelly, James A. Eastham
      Abstract: Objective To determine long‐term oncological outcomes of radical prostatectomy (RP) after neoadjuvant chemohormonal therapy (CHT) for clinically localised, high‐risk prostate cancer. Patients and Methods In this phase II multicentre trial of patients with high‐risk prostate cancer (PSA level >20 ng/mL, Gleason ≥8, or clinical stage ≥T3), androgen‐deprivation therapy (goserelin acetate depot) and paclitaxel, carboplatin and estramustine were administered before RP. We report the long‐term oncological outcomes of these patients and compared them to a contemporary cohort who met oncological inclusion criteria but received RP only. Results In all, 34 patients were enrolled and followed for a median of 13.1 years. Within 10 years most patients had biochemical recurrence (BCR‐free probability 22%; 95% confidence interval [CI] 10–37%). However, the probability of disease‐specific survival at 10 years was 84% (95% CI 66–93%) and overall survival was 78% (95% CI 60–89%). The CHT group had higher‐risk features than the comparison group (123 patients), with an almost doubled risk of calculated preoperative 5‐year BCR (69% vs 36%, P < 0.01). After adjusting for these imbalances the CHT group had trends toward improvement in BCR (hazard ratio [HR] 0.76, 95% CI 0.43–1.34; P = 0.3) and metastasis‐free survival (HR 0.55, 95% CI 0.24–1.29; P = 0.2) although these were not statistically significant. Conclusions Neoadjuvant CHT followed by RP was associated with lower rates of BCR and metastasis compared with the RP‐only group; however, these results were not statistically significant. Because this treatment strategy has known harms and unproven benefit, this strategy should only be instituted in the setting of a clinical trial.
      PubDate: 2015-04-17T04:18:08.208507-05:
      DOI: 10.1111/bju.12676
  • Prostate cancers detected on repeat prostate biopsies show spatial
           distributions that differ from those detected on the initial biopsies
    • Authors: Okyaz Eminaga; Reemt Hinkelammert, Mahmoud Abbas, Ulf Titze, Elke Eltze, Olaf Bettendorf, Fabian Wötzel, Martin Bögemann, Axel Semjonow
      Abstract: Objective To evaluate the spatial distribution of prostate cancer detected at a single positive biopsy (PBx) and a repeat PBx (rPBx). Patients and Methods We evaluated 533 consecutive men diagnosed with prostate cancer who underwent radical prostatectomy using a clinical map document based on XML (cMDX©)‐based map model of the prostate. We determined the number of cancer foci, relative tumour volume, Gleason score, zone of origin, localisation, and pathological stage after stratification according to the number of PBx sessions (PBx vs rPBx). The distribution of 3966 prostate cancer foci was analysed and visualised on heat maps. The colour gradient of the heat map was reduced to six colours representing the frequency classification of prostate cancer using an image posterisation effect. Additionally, the spatial distribution of organ‐confined prostate cancer between PBx and rPBx was evaluated. Results Prostate cancer diagnosed on PBx was mostly localised to the apical portion and the peripheral zone of the prostate. Prostate cancer diagnosed on rPBx was more frequently found in the anterior portion and the base of the prostate. Organ‐confined prostate cancer foci were mostly localised in the dorsolateral zone of the prostate in men at PBx, whereas men at rPBx had more prostate cancer foci in the anterior portion. Conclusions The spatial distribution of prostate cancer with rPBx differs significantly from the spatial distribution of prostate cancer with PBx. The whole anterior portion of the prostate should be considered by rPBx.
      PubDate: 2015-04-17T04:17:36.697992-05:
      DOI: 10.1111/bju.12691
  • Patient experience and satisfaction with Onabotulinumtoxin A for
           refractory overactive bladder
    • Authors: Sachin Malde; Christopher Dowson, Olivia Fraser, Jane Watkins, Muhammed S. Khan, Prokar Dasgupta, Arun 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 assess 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. Most patients received 200 U OnabotulinumtoxinA (Botox®) via an outpatient local anaesthetic flexible cystoscopy technique. Results Complete data was available for 72 patients. In all, 49 patients were continuing to receive BTX‐A treatment while 23 had opted for no further injections. The overall mean (sd) CSQ‐8 satisfaction score was 38.3 (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 < 0.01). Overall patient satisfaction with the result of the treatment was high with an overall mean (sd) score of 8.6 (2.0) on a visual analogue scale. Of those who had discontinued BTX‐A, most were either using conservative measures only (44%) or had recommenced anticholinergic medications. Conclusion Overall patient satisfaction with the dedicated BTX‐A service offered in our institution is high and can result in a positive patient experience. The use of PREMs are advocated in order to fully capture the patient's views of the quality of services and treatments they receive.
      PubDate: 2015-04-16T06:38:01.985157-05:
      DOI: 10.1111/bju.13025
  • Simulation‐based training for prostate surgery
    • Authors: Raheej Khan; Abdullatif Aydin, Muhammad Shamim Khan, Prokar Dasgupta, Kamran Ahmed
      Abstract: Objectives To identify and review the currently available simulators for prostate surgery and to explore the evidence supporting their validity for training purposes. Materials and Methods A review of the literature between 1999 and 2014 was performed. The search terms included a combination of urology, prostate surgery, robotic prostatectomy, laparoscopic prostatectomy, transurethral resection of the prostate (TURP), simulation, virtual reality, animal model, human cadavers, training, assessment, technical skills, validation and learning curves. Furthermore, relevant abstracts from the American Urological Association, European Association of Urology, British Association of Urological Surgeons and World Congress of Endourology meetings, between 1999 and 2013, were included. Only studies related to prostate surgery simulators were included; studies regarding other urological simulators were excluded. Results A total of 22 studies that carried out a validation study were identified. Five validated models and/or simulators were identified for TURP, one for photoselective vaporisation of the prostate, two for holmium enucleation of the prostate, three for laparoscopic radical prostatectomy (LRP) and four for robot‐assisted surgery. Of the TURP simulators, all five have demonstrated content validity, three face validity and four construct validity. The GreenLight laser simulator has demonstrated face, content and construct validities. The Kansai HoLEP Simulator has demonstrated face and content validity whilst the UroSim HoLEP Simulator has demonstrated face, content and construct validity. All three animal models for LRP have been shown to have construct validity whilst the chicken skin model was also content valid. Only two robotic simulators were identified with relevance to robot‐assisted laparoscopic prostatectomy, both of which demonstrated construct validity. Conclusions A wide range of different simulators are available for prostate surgery, including synthetic bench models, virtual‐reality platforms, animal models, human cadavers, distributed simulation and advanced training programmes and modules. The currently validated simulators can be used by healthcare organisations to provide supplementary training sessions for trainee surgeons. Further research should be conducted to validate simulated environments, to determine which simulators have greater efficacy than others and to assess the cost‐effectiveness of the simulators and the transferability of skills learnt. With surgeons investigating new possibilities for easily reproducible and valid methods of training, simulation offers great scope for implementation alongside traditional methods of training.
      PubDate: 2015-04-16T06:24:50.24029-05:0
      DOI: 10.1111/bju.12721
  • Prostatic arterial embolization for the treatment of LUTS due to benign
           prostatic hyperplasia:A comparative study of medium and large size
    • Authors: Maoqiang Wang; Liping Guo, Feng Duan, Kai Yuan, Guodong Zhang, Kai Li, Jieyu Yan, Yan Wang, Haiyan Kang
      Abstract: Objectives To compare the outcomes of prostatic arterial embolization (PAE) in treating large prostates (>80 mL) in comparison with medium‐sized prostates (50‐80 mL), largely to determine whether size may affect the outcome of PAE. Patients and methods A total of 115 patients (mean, 71.5 years) diagnosed with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) that was refractory to medical treatment underwent PAE. Group A (n=64) included patients with a mean prostate volume of 129 mL; group B (n=51) included patients with a mean prostate volume of 64 mL. PAE was performed using 100‐μm particles. Follow‐up was performed using the international prostate symptoms score (IPSS), quality of life (QoL), peak urinary flow rate (Qmax), post‐void residual volume (PVR), the international index of erectile function short form (IIEF‐5), prostatic specific antigen (PSA) and prostate volume (PV) measured by magnetic resonance (MR) imaging, at 1, 3, 6 and every 6 months thereafter. Results There were no significant differences in baseline IPSS, QoL, Qmax, PVR, PSA, or IIEF‐5, between groups. Technical success rate was 93.8% in group A and 96.8% in group B (P=0.7). A total of 101 patients (55 patients in group A and 46 patients in group B) had completed the follow‐up with a mean of 17 months (range 12–33 months). Compared with the baseline, there were significant improvements in IPSS, QoL, Qmax, PV, and PVR in both groups after PAE. The outcomes in group A were significantly better (group A vs group B mean±SD) regarding IPSS (‐14±6.5 vs ‐10.5±5.5), Qmax (6.0±1.5 vs 4.5±1.0), PVR (‐80.0±25.0 vs ‐60.0±20.0), PV (‐54.5±18.0 [‐42.3%] vs ‐18.5±5.0 [‐28.9%]), and QoL (‐3.0±1.5 vs ‐2.0±1.0) with P values
      PubDate: 2015-04-07T11:22:03.642318-05:
      DOI: 10.1111/bju.13147
  • Comparing long‐term outcomes between primary versus progressive
           muscle invasive bladder cancer after radical cystectomy
    • Authors: Marco Moschini; Vidit Sharma, Paolo Dell'oglio, Vito Cucchiara, Giorgio Gandaglia, Francesco Cantiello, Fabio Zattoni, Federico Pellucchi, Alberto Briganti, Rocco Damiano, Francesco Montorsi, Andrea Salonia, Renzo Colombo
      Abstract: Objective To assess the impact of primary or progressive status on recurrence‐free survival (RFS), cancer specific mortality (CSM) and overall mortality (OM) after radical cystectomy (RC) for muscle invasive bladder cancer (MIBC). Patients and Methods Overall, 768 consecutive patients underwent RC due to MIBC at our institution between 2000 and 2012. Primary MIBC was defined as no previous history of BCa and progressive was defined as recorded previous treated non‐MIBC that had progressed to MIBC. The median follow‐up was 85 (60‐109) months. Univariate and multivariate Cox regression models were used to compare RFS, CSM, and OM between these two cohorts. Results Overall, 475 (61.8%) patients had primary and 293 (38.2%) patients had progressive MIBC. There were no differences between the two groups in terms of demographics, pathological and perioperative complications (all p>0.1). The 10‐year rates of RFS, CSM, and OM for primary vs. progressive status were 43% vs. 36% (p=0.01), 43% vs. 37% (p=0.01), and 35% vs 28% (p=0.03), respectively. On multivariable Cox regression analyses, progressive status remained significantly associated with a higher rate of RFS (HR: 1.47, 95%CI: 1.12‐1.79, p=0.03) (Table 2), CSM (HR: 1.42, 95%CI: 1.07‐1.89, p=0.01) (Table 2), and OM (HR: 1.42, 95%CI: 1.13‐1.65, p=0.02). Conclusions Among patients treated with RC due to MIBC, progressive status is associated with a higher CSM, OM and recurrence rate after RC. Our study thus provides an impetus to improve risk sub‐stratification when bladder cancer is still at the NMIBC stage, be it through new biomarkers or improved imaging, as a subset of NMIBC are likely to benefit from early RC. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-07T11:11:16.864512-05:
      DOI: 10.1111/bju.13146
  • A novel randomised controlled trial design in prostate cancer
    • Authors: Eleni Anastasiadis; Hashim Uddin Ahmed, Clare Relton, Mark Emberton
      PubDate: 2015-04-06T00:24:18.236276-05:
      DOI: 10.1111/bju.12735
  • Altered significance of D'Amico risk classification in patients with
           prostate cancer linked to a familial breast cancer (kConFab) cohort
    • Authors: Damien Bolton; Yuan Cheng, Amber J. Willems‐Jones, Jason Li, Eveline Niedermeyr, Gillian Mitchell, David Clouston, Nathan Lawrentschuk, Ania Sliwinski, Stephen Fox, Heather Thorne
      Abstract: Objective To ascertain whether D'Amico risk classification is an accurate discriminator of prostate cancer mortality risk in BRCA2 pathogenic mutation carriers and non‐carriers from a familial breast cancer cohort. Patients and Methods From family cancer pedigrees of patients evaluated through a familial breast cancer cohort all related men with a diagnosis of prostate cancer were identified. Genotyping of each patient or of the dominant familial BRCA2 mutation was undertaken in each instance. Prostate cancers were analysed by BRCA2 carrier vs non‐carrier status for their clinical progression and survival according to their D'Amico risk groups. Results For patients who were BRCA2‐mutation positive, there was no significant difference in cancer‐specific survival (CSS) between those patients who were graded as having D'Amico high‐ or intermediate‐risk disease. For patients who were BRCA2‐mutation negative, but were identified via a family cancer pedigree, there was no statistically significant difference in CSS between D'Amico high‐ and intermediate‐risk prostate cancers. Patients with D'Amico high‐risk disease who were BRCA2‐mutation carriers had substantially increased disease‐specific mortality compared with high‐risk non‐carriers (hazard ratio 2.94, P = 0.004). Conclusion D'Amico risk classification has limitations in predicting variations in prostate cancer‐specific mortality for this group of patients.
      PubDate: 2015-04-06T00:23:29.058839-05:
      DOI: 10.1111/bju.12792
  • A trial of devices for urinary incontinence after treatment for prostate
    • Authors: Margaret Macaulay; Jackie Broadbridge, Heather Gage, Peter Williams, Brian Birch, Katherine N. Moore, Alan Cottenden, Mandy J. Fader
      Abstract: Objective To compare the performance of three continence management devices and absorbent pads used by men with persistent urinary incontinence (>1 year) after treatment for prostate cancer. Patients and Methods Randomised, controlled trial of 56 men with 1‐year follow‐up. Three devices were tested for 3 weeks each: sheath drainage system, body‐worn urinal (BWU) and 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 were assessed. Value‐for‐money was gathered. Results Substantial and significant differences in performance were found. The sheath was rated as ‘good’ for extended use (e.g. golf and travel) when pad changing is difficult; for keeping skin dry, not leaking, not smelling and convenient for storage and travel. The BWU was 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) and was not good for seated activities. The clamp was good for short vigorous activities like swimming/exercise; it was the most secure, least likely to leak, most discreet but almost all men described it as uncomfortable or painful. The pads were 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. There was 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 with 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: 2015-04-06T00:23:14.913122-05:
      DOI: 10.1111/bju.13016
  • Transperineal biopsy prostate cancer detection in first biopsy and repeat
           biopsy after negative transrectal ultrasound‐guided biopsy: 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 after previous negative transrectal ultrasound‐guided (TRUS) biopsy, between September 2009 and September 2013 in the VTBC database were included. Data for each patient were collected prospectively (except for TPB before 2011 in one institution), based on the minimum dataset published by the Ginsburg Study Group. Univariate and multivariate analyses were used to identify factors predictive of cancer detection on TPB. Results In all, 160 patients were included in the study, of whom 57 had TPB as first biopsy and 103 had TPB as repeat biopsy after previous negative TRUS biopsies. The median patient age at TPB was 63 years, with the repeat‐biopsy patients having a higher median serum PSA level (5.8 ng/mL for first biopsy and 9.6 ng/mL for repeat biopsy) and larger prostate volumes (40 mL for first biopsy, and 51 mL for repeat biopsy). Prostate 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 a Gleason score of ≥7, or more than three positive cores of Gleason 6. Of the cancers detected in repeat biopsies, 75% 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 cancers 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 in first biopsies. Conclusions TPB is an alternative approach to TRUS biopsy of the prostate, offering a high rate of detection of clinically significant prostate cancer. It provides excellent sampling of the anterior region of the prostate, which is often under‐sampled using the TRUS approach, and should be considered as an option for all men in whom a prostate biopsy is indicated.
      PubDate: 2015-04-06T00:23:01.420536-05:
      DOI: 10.1111/bju.13031
  • Over the horizon ‐ future innovations in global urology
    • Authors: Nicholas J Campain; Ruaraidh P MacDonagh, Kien Alfred Mteta, John S McGrath,
      Abstract: In the previous two commentary articles we have discussed some of the issues surrounding global urology, with a focus on sub‐Saharan Africa where the burden of urological disease is greatest. Coupled with low levels of infrastructure, funding and resources, the urological training environment is complex, with most urological care being provided by non‐specialists. Accepting the challenges of working in this environment, we look ahead to potential developments and innovations to improve global urological care. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-04T02:46:11.848675-05:
      DOI: 10.1111/bju.13145
  • Risk of Prostate Cancer Mortality in Men with a History of Prior Cancer
    • Authors: Kathryn T. Dinh; Brandon A. Mahal, David R. Ziehr, Vinayak Muralidhar, Yu‐Wei Chen, Vidya B. Viswanathan, Michelle D. Nezolosky, Clair J. Beard, Toni K. Choueiri, Neil E. Martin, Peter F. Orio, Christopher J. Sweeney, Quoc‐Dien Trinh, Paul L. Nguyen
      Abstract: Objectives To describe outcomes of patients with prostate cancer (PCa) diagnosed after another malignancy and identify factors associated with PCa death in this population, as little is known about the clinical significance of PCa as a subsequent malignancy. Patients and methods We studied 18,225 men diagnosed with PCa after another malignancy from 1973 to 2006. We compared demographic and clinical variables and proportion of death from PCa versus prior malignancy with T‐test and chi‐squared analyses. Fine and Gray's regression was used to consider the effect of treatment on PCa death. We then studied a second cohort of 88,013 men with PCa as a first or second malignancy to describe current diagnostic and treatment patterns. Results One in seven men died from PCa in our first cohort. More died from PCa following colorectal cancer (16.8 vs. 13.7%), melanoma (13.4 vs. 7.56%), and oral cancer (19.1 vs. 4.04%), but fewer following bladder, kidney, lung, leukemia and non‐Hodgkin's lymphoma (all p
      PubDate: 2015-04-04T02:17:41.264842-05:
      DOI: 10.1111/bju.13144
  • Improving Multivariable Prostate Cancer Risk Assessment Using The Prostate
           Health Index
    • Authors: Robert W Foley; Laura Gorman, Neda Sharifi, Keefe Murphy, Helen Moore, Alexandra V Tuzova, Antoinette S Perry, T Brendan Murphy, Dara J Lundon, R William G Watson
      Abstract: Objectives To analyse the clinical utility of a prediction model incorporating both clinical information as well as a novel biomarker in order to inform the decision for prostate biopsy in an Irish cohort. Patients and Methods Serum isolated from 250 men from three tertiary referral centres with pre‐biopsy blood draws was analysed for total PSA, free PSA and p2PSA. From this, the phi score was calculated (phi=(p2PSA/fPSA)*√tPSA). Their clinical information was used to derive their risk according to the Prostate Cancer Prevention Trial risk model (PCPT). Two clinical prediction models were created via multivariable regression consisting of age, family history, abnormality on digital rectal exam, prior negative biopsy and either PSA or phi score respectively. Calibration plots, receiver‐operating characteristic (ROC) curves as well as decision curves were generated to assess the performance of the three models. Results The PSA model and phi model were both highly calibrated in this cohort, with the phi model demonstrating the best correlation between predicted probabilities and actual outcome. The areas under the ROC curve for the phi model, PSA model and PCPT were 0.77, 0.71 & 0.69 respectively for the prediction of PCa and 0.79, 0.72 & 0.72 for the prediction of high grade PCa. Decision curve analysis demonstrated a superior net benefit of the phi model over both the PSA model and PCPT in the diagnosis of PCa and high grade PCa over the entire range of risk probabilities. Conclusion A logical and standardised approach to the use of clinical risk factors can allow for more accurate risk stratification of men under investigation for PCa. The measurement of p2PSA and the integration of this biomarker into a clinical prediction model can further increase the accuracy of risk stratification, helping to better inform the decision for prostate biopsy in a referral population. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-03T08:23:58.385061-05:
      DOI: 10.1111/bju.13143
  • UK practice of nephrectomy for benign disease. Results from the British
           Association of Urological Surgeons (BAUS) nephrectomy database
    • Authors: B Zelhof; IG McIntyre, SM Fowler, RD Napier‐Hemy, DM Burke, BR Grey,
      Abstract: Objective To summarise the UK urologists’ practice with regards to nephrectomy for benign disease documenting the indications, procedural techniques and outcomes. Patients and Methods All patients undergoing nephrectomy for a benign condition in 2012 were identified from the BAUS nephrectomy database. Recorded parameters included the technique of surgery, the type of minimal invasive procedure, operative time, blood loss, transfusion rate, conversion rate, intra and post operative complications, and mortality rate. Cases were also sub‐analysed according to their pathologies to determine the differences in complication rate between stone disease, pyelonephritis, non‐functioning kidney and others benign lesions. To contextualise procedural complexity, the simple nephrectomy (SN) data were compared with that obtained from the BAUS stage T1 radical nephrectomy (RN) audit. Results A total of 1093 nephrectomies were performed (537 non‐functioning kidneys, 142 stone disease, 129 nephrectomies secondary to pyelonephritis and 285 cases with other benign conditions). 76% were performed laparoscopically. Blood loss greater than 500ml was noted in 74 cases with a 4.8% blood transfusion rate. The intra‐ and post‐operative complication rates were 5.2% and 11.9% respectively. Of the 847 minimal invasive surgery procedures, conversion rate was 5.9%. Patients with stone disease have the highest intra‐ and post‐operative complications (9.9% and 23.9% respectively) compared to other benign pathologies. The total number of T1 RN cases was 1095 cases. In comparison to T1 RN, SN carries an increased risk of conversion to an open procedure (1.8 times), a higher rate of blood transfusion (4.8% vs 2.8%), and a higher risk of intra and postoperative complications (5.2% vs 3.7% and 11.9% vs 10%) respectively. Conclusion This study reports the largest series of nephrectomy performed for benign disease and the resultant data now supports the bespoke pre‐operative counselling of patients.. Furthermore, it confirms the commonly held view that ‘simple’ nephrectomy can be more difficult than its radical counterpart. The authors suggest that the term simple nephrectomy is changed to benign nephrectomy. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-30T10:53:31.084879-05:
      DOI: 10.1111/bju.13141
  • %[‐2]proPSA and “prostate health index” (PHI) improve
           the diagnostic accuracy for clinically relevant prostate cancer at initial
           and repeat biopsy compared to t‐PSA and %f‐PSA in men ≤
           65 years old
    • Authors: Martin Boegemann; Carsten Stephan, Henning Cammann, Sébastien Vincendeau, Alain Houlgatte, Klaus Jung, Jean‐Sebastien Blanchet, Axel Semjonow
      Abstract: Aim %[‐2]proPSA and “prostate health index” (PHI) improve the diagnostic accuracy for clinically relevant prostate cancer at initial and repeat biopsy compared to t‐PSA and %f‐PSA in men ≤ 65 years old Objectives To prospectively test the diagnostic accuracy of %[–2]proPSA and PHI and to determine its role for discrimination between significant and insignificant prostate cancer (PCa) at initial and repeat prostate biopsy in men ≤ 65 years. Patients and Methods The diagnostic performance of %[‐2]proPSA and PHI were evaluated in a multicenter study. A total of 769 men ≤ 65 years old scheduled for initial or repeat prostate biopsy were recruited in four sites based on t‐PSA level 1.6‐8.0 ng/ml WHO‐calibrated (2‐10 ng/ml Hybritech‐calibrated). Serum samples were measured for the concentration of t‐PSA, f‐PSA and [‐2]proPSA with Beckman Coulter immunoassays on Access‐2‐ or DxI800‐instruments. PHI was calculated as ([–2]proPSA/f‐PSA) x √t‐PSA). Uni‐ and multivariable logistic regression models and an artificial neural network (ANN) were complemented by decision curve analysis (DCA). Results In univariate analysis %[‐2]proPSA and PHI were best predictors of PCa detection in all patients (AUC: 0.72 and 0.73), at initial (AUC: 0.67 and 0.69) and repeat biopsy (AUC: 0.74 and 0.74). t‐PSA and %f‐PSA performed less accurate for all patients (AUC: 0.54 and 0.62). For detection of significant PCa (based on PRIAS‐criteria) %[‐2]proPSA and PHI equally demonstrated best performance (AUC: 0.70 and 0.73) compared with t‐PSA and %f‐PSA (AUC: 0.54 and 0.59). In multivariate analysis PHI added to a base model of age, prostate volume, DRE, t‐PSA and %f‐PSA. PHI was strongest in predicting PCa in all patients, at initial and repeat biopsy and for significant PCa (AUC: 0.73, 0.68, 0.78 and 0.72, respectively). In DCA for all patients the artificial neural network (ANN) showed the broadest threshold probability and best net benefit. PHI as single parameter and the base model + PHI were equivalent with threshold probability and net benefit nearing those of the ANN. For significant cancers the ANN was the strongest parameter in DCA. Conclusion This multicenter study showed that %[‐2]proPSA and PHI have a superior diagnostic performance for detecting PCa in PSA range of 1.6‐8.0 ng/ml compared with t‐PSA and %f‐PSA at initial and repeat biopsy and for predicting significant PCa in men ≤ 65 years old. They are equally superior for counceling patients prior to biopsy. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-28T09:56:18.800712-05:
      DOI: 10.1111/bju.13139
  • Symptoms, unmet needs, psychological well‐being and health status in
           prostate cancer survivors: implications for redesigning follow‐up
    • Authors: Eila Watson; Bethany Shinkins, Emma Frith, David Neal, Freddie Hamdy, Fiona Walter, David Weller, Clare Wilkinson, Sara Faithfull, Jane Wolstenholme, Prasanna Sooriakumaran, Christof Kastner, Christine Campbell, Richard Neal, Hugh Butcher, Mike Matthews, Rafael Perera, Peter Rose
      Abstract: Objective To explore ongoing symptoms, unmet needs, psychological wellbeing, self‐efficacy and overall health status in prostate cancer survivors. Subjects/patients and Methods An invitation to participate in a postal questionnaire survey was sent to 546 men, diagnosed with prostate cancer 9 – 24 months previously at two UK cancer centres. The study group comprised men who had been subject to a range of treatments: surgery, radiotherapy, hormone therapy and active surveillance. The questionnaire included measures of prostate‐related quality of life (EPIC‐26); unmet needs (SCNS SF34); anxiety and depression (HADS), self‐efficacy (modified Self‐efficacy Scale), health status (EQ‐5D) and satisfaction with care (questions developed for study). A single reminder was sent to non‐responders after three weeks. Data were analysed by age, co‐morbidities, and treatment group. Results 316 men completed questionnaires (64.1% response rate). Overall satisfaction with follow‐up care was high, but was lower for psychosocial than physical aspects of care. Urinary, bowel, and sexual functioning was reported as a moderate/big problem in the last month for 15.2% (n = 48), 5.1% (n = 16), and 36.5% (n = 105) men, respectively. The most commonly reported moderate/high unmet needs related to changes in sexual feelings/relationships, managing fear of recurrence/uncertainty, and concerns about the worries of significant others. It was found that 17% of men (n = 51/307) reported potentially moderate to severe levels of anxiety and 10.2% reported moderate to severe levels of depression (n = 32/308). The presence of problematic side‐effects was associated with higher psychological morbidity, poorer self‐efficacy, greater unmet needs, and poorer overall health status. Conclusion While some men report relatively few problems following prostate cancer treatment, this study highlights important physical and psycho‐social issues for a significant minority of prostate cancer survivors. Strategies for identifying those men with on‐going problems, alongside new interventions and models of care, tailored to individual needs, are needed to improve quality of life. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-27T10:18:19.8912-05:00
      DOI: 10.1111/bju.13122
  • Enzalutamide: Targeting the androgen signalling pathway in metastatic
           castration‐resistant prostate cancer
    • Authors: Jack Schalken; John M. Fitzpatrick
      Abstract: Context Significant progress has been made in the understanding of the underlying cancer biology of castration‐resistant prostate cancer (CRPC) with the androgen receptor (AR) signalling pathway remaining implicated throughout the prostate cancer disease continuum. Reactivation of the AR signalling pathway is considered to be a key driver of CRPC progression and, as such, the AR is a logical target for therapy in CRPC. Objective To understand the importance of AR signalling in the treatment of patients with metastatic CRPC (mCRPC) and to discuss the clinical benefits associated with inhibition of the AR signalling pathway. Evidence Acquisition A search was conducted to identify articles relating to the role of AR signalling in CRPC and therapies that inhibit the AR signalling pathway. Evidence Synthesis Current understanding of prostate cancer has identified the AR signalling pathway as a logical target for the treatment of CRPC. Available therapies that inhibit the AR signalling pathway include AR blockers, androgen biosynthesis inhibitors and AR signalling inhibitors. Enzalutamide, the first approved AR signalling inhibitor, has a novel mode of action targeting AR signalling at three key stages. The direct mode of action of enzalutamide has been shown to translate into clinical responses in patients with mCRPC. Conclusions The targeting of the AR signalling pathway in patients with mCRPC results in numerous clinical benefits. As the number of treatment options increase, more trials evaluating the sequencing and combination of treatments are required. Patient Summary This review highlights the continued importance of targeting a key driver in the progression of CRPC, AR signalling, and the clinical benefits associated with inhibition of the AR signalling pathway in the treatment of patients with CRPC. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-27T10:08:00.172758-05:
      DOI: 10.1111/bju.13123
  • Analysis of the Clinical Safety of Intralesional Injection of Collagenase
           Clostridium Histolyticum for Adults with Peyronie's Disease
    • Authors: Culley C. Carson; Hossein Sadeghi‐Nejad, James P. Tursi, Ted M. Smith, Gregory J. Kaufman, Kimberly Gilbert, Stanton C. Honig
      Abstract: Objective To examine the safety of intralesional injection of CCH for the treatment of PD, using a pooled safety analysis of subjects who received at least 1 dose of CCH in any of 6 clinical studies. Materials and Methods Subjects from 6 clinical studies, including 3 randomized, double‐blind, placebo‐controlled studies and 3 open‐label safety and efficacy studies, were included if they had received at least 1 dose of 0.58 mg CCH. AEs, including TEAEs, treatment‐related AEs, and SAEs, were characterized. Potential immunogenicity‐related AEs were evaluated through examination of increased anti‐AUX‐I and anti‐AUX‐II antibody levels, AEs, and reported terms possibly associated with immunological or hypersensitivity events. Results Overall, 85.8% of 1044 pooled subjects reported at least 1 treatment‐related AE. The most frequently reported (≥25.0% of subjects) treatment‐related AEs included penile hematoma (82.7% had the verbatim “penile bruising”), penile pain, and penile swelling. Most subjects (75.2%) had mild‐ or moderate‐severity treatment‐related AEs, and 14.2% had no treatment‐related AEs. Nine subjects (0.9%) had treatment‐related SAEs: 5 with penile hematoma and 4 with corporal rupture. No association was found between AEs and anti‐AUX‐I or anti‐AUX‐II antibody levels across treatment cycles, and no systemic hypersensitivity reactions occurred. Conclusions This pooled safety analysis demonstrates that although nonserious and serious treatment‐related AEs can occur following CCH treatment for PD, most were nonserious and the SAEs were manageable. Providers should be prepared to manage possible SAEs. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-27T09:41:11.069143-05:
      DOI: 10.1111/bju.13120
  • Perineal repair of pelvic fracture urethral injury: in pursuit of a
           successful outcome
    • Authors: Mamdouh M. Koraitim; Mohamed I. Kamel
      Abstract: Objective To determine perioperative factors that may optimize the outcome after delayed perineal repair of a pelvic fracture urethral injury (PFUI). Patients and Methods In all, 86 consecutive patients who underwent perineal repair of a PFUI between 2004 and 2011 were prospectively enrolled in this study. The mean (range) patient age was 23 (5–50) years. The mean (range) follow‐up was 5.5 (2–8) years. We examined seven perioperative variables that might influence the outcome including: prior failed treatment, condition of the bulbar urethra, displacement of the prostate, excision of scarred tissues, fixation of the mucosae of the two urethral ends, and the number and size of sutures used for urethral anastomosis. Univariate and multivariate analyses were used to identify factors that influence postoperative outcome. Results Of the patients, 76 (88%) had successful outcomes and 10 (12%) were considered treatment failures. On univariate analysis, four variables were significant factors influencing the outcome: excision of scarred tissues, prostatic displacement, condition of the bulbar urethra and fixation of the mucosae. On multivariate analysis only two remained strong and independent factors namely complete excision of scarred tissues and prostatic displacement in a lateral direction. Conclusions Meticulous and complete excision of scar tissue is critically important to optimise the outcome after perineal urethroplasty. This is particularly emphasised in cases associated with lateral prostatic displacement. Six sutures of 3/0 or 4/0 polyglactin 910 are usually sufficient to create a sound urethral anastomosis. Prior treatment and scarring of the anterior urethra do not affect the outcome.
      PubDate: 2015-03-27T00:58:57.544376-05:
      DOI: 10.1111/bju.12679
  • Serotonin (5‐HT)2A/2C receptor agonist
           hydrochloride (DOI) improves voiding efficiency in the diabetic rat
    • Authors: Hongjian Tu; Nailong Cao, Baojun Gu, Jiemin Si, Zhong Chen, Karl‐Erik Andersson
      Abstract: Objectives To examine the effects of the serotonin (5‐HT)2A/2C receptor agonist (2,5‐dimethoxy‐4‐idophenyl)‐2‐aminopropane hydrochloride (
      DOI ) on micturition in rats with diabetes mellitus (DM). Methods Female Sprague–Dawley rats (n = 16) were divided into two groups: rats with Type 1 DM and age‐matched control rats. DM was induced by i.p. injection of streptozotocin (65 mg/kg) and detailed cystometrogram (CMG) studies were performed 8 weeks post‐injection in all rats under urethane anaesthesia. The selective 5‐HT2A antagonist ketanserin was administered after each
      DOI dose–response curve was plotted. All drugs were administered i.v. Results Compared with controls, comprehensive urodynamic studies showed that DM rats had a higher bladder capacity and post‐void residual urine volume (PVR), and a markedly lower voiding efficiency. In DM rats,
      DOI (0.01–0.3 mg/kg) induced significant dose‐dependent increases in micturition volume and reductions in PVR, resulting in greater voiding efficiency. CMG measurements showed a dose‐dependent increase in high‐frequency oscillation (HFO) activity, evidenced by an increased duration of HFOs per voiding. This correlated with the improved voiding efficiency. Ketanserin (0.1 mg/kg) partially or completely reversed the
      DOI ‐induced changes. Conclusions The HFOs observed in the present study seem to correlate with external urethral sphincter bursting activity during voiding. Bladder voiding efficiency was reduced in DM rats. The 5‐HT2A receptor agonist can enhance HFO activity and improves voiding efficiency, and so may represent a new strategy to improve voiding efficiency after DM in experimental studies.
      PubDate: 2015-03-27T00:47:46.884119-05:
  • Stratification of patients with intermediate‐risk prostate cancer
    • Authors: Jin‐Woo Jung; Jung Keun Lee, Sung Kyu Hong, Seok‐Soo Byun, Sang Eun Lee
      Abstract: Objective To identify an appropriate risk stratification system for intermediate‐risk prostate cancer (PCa). Patients and Methods We reviewed the data on 1559 patients who were treated with radical prostatectomy (RP) at our institution between 2005 and 2013 and classified them according to National Comprehensive Cancer Network (NCCN) risk groups. For our analyses, intermediate‐risk PCa was designated as unfavourable intermediate‐risk PCa if it met at least one of the following two criteria: biopsy Gleason score 4 + 3 and/or presence of ≥2 intermediate‐risk criteria. All other men with intermediate‐risk PCa were designated as having favourable intermediate‐risk disease. Postoperative outcomes, including biochemical recurrence (BCR)‐free survival, were calculated and compared using the log‐rank test and Cox proportional hazards model. Results In multivariable analysis, biopsy Gleason score 4 + 3 and multiple (≥2) intermediate‐risk criteria were observed to be independent predictors of BCR risk among men in the intermediate‐risk group undergoing RP. The favourable intermediate‐risk group had a significantly higher 5‐year BCR‐free survival compared with the unfavourable intermediate‐risk group (87.5 vs 66.5%; P < 0.001). The unfavourable intermediate‐risk group had significantly higher 5‐year BCR‐free survival than the high‐risk group (66.5 vs 47.9%; P < 0.001) while the favourable intermediate‐risk group had significantly lower 5‐year BCR‐free survival than the low‐risk group (87.5 vs 93.5%; P = 0.002). Conclusions A marked heterogeneity exists in the biochemical outcomes of contemporary patients with intermediate‐risk PCa who undergo definitive RP. According to biopsy Gleason score and number of intermediate‐risk criteria present, the intermediate‐risk group should be sub‐divided into those with favourable and unfavourable intermediate‐risk disease.
      PubDate: 2015-03-27T00:45:21.852895-05:
      DOI: 10.1111/bju.12703
  • Impact of laparoscopic radical prostatectomy on clinical T3 prostate
           cancer: experience of a single centre with long‐term follow‐up
    • Authors: Ali S. Gözen; Yigit Akin, Mutlu Ates, Marcel Hruza, Jens Rassweiler
      Abstract: Objective To investigate the oncological safety and effectiveness of laparoscopic radical prostatectomy (LRP) for patients with clinical T3 (cT3) prostate cancer compared with patients with cT1 and cT2 prostate cancer. Patients and Methods In all, 2375 consecutive LRPs were evaluated between 1999 and 2013. Of the 1751 patients enrolled with complete follow‐up data (>24 months), patients were divided into three groups according to clinical stage of prostate cancer using Tumour‐Node‐Metastasis (TNM) classification. Group 1 consisted of patients with cT1 stage prostate cancer, group 2 those with cT2, and group 3 those with cT3. Demographic, postoperative, and long‐term data of patients were recorded and statistical analyses were performed. Results The mean (sd) age was 63.6 (6.2) years. The mean (sd) follow‐up was 104 (28.4) months. There were 417 patients in group 1, 842 patients in group 2, and 492 patients in group 3. The mean prostate‐specific antigen level, biopsy Gleason score, tumour volume, body mass index, and age, were all higher in group 3 (P < 0.001). Nerve‐sparing techniques were used more in group 1 than in the other groups (P < 0.001). Extracapsular extension, seminal vesicle invasion, Gleason score, positive surgical margin (PSM), and rate of adjuvant hormone and radiotherapies were highest in group 3. However, urinary continence was similar in all groups. Group 1 contained the most patients with an erection sufficient for intercourse. Group 1 had the best cancer‐specific survival rate, whereas overall survival (OS) rates and complications were similar in all groups. Conclusion LRP seems effective and safe for patients with cT3 prostate cancer with similar OS rates as for those with cT1 and cT2; however, additional therapies may have contributed to these rates. LRP can be considered for the treatment of patients with cT3 prostate cancer.
      PubDate: 2015-03-27T00:44:02.726129-05:
      DOI: 10.1111/bju.12710
  • Clinical performance of serum isoform [‐2]proPSA (p2PSA), and its
           derivatives %p2PSA and the Prostate Health Index, in men aged <60
           years: results from a multicentric European study
    • Authors: Nicola Fossati; Massimo Lazzeri, Alexander Haese, Thomas McNicholas, Alexandre Taille, Nicolò Maria Buffi, Giovanni Lughezzani, Giulio Maria Gadda, Giuliana Lista, Alessandro Larcher, Alberto Abrate, Francesco Mistretta, Vittorio Bini, Joan Palou Redorta, Markus Graefen, Giorgio Guazzoni
      Abstract: Objectives To test the hypothesis that [‐2]proPSA (p2PSA) and its derivatives are more accurate than total prostate‐specific antigen (tPSA), free prostate‐specific antigen (fPSA) and fPSA as percentage of tPSA (%fPSA) in detecting prostate cancer (PCa) in men aged
      PubDate: 2015-03-26T04:28:54.041829-05:
      DOI: 10.1111/bju.12718
  • Absorption of the Wolffian duct and duplicated ureter by the urogenital
           sinus: morphological study using human fetuses and embryos
    • Authors: Michiko Naito; Nobuyuki Hinata, Jose Francisco Rodriguez‐Vazquez, Gen Murakami, Shin Aizawa, Masato Fujisawa
      Abstract: Objectives To describe the embryological origin of the duplicated ureter and to investigate whether the urogenital sinus absorbs not only the Wolffian duct (WD) but also the ureter. Materials and Methods During studies using sections of human fetuses (45 specimens), we incidentally found a specific type of ureteric duplication (at ~7 weeks) in which two unilateral ureters joined at the vesico‐ureteric junction, apparently representing a morphology arising at an intermediate stage between complete and partial ureteric duplication. The existing literature lacks any photographic representation of early development of the vesico‐ureteric junction, and we therefore studied horizontal sections of 10 human embryos (at ~5–6 weeks' gestation) in which the ureter did not join the urogenital sinus (future bladder) but instead joined the WD (future vas deferens). Results The sinus consistently showed a reversed Y‐shape, the arms of which extended posteriorly to receive the WD. When absorption of the duct into the sinus wall reached the distal end of the ureter, the arm‐like parts appeared to enlarge posteriorly for further involvement of the duct, with little or no incorporation of the ureter; therefore, the future trigone of the bladder might develop from these arm‐like parts of the sinus posterior wall. Consequently, in the case of ureteric duplication included in the present study, it is considered that the ureters would probably have merged with the WD at closely adjacent sites. Conclusion The present study represents the first photographic illustration of the early development of the human vesico‐ureteric junction.
      PubDate: 2015-03-26T04:26:27.52226-05:0
      DOI: 10.1111/bju.13006
  • Twitter response to the United States Preventive Services Task Force
           recommendations against screening with prostate‐specific antigen
    • Authors: Vinay Prabhu; Ted Lee, Stacy Loeb, John H. Holmes, Heather T. Gold, Herbert Lepor, David F. Penson, Danil V. Makarov
      Abstract: ObjectiveTo examine public and media response to the draft (October 2011) and finalised (May 2012) recommendations of the United States Preventive Services Task Force (USPSTF) against prostate‐specific antigen (PSA) testing via Twitter, a popular social network with over 200 million active users. Materials and Methods We used a mixed‐methods design to analyse posts on Twitter, known as ‘tweets’. Using the search term ‘prostate cancer’, we archived tweets in the 24‐h periods following the release of both the draft and the finalised USPSTF recommendations. We recorded tweet rate per h and developed a coding system to assess the type of user and sentiment expressed in tweets and linked articles. Results After the draft and finalised USPSTF recommendations were released, 2042 and 5357 tweets focused on the USPSTF report, respectively. The tweet rate nearly doubled within 2 h of both announcements. Fewer than 10% of tweets expressed an opinion about screening, and the majority of these were pro‐screening during both periods. By contrast, anti‐screening articles were tweeted more frequently in both the draft and finalised study periods. Between the draft and the finalised recommendations, the proportion of anti‐screening tweets and anti‐screening article links increased (P = 0.03 and P < 0.01, respectively). Conclusions There was increased Twitter activity surrounding the USPSTF draft and finalised recommendations. The percentage of anti‐screening tweets and articles appeared to increase, perhaps due to the interval public comment period. Despite this, most tweets did not express an opinion, suggesting a missed opportunity in this important arena for advocacy.
      PubDate: 2015-03-25T05:21:15.236041-05:
      DOI: 10.1111/bju.12748
  • Prevalence of ciprofloxacin‐resistant Enterobacteriaceae in the
           intestinal flora of patients undergoing transrectal prostate biopsy in
           Norwich, UK
    • Authors: Marcelino Yazbek Hanna; Catherine Tremlett, Gurvir Josan, Ali Eltom, Robert Mills, Mark Rochester, David M. Livermore
      Abstract: Objective To determine the efficacy of fluoroquinolone prophylaxis in patients undergoing transrectal ultrasonography (TRUS)‐guided biopsy of the prostate in the Norwich population, and its correlation with ciprofloxacin resistance in the faecal flora. We also aimed to determine the usefulness of a pre‐biopsy rectal screen for resistant bacteria in these patients. Patients and Methods The incidence and microbiology of sepsis after TRUS‐guided prostate biopsies between 2007 and 2011 was audited retrospectively. Subsequently, in 2012, a prospective study was performed, collecting the same data but also culturing rectal swabs from all patients undergoing TRUS‐guided biopsy, with a post‐biopsy follow‐up period of 6 months. All patients were given prophylactic oral ciprofloxacin, as per Trust policy (750 mg 1 h before biopsy, followed by 250 mg twice daily for 3 subsequent days). Results Between 2007 and 2011, 3600 patients underwent TRUS‐guided biopsy. Among these, 11 (0.3%) were admitted to hospital for post‐biopsy related sepsis but only 4 (0.1%) had ciprofloxacin‐resistant Escherichia coli confirmed from blood cultures: three had ciprofloxacin‐susceptible Enterobacteriaceae, and four had no ciprofloxacin susceptibility data. In 2012, 10 (3.7%) of 267 patients sampled before biopsy had ciprofloxacin‐resistant E. coli recovered on rectal swab culture but none of these men presented with post‐biopsy sepsis; during the 6‐month follow‐up period, seven patients were diagnosed with urinary tract infections. Conclusion Ciprofloxacin‐resistant Enterobacteriaceae remains rare in the intestinal flora of the Norwich TRUS population, meaning that the drug remains adequate as prophylaxis. Pre‐biopsy rectal swabs may be useful for individual departments to periodically assess their own populations and to ensure their antibiotic policy remains valid. In populations where resistance is known to be highly prevalent, pre‐biopsy rectal swabs can help guide addition of further antibiotics to prevent post‐biopsy septicaemia.
      PubDate: 2015-03-25T05:17:16.286071-05:
      DOI: 10.1111/bju.12865
  • Inhibition of urothelial P2X3 receptors prevents desensitization of
           purinergic detrusor contractions in the rat bladder
    • Authors: Andrew C. Ferguson; Broderick W. Sutton, Timothy B. Boone, Anthony P. Ford, Alvaro Munoz
      Abstract: Objectives To evaluate whether P2X3 receptors (P2X3R) are expressed in the bladder urothelium and to determine their possible function in modulating purinergic detrusor contractions in the rat urinary bladder. Materials and Methods The expression of urothelial receptors was determined using conventional immunohistochemistry in bladders from normal Sprague–Dawley rats. The urothelial layer was removed by incubation with protamine, and disruption of the urothelium was confirmed using haematoxylin and eosin staining on bladder sections. Open cystometry was used to determine the effects of both urothelial removal as well as intravesical application of a specific P2X3R antagonist on bladder properties from intact and protamine‐treated rats. Isometric contractile responses to potassium chloride (KCl) depolarization, electrical field stimulation (EFS) or chemical P2X activation were determined in normal and urothelium‐denuded bladder strips, with and without application of the P2X3R antagonist. Results Immunohistochemical staining showed high expression of P2X3R in the medial and basal layers of the urothelium. Removal of the urothelial layer disturbed normal bladder performance in vivo and eliminated the effects of the P2X3R antagonist on increasing the contractile interval and reducing the amplitude of voiding contractions. Removal of the urothelium did not affect bladder strip contractile responses to KCl depolarization or EFS. Pharmacological inhibition of P2X3R prevented desensitization to P2X‐mediated detrusor muscle contractions during EFS only in the strips with an intact urothelium. A concentration‐dependent, specific inhibition of P2X3R also prevented desensitization of purinergic contractile responses in intact bladder strips. Conclusions In the rat bladder, medial and basal urothelial cells express P2X3R, and specific inhibition of the receptor leads to a more hyporeflexive bladder condition. This pathway may involve P2X3R driving a paracrine amplification of ATP released from umbrella cells to increase afferent transmission in the sub‐urothelial sensory plexus and desensitization of P2X1‐mediated purinergic detrusor contractions.
      PubDate: 2015-03-25T05:14:16.815641-05:
      DOI: 10.1111/bju.13003
  • Demographic and socio‐economic differences between men seeking
           infertility evaluation and those seeking surgical sterilization: from the
           National Survey of Family Growth
    • Authors: James M. Hotaling; Darshan P. Patel, William O. Brant, Jeremy B. Myers, Mark R. Cullen, Michael L. Eisenberg
      Abstract: Objective To identify differences in demographic and socio‐economic factors between men seeking infertility evaluation and those undergoing vasectomy, to address disparities in access to these services. Patients and Methods Data from Cycle 6 and Cycle 7 (2002 and 2006–2008) of the National Survey of Family Growth (NSFG) were reviewed. The NSFG is a multistage probability survey designed to capture a nationally representative sample of households with men and women aged 15–45 years in the USA. The variables analysed included age, body mass index, self‐reported health, alcohol use, race, religious affiliation, marital status, number of offspring, educational attainment, income level, insurance status and metropolitan home designation. Our primary outcome was the correlation of these demographic and socio‐economic factors with evaluation for male infertility or vasectomy. Results Of the 11 067 men identified through the NSFG, 466 men (4.2%) sought infertility evaluation, representing 2 187 455 men nationally, and 326 (2.9%) underwent a vasectomy, representing 1 510 386 men nationally. Those seeking infertility evaluation were more likely to be younger and have fewer children (P = 0.001, 0.001) and less likely to be currently married (78 vs 74%; P = 0.010) or ever married (89 vs 97%; P = 0.002). Men undergoing a vasectomy were more likely to be white (86 vs 70%; P = 0.001). Men seeking infertility evaluation were more likely to have a college or graduate degree compared with men undergoing a vasectomy (68 vs 64%; P = 0.015). There was no difference between the two groups for all other variables. Conclusion While differences in demographic characteristics such as age, offspring number and marital status were identified, measures of health, socio‐economic status, religion and insurance were similar between men undergoing vasectomy and those seeking infertility services. These factors help characterize the utilization of male reproductive health services in the USA and may help address disparities in access to these services and improve public health strategies.
      PubDate: 2015-03-25T05:09:44.092628-05:
      DOI: 10.1111/bju.13012
  • Significance of lymphovascular invasion in organ‐confined,
           node‐negative urothelial cancer of the bladder: data from the
           prospective p53‐MVAC trial
    • Authors: Friedrich‐Carl Rundstedt; Douglas A. Mata, Susan Groshen, John P. Stein, Donald G. Skinner, Walter M. Stadler, Richard J. Cote, Oleksandr N. Kryvenko, Guilherme Godoy, Seth P. Lerner
      Abstract: Objectives To investigate the association between lymphovascular invasion (LVI) and clinical outcome in organ‐confined, node‐negative urothelial cancer of the bladder (UCB) in a post hoc analysis of a prospective clinical trial. To explore the effect of adjuvant chemotherapy with methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) on outcome in the subset of patients whose tumours exhibited LVI. Patients and Methods Surgical and tumour factors were extracted from the operative and pathology reports of 499 patients who had undergone radical cystectomy (RC) for pT1–T2 N0 UCB in the p53‐MVAC trial (Southwest Oncology Group 4B951/NCT00005047). The presence or absence of LVI was determined by pathological examination of transurethral resection or RC specimens. Variables were examined in univariate and multivariate Cox proportional hazards models for associations with time to recurrence (TTR) and overall survival (OS). Results Among 499 patients with a median follow‐up of 4.9 years, a subset of 102 (20%) had LVI‐positive tumours. Of these, 34 patients had pT1 and 68 had pT2 disease. LVI was significantly associated with TTR with a hazard ratio (HR) of 1.78 [95% confidence interval (CI) 1.15–2.77; number of events (EV) 95; P = 0.01) and with OS with a HR of 2.02 (95% CI 1.31–3.11; EV 98; P = 0.001) after adjustment for pathological stage. Among 27 patients with LVI‐positive tumours who were randomised to receive adjuvant chemotherapy, receiving MVAC was not significantly associated with TTR (HR 0.70, 95% CI 0.16–3.17; EV 7; P = 0.65) or with OS (HR 0.45, 95% CI 0.11–1.83; EV 9; P = 0.26). Conclusions Our post hoc analysis of the p53‐MVAC trial revealed an association between LVI and shorter TTR and OS in patients with pT1–T2N0 disease. The analysis did not show a statistically significant benefit of adjuvant MVAC chemotherapy in patients with LVI, although a possible benefit was not excluded.
      PubDate: 2015-03-25T04:19:15.279332-05:
      DOI: 10.1111/bju.12997
  • Addendum
    • PubDate: 2015-03-25T02:36:55.90766-05:0
      DOI: 10.1111/bju.13095
  • Predicting postoperative complications of inguinal lymph node dissection
           for penile cancer in an international multicentre cohort
    • Authors: Jared M. Gopman; Rosa S. Djajadiningrat, Adam S. Baumgarten, Patrick N. Espiritu, Simon Horenblas, Yao Zhu, Chris Protzel, Julio M. Pow‐Sang, Timothy Kim, Wade J. Sexton, Michael A. Poch, Philippe E. Spiess
      Abstract: Objectives To assess the potential complications associated with inguinal lymph node dissection (ILND) across international tertiary care referral centres, and to determine the prognostic factors that best predict the development of these complications. Materials and Methods A retrospective chart review was conducted across four international cancer centres. The study population of 327 patients underwent diagnostic/therapeutic ILND. The endpoint was the overall incidence of complications and their respective severity (major/minor). The Clavien–Dindo classification system was used to standardize the reporting of complications. Results A total of 181 patients (55.4%) had a postoperative complication, with minor complications in 119 cases (65.7%) and major in 62 (34.3%). The total number of lymph nodes removed was an independent predictor of experiencing any complication, while the median number of lymph nodes removed was an independent predictor of major complications. The American Joint Committee on Cancer stage was an independent predictor of all wound infections, while the patient's age, ILND with Sartorius flap transposition, and surgery performed before the year 2008 were independent predictors of major wound infections. Conclusions This is the largest report of complication rates after ILND for squamous cell carcinoma of the penis and it shows that the majority of complications associated with ILND are minor and resolve without prolonged morbidity. Variables pertaining to the extent of disease burden have been found to be prognostic of increased postoperative morbidity.
      PubDate: 2015-03-24T23:36:17.706476-05:
      DOI: 10.1111/bju.13009
  • Clinical Significance of Peripheral Zone Thickness in Men with Lower
           Urinary Tract Symptom/Benign Prostatic Hyperplasia
    • Authors: Jong Kyou Kwon; Jang Hee Han, Ho Chul Choi, Dong Hyuk Kang, Joo Yong Lee, Jae Heon Kim, Cheol Kyu Oh, Young Deuk Choi, Kang Su Cho
      Abstract: Objective To evaluate the clinical impact of peripheral zone thickness (PZT), based on presumed circle area ratio (PCAR) theory, on urinary symptoms in men with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) as a novel prostate parameter. Patients And Methods Medical records were obtained from a prospective database of first‐visit men with LUTS/BPH. Age, international prostate symptom score (IPSS), overactive bladder symptom score (OABSS), maximum flow rate (Qmax), and post‐void residual (PVR) were assessed. Total prostate volume (TPV), transition zone volume (TZV), and transition zone index (TZI), and PZT were measured from transrectal ultrasonography. Reliability analysis was also performed. Results A total of 1009 patients were enrolled for the analysis. Mean PZT was 11.10 ± 2.50 mm, and patients were classified into 3 groups; PZT < 9.5 mm, 9.5 mm ≤ PZT
      PubDate: 2015-03-23T07:45:37.655271-05:
      DOI: 10.1111/bju.13130
  • Characterisation of the contractile dynamics of the resting ex vivo
           urinary bladder of the pig
    • Authors: R G Lentle; G W Reynolds, P W M Janssen, C M Hulls, Q M King, J P Chambers
      Abstract: Objectives To characterise the area and movements of ongoing spontaneous localised contractions in the resting porcine urinary bladder and relate these to ambient intravesical pressure (pves) in order to further our understanding of their genesis and role in accommodating incoming urine Materials and methods We used image analysis to quantify the areas and movements of discrete propagating patches of contraction (PPCs) on the anterior, anterolateral and posterior surfaces of the urinary bladders of 6 pigs maintained ex vivo with small incremental increases in volume. We then correlated the magnitude of pves and cyclic changes in pves with parameters derived from spatiotemporal maps. Results Contractile movements in the resting bladder consisted only of PPCs that covered around 1/5th of the surface of the bladder, commenced at various sites and were of around 6 s duration. They propagated at around 6 mm/s mainly across the anterior and lateral surface of the bladder by various, sometimes circular, routes in a quasi‐stable rhythm, and did not traverse the trigone. The frequencies of these rhythms were low (3.15 cpm) and broadly similar to those of cyclic changes in pves (3.55 cpm). Each PPC was associated with a region of stretching (positive strain rate) and these events occurred in a background of more constant strain. The amplitudes of cycles in pves and the areas undergoing PPCs increased following a sudden increase in pves but the frequency of cycles of pves and of origin of PPCs did not change. Peaks in pves cycles occurred when PPCs were traversing the upper half of the bladder, which was more compliant. The velocity of propagation of PPCs was similar to that of transverse propagation of action potentials in bladder myocytes and significantly greater than that reported in interstitial cells. The size of PPCs, their frequency and their rate of propagation were not affected by intra‐arterial dosage with tetrodotoxin or lidocaine. Conclusions The origin and duration of PPCs influence both pves and cyclic variation in pves. Hence, propagating rather than stationary areas of contraction may contribute to overall tone and to variation in pves. Spatiotemporal mapping of PPCs may contribute to our understanding of the generation of tone and the basis of clinical entities such as overactive bladder, painful bladder syndrome and detrusor overactivity. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-23T07:45:30.620902-05:
      DOI: 10.1111/bju.13132
  • Radical treatment of localised prostate cancer in the elderly
    • Authors: Wouter Everaerts; Simon Van Rij, Fairleigh Reeves, Anthony Costello
      Abstract: Elderly men are more likely to be diagnosed with aggressive cancer, but are often inappropriately denied curative treatment. Biological rather than chronological age should be used to decide if a patient will profit from radical treatment. Therefore, every man above 70 should undergo a health assessment using a validated tool prior to making treatment decisions. Fit elderly males with intermediate or high‐risk disease should be offered standard curative local treatment in keeping with guidelines for younger men. Vulnerable and frail elderly men warrant geriatric intervention prior to treatment. In the case of vulnerable patients, this intervention may render them suitable for standard care. When considering radical prostatectomy outcomes a ‘bifecta’ of oncological control and continence is appropriate as erectile dysfunction (although prevalent) has a much smaller impact on quality of life than in younger patients. Radiotherapy is an alternative to radical prostatectomy in men with a life expectancy of less than ten years. Primary ADT is not associated with improved survival in localised prostate cancer and should only be used for symptom palliation. Further elderly‐specific research is needed to guide prostate cancer care. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-23T07:35:23.801485-05:
      DOI: 10.1111/bju.13128
  • Envisioning an IDEAL Future for Urological Innovation
    • Authors: Philipp Dahm
      Abstract: Urologists take pride in standing at the forefront of cutting‐edge innovation and being among the first to embrace new procedures and technologies. In fact, when talking to urology residency applicants, access to advanced technology is among the most frequently cited motivating factors for their career choice. This innovative spirit has allowed urologists to harness acoustic waves to treat nephrolithiasis, made us leaders in the use of miniaturized endoscopic equipment and pioneers in the application of robotic‐assisted, laparoscopic surgery. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-23T06:59:58.911988-05:
      DOI: 10.1111/bju.13129
  • Novel anticoagulants and antiplatelet agents; a guide for the urologist
    • Authors: G Ellis; A J Camm, S N Datta
      Abstract: Novel Oral Anti‐Coagulants (NOACs) are increasingly being used in clinical practice and are set to almost entirely replace the Vitamin K agonists, such as warfarin, in the near future. Similarly, new antiplatelet agents are now regularly used in place of older agents such as aspirin and clopidogrel. In an aging population, with an increasing burden of complex comorbidities, urologists will frequently encounter patients who will be using such agents. Some background knowledge, and an understanding, of these drugs and the issues that surround their usage is essential. This article will provide readers with an understanding of these new drugs, including their mechanisms of action, the up‐to‐date evidence justifying their recent introduction into clinical practice and the appropriate interval for stopping them prior to surgery. It will also consider the risks of peri‐operative bleeding with regard to patients taking these drugs and the risks of venous thromboembolism in those in whom they are stopped. Strategies to manage anticoagulant‐associated bleeding are discussed. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-23T06:57:56.040672-05:
      DOI: 10.1111/bju.13131
  • A prospective study of erectile function after transrectal
           ultrasonography‐guided prostate biopsy
    • Authors: Katie S. Murray; Jason Bailey, Keegan Zuk, Ernesto Lopez‐Corona, J. Brantley Thrasher
      Abstract: Objective To prospectively evaluate the effect of transrectal ultrasonography (TRUS)‐guided prostate biopsy on erectile and voiding function at multiple time‐points after biopsy. Patients and Methods All men who underwent TRUS‐guided prostate biopsy completed a five‐item version of the International Index of Erectile Function (IIEF‐5) and the International Prostate Symptom Score (IPSS) before and at 1, 4 and 12 weeks after TRUS‐guided biopsy. Statistical analyses used were a general descriptive analysis, continuous variables using a t‐test and categorical data using chi‐square analysis. A paired t‐test was used to compare each patient's baseline score to their own follow‐up survey scores. Results In all, 220 patients were enrolled with a mean age of 64.1 years and PSA level of 6.7 ng/dL. At initial presentation, 38.6% reported no erectile dysfunction (ED), 22.3% mild ED, 15.5% mild‐to‐moderate ED, 10% moderate ED, and 13.6% severe ED. On paired t‐test there was a statistically significant reduction in IIEF‐5 score at 1 week after biopsy compared with before biopsy (18.2 vs 15.5; P < 0.001). This remained significantly reduced at 4 (18.4 vs 17.3; P = 0.008) and 12 weeks (18.4 vs 16.9, P = 0.004) after biopsy. Conclusions The effects of TRUS‐guided prostate biopsy on erectile function have probably been underestimated. It is important to be aware of these transient effects so patients can be appropriately counselled. The exact cause of this effect is yet to be determined.
      PubDate: 2015-03-23T05:20:05.071868-05:
      DOI: 10.1111/bju.13002
  • Clinical and radiographic predictors of the need for inferior vena cava
           resection during nephrectomy for patients with renal cell carcinoma and
           caval tumour thrombus
    • Authors: Sarah P. Psutka; Stephen A. Boorjian, Robert H. Thompson, Grant D. Schmit, John J. Schmitz, Thomas C. Bower, Suzanne B. Stewart, Christine M. Lohse, John C. Cheville, Bradley C. Leibovich
      Abstract: Objective To evaluate the clinical and radiographic predictors of the need for partial or circumferential resection of the inferior vena cava (IVC) requiring complex vascular reconstruction during venous tumour thrombectomy for renal cell carcinoma (RCC). Patients and Methods Data were collected on 172 patients with RCC and IVC (levels I–IV) venous tumour thrombus who underwent radical nephrectomy with tumour thrombectomy at the Mayo Clinic between 2000 and 2010. Preoperative imaging was re‐reviewed by one of two radiologists blinded to details of the patient's surgical procedure. Univariable and multivariable associations of clinical and radiographic features with IVC resection were evaluated by logistic regression. A secondary analysis was used to assess the ability of the model to predict histological invasion of the IVC by the tumour thrombus. Results Of the 172 patients, 38 (22%) underwent IVC resection procedures during nephrectomy. Optimum radiographic thresholds were determined to predict the need for IVC resection based on preoperative imaging included a renal vein diameter at the renal vein ostium (RVo) of 15.5 mm, maximum anterior–posterior (AP) diameter of the IVC of 34.0 mm and AP and coronal diameters of the IVC at the RVo of 24 and 19 mm, respectively. On multivariable analysis, the presence of a right‐sided tumour (odds ratio 3.3; P = 0.017), an AP diameter of the IVC at the RVo of ≥24.0 mm (odds ratio 4.4; P = 0.017), and radiographic identification of complete occlusion of the IVC at the RVo (odds ratio 4.9; P 
      PubDate: 2015-03-23T05:19:38.358895-05:
      DOI: 10.1111/bju.13005
  • Frozen section during partial nephrectomy: does it predict positive
    • Authors: Jennifer Gordetsky; Michael A. Gorin, Joe Canner, Mark W. Ball, Phillip M. Pierorazio, Mohamad E. Allaf, Jonathan I. Epstein
      Abstract: Objective To investigate the clinical utility of frozen section (FS) analysis performed during partial nephrectomy (PN) and its influence on intra‐operative management. Patients and Methods We performed a retrospective analysis of consecutive PN cases from 2010 to 2013. We evaluated the concordance between the intra‐operative FS diagnosis and the FS control diagnosis, a postoperative quality assurance measure performed on all FS diagnoses after formalin fixation of the tissue. We also evaluated the concordance between the intra‐operative FS diagnosis and the final specimen margin. Operating reports were reviewed for change in intra‐operative management for cases with a positive or atypia FS diagnosis, or if the mass was sent for FS. Results A total of 576 intra‐operative FSs were performed in 351 cases to assess the PN tumour bed margin, 19 (5.4%) of which also had a mass sent for FS to assess the tumour type. The concordance rate between the FS diagnosis and the FS control diagnosis was 98.3%. There were 30 (8.5%) final positive specimen margins, of which four (13.3%) were classified as atypia, 17 (56.7%) as negative and nine (30%) as positive on FS diagnosis. Intra‐operative management was influenced in six of nine cases with a positive FS diagnosis and in one of nine cases with an FS diagnosis of atypia. Conclusions The relatively high false‐negative rate, controversy over the prognosis of a positive margin, and inconsistency in influencing intra‐operative management are arguments against the routine use of FS in PN cases.
      PubDate: 2015-03-23T05:19:07.418853-05:
      DOI: 10.1111/bju.13011
  • Recourse to radical prostatectomy and associated short‐term outcomes
           in Italy: a country‐wide study over the last decade
    • Authors: Giacomo Novara; Vincenzo Ficarra, Filiberto Zattoni, Ugo Fedeli
      Abstract: Objective To estimate time trends in the recourse to radical prostatectomy (RP) and associated short‐term outcomes after RP in Italy, as population‐based data on RP adoption and outcomes are available mainly from Northern America and Northern Europe. Patients and Methods All RPs for prostate cancer performed between 2001 and 2010 were extracted from the Italian national archive of hospital discharge records. Age‐specific and age‐standardised RP rates were computed. The effect of procedural volume on in‐hospital mortality, complications, and length of stay (LOS) was estimated by multilevel regression models. Results In all, 144 432 RPs were analysed. Country‐wide RP rates increased between 2001 and 2004, and thereafter remained stable, with large differences between geographical areas. The mean hospital volume increased in the first study years, without centralisation but due to increasing RP numbers at the population level. The median LOS declined from 10 to 8 days over the study period (mean from 11.7 to 9.2 days). In‐hospital mortality declined from 0.16% in 2001 to 0.07% in 2010. In‐hospital mortality, LOS, and the prevalence of complications increased with age, and decreased with year of surgery. Compared with very low‐volume hospitals, procedures performed in high‐volume hospitals were associated with decreased in‐hospital mortality, in‐hospital complications, and LOS. Conclusions The study adds evidence on rapidly changing trends in RP rates in Italy, on improving in‐hospital outcomes, and on their association with procedural volume.
      PubDate: 2015-03-23T05:03:58.124349-05:
      DOI: 10.1111/bju.13000
  • Development of a standardised training curriculum for robotic surgery: a
           consensus statement from an international multidisciplinary group of
    • Authors: Kamran Ahmed; Reenam Khan, Alexandre Mottrie, Catherine Lovegrove, Ronny Abaza, Rajesh Ahlawat, Thomas Ahlering, Goran Ahlgren, Walter Artibani, Eric Barret, Xavier Cathelineau, Ben Challacombe, Patrick Coloby, Muhammad S. Khan, Jacques Hubert, Maurice Stephan Michel, Francesco Montorsi, Declan Murphy, Joan Palou, Vipul Patel, Pierre‐Thierry Piechaud, Hendrik Van Poppel, Pascal Rischmann, Rafael Sanchez‐Salas, Stefan Siemer, Michael Stoeckle, Jens‐Uwe Stolzenburg, Jean‐Etienne Terrier, Joachim W. Thüroff, Christophe Vaessen, Henk G. Van Der Poel, Ben Van Cleynenbreugel, Alessandro Volpe, Christian Wagner, Peter Wiklund, Timothy Wilson, Manfred Wirth, Jörn Witt, Prokar Dasgupta
      Abstract: Objectives To explore the views of experts about the development and validation of a robotic surgery training curriculum, and how this should be implemented. Materials and methods An international expert panel was invited to a structured session for discussion. The study was of a mixed design, including qualitative and quantitative components based on focus group interviews during the European Association of Urology (EAU) Robotic Urology Section (ERUS) (2012), EAU (2013) and ERUS (2013) meetings. After introduction to the aims, principles and current status of the curriculum development, group responses were elicited. After content analysis of recorded interviews generated themes were discussed at the second meeting, where consensus was achieved on each theme. This discussion also underwent content analysis, and was used to draft a curriculum proposal. At the third meeting, a quantitative questionnaire about this curriculum was disseminated to attendees to assess the level of agreement with the key points. Results In all, 150 min (19 pages) of the focus group discussion was transcribed (21 316 words). Themes were agreed by two raters (median agreement κ 0.89) and they included: need for a training curriculum (inter‐rater agreement κ 0.85); identification of learning needs (κ 0.83); development of the curriculum contents (κ 0.81); an overview of available curricula (κ 0.79); settings for robotic surgery training ((κ 0.89); assessment and training of trainers (κ 0.92); requirements for certification and patient safety (κ 0.83); and need for a universally standardised curriculum (κ 0.78). A training curriculum was proposed based on the above discussions. Conclusion This group proposes a multi‐step curriculum for robotic training. Studies are in process to validate the effectiveness of the curriculum and to assess transfer of skills to the operating room.
      PubDate: 2015-03-23T04:23:18.354723-05:
      DOI: 10.1111/bju.12974
  • DaPeCa‐1: Diagnostic Accuracy of Sentinel Node Biopsy in 222 Penile
           Cancer Patients at four Tertiary Referral Centres – a National Study
           from Denmark
    • Authors: Jakob Kristian Jakobsen; Kim Predbjørn Krarup, Peter Sommer, Henrik Nerstrøm, Vivi Bakholdt, Jens Ahm Sørensen, Kasper Ørding Olsen, Bjarne Kromann‐Andersen, Birgitte Grønkær Toft, Søren Høyer, Kirsten Bouchelouche, Jørgen Bjerggaard Jensen
      Abstract: Objectives To estimate the diagnostic accuracy of sentinel node biopsy (SNB) in penile cancer patients and assess SNB complications in a national multicentre setting. Patients and methods Retrospectively data were collected from records in four university centres by one medical doctor covering all SNBs performed in Denmark 2000‐2010. Patients had either nonpalpable nodes in one or both groins or had a palpable inguinal mass from which aspiration cytology failed to reveal malignancy. Patients were injected with nanocolloid technetium and had a scintigram recorded before the SNB. Primary end point was nodal recurrence on follow‐up. Secondary endpoint was complications after SNB. Diagnostic accuracy was computed. Results 409 groins in 222 patients were examined by SNB. Median follow‐up of patients who survived was 6.6 (IQR: 5‐10) years. Of 343 negative groins eight disclosed false negative. Sensitivity was 89.2% (95% CI, 79.8‐95.2%) per groin. Interestingly four of 67 T1G1 patients had a positive SNB. Twenty‐eight of 222 (13%) patients had complications of Clavien‐Dindo grade I‐IIIa. Conclusion Penile cancer sentinel node biopsy with a close follow‐up stages lymph node involvement reliably and has few complications in a national multicentre setting. Inguinal lymph node dissection was avoided in 76% of patients. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-21T09:08:44.140524-05:
      DOI: 10.1111/bju.13127
  • Multicenter prospective evaluation of the learning curve of the holmium
           laser enucleation of the prostate (HoLEP)
    • Authors: Grégoire Robert; Jean‐Nicolas Cornu, Marc Fourmarier, Saussine Christian, Aurélien Descazeaud, Abdel Rahmène Azzouzi, Eric Vicaut, Bertrand Lukacs
      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.
      PubDate: 2015-03-17T08:22:57.144723-05:
      DOI: 10.1111/bju.13124
  • Impact of stage migration and practice changes on high risk prostate
           cancer: results from patients treated with radical prostatectomy over the
           last two decades
    • Authors: N. Fossati; N. M. Passoni, M. Moschini, G. Gandaglia, A. Larcher, M. Freschi, G. Guazzoni, D. D. Sjoberg, A. J. Vickers, F. Montorsi, A. Briganti
      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.
      PubDate: 2015-03-17T08:22:50.622373-05:
      DOI: 10.1111/bju.13125
  • A Comparative Analysis of Robotic versus Laparoscopic Retroperitoneal
           Lymph Node Dissection for Testicular Cancer
    • Authors: Kelly T. Harris; Michael A. Gorin, Mark W. Ball, Phillip M. Pierorazio, Mohamad E. Allaf
      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.
      PubDate: 2015-03-17T08:06:48.805506-05:
      DOI: 10.1111/bju.13121
  • Targeted microbubbles: a novel application for the treatment of kidney
    • Authors: Krishna Ramaswamy; Vanessa Marx, Daniel Laser, Thomas Kenny, Thomas Chi, Michael Bailey, Mathew D. Sorensen, Robert H. Grubbs, Marshall L. Stoller
      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.
      PubDate: 2015-03-17T05:57:06.698073-05:
      DOI: 10.1111/bju.12996
  • Psychosocial interventions for men with prostate cancer: a Cochrane
           systematic review
    • Authors: Kader Parahoo; Suzanne McDonough, Eilis McCaughan, Jane Noyes, Cherith Semple, Elizabeth J. Halstead, Molly M. Neuberger, Philipp Dahm
      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.
      PubDate: 2015-03-17T05:45:29.831054-05:
      DOI: 10.1111/bju.12989
  • A novel interface for the telementoring of robotic surgery
    • Authors: Daniel H. Shin; Leonard Dalag, Raed A. Azhar, Michael Santomauro, Raj Satkunasivam, Charles Metcalfe, Matthew Dunn, Andre Berger, Hooman Djaladat, Mike Nguyen, Mihir M. Desai, Monish Aron, Inderbir S. Gill, Andrew J. Hung
      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.
      PubDate: 2015-03-17T05:29:34.362818-05:
      DOI: 10.1111/bju.12985
  • Comparative effectiveness and safety of various treatment procedures for
           lower pole renal calculi: a systematic review and network
    • Authors: Shaun Wen‐Huey Lee; Nathorn Chaiyakunapruk, Huey‐Yi Chong, Men‐Long Liong
      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
      PubDate: 2015-03-17T05:25:15.033386-05:
      DOI: 10.1111/bju.12983
  • Mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney: a
           detailed study of radiological, pathological and clinical outcomes
    • Authors: Patrick A. Kenney; Raghunandan Vikram, Srinivasa R. Prasad, Pheroze Tamboli, Surena F. Matin, Christopher G. Wood, Jose A. Karam
      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.
      PubDate: 2015-03-12T01:05:35.601339-05:
      DOI: 10.1111/bju.12992
  • The genetic diversity of cystinuria in a UK population of patients
    • Authors: Kathie A. Wong; Rachael Mein, Mark Wass, Frances Flinter, Caroline Pardy, Matthew Bultitude, Kay Thomas
      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
      PubDate: 2015-03-12T01:04:04.830595-05:
      DOI: 10.1111/bju.12894
  • Histopathological characteristics of microfocal prostate cancer detected
           during systematic prostate biopsy
    • Authors: Andrea Guttilla; Michele Zazzara, Fabio Zattoni, Giacomo Novara, Martina Zanin, Marina Gardiman, Vincenzo Ficarra, Filiberto Zattoni
      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.
      PubDate: 2015-03-12T01:03:50.266702-05:
      DOI: 10.1111/bju.12786
  • 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
    • Authors: Francesco Porpiglia; Cristian Fiori, Riccardo Bertolo, Diletta Garrou, Giovanni Cattaneo, Daniele Amparore
      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
      PubDate: 2015-03-07T02:30:02.001904-05:
      DOI: 10.1111/bju.12982
  • Disease‐specific death and metastasis do not occur in patients with
           Gleason score ≤6 at radical prostatectomy
    • Authors: Charlotte F. Kweldam; Mark F. Wildhagen, Chris H. Bangma, Geert J.L.H. Leenders
      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.
      PubDate: 2015-03-07T02:28:35.748061-05:
      DOI: 10.1111/bju.12879
  • Full immersion simulation: validation of a distributed simulation
           environment for technical and non‐technical skills training in
    • Authors: James Brewin; Jessica Tang, Prokar Dasgupta, Muhammad S. Khan, Kamran Ahmed, Fernando Bello, Roger Kneebone, Peter Jaye
      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.
      PubDate: 2015-03-07T02:28:21.438744-05:
      DOI: 10.1111/bju.12875
  • The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer
           Trials Group – a new co‐operative cancer trials group in
           genitourinary oncology
    • Authors: Shomik Sengupta; Peter Grimison, Dickon Hayne, Scott Williams, Suzanne Chambers, Paul DeSouza, Martin Stockler, Margaret McJannett, Guy Toner, Ian D. Davis
      PubDate: 2015-03-07T02:27:46.571686-05:
      DOI: 10.1111/bju.12925
  • Hypogonadal symptoms in young men are associated with a serum total
           testosterone threshold of 400 ng/dL
    • Authors: Jason M. Scovell; Ranjith Ramasamy, Nathan Wilken, Jason R. Kovac, Larry I. Lipshultz
      Abstract: Objective To investigate the association between hypogonadal symptoms and serum total testosterone (TT) levels in young men (aged
      PubDate: 2015-03-07T02:26:28.141302-05:
      DOI: 10.1111/bju.12970
  • Risk of acute myocardial infarction after androgen‐deprivation
           therapy for prostate cancer in a Chinese population
    • Authors: Jeremy Y.C. Teoh; Samson Y.S. Chan, Peter K.F. Chiu, Darren M.C. Poon, Ho‐Yuen Cheung, Simon S.M. Hou, Chi‐Fai Ng
      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.
      PubDate: 2015-03-07T02:25:47.448285-05:
      DOI: 10.1111/bju.12967
  • Upper limit of cancer extent on biopsy defining very low‐risk
           prostate cancer
    • Authors: Ola Bratt; Yasin Folkvaljon, Stacy Loeb, Laurence Klotz, Lars Egevad, Pär Stattin
      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
      PubDate: 2015-03-07T02:25:38.445843-05:
      DOI: 10.1111/bju.12874
  • The role of adjuvant chemotherapy for lymph node‐positive upper
           tract urothelial carcinoma following radical nephroureterectomy: a
           retrospective study
    • Authors: Ilaria Lucca; Wassim Kassouf, Anil Kapoor, Adrian Fairey, Ricardo A. Rendon, Jonathan I. Izawa, Peter C. Black, Harun Fajkovic, Christian Seitz, Mesut Remzi, Peter Nyirády, Morgan Rouprêt, Vitaly Margulis, Yair Lotan, Michela Martino, Sebastian L. Hofbauer, Pierre I. Karakiewicz, Alberto Briganti, Giacomo Novara, Shahrokh F. Shariat, Tobias Klatte
      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.
      PubDate: 2015-03-06T23:27:05.442517-05:
      DOI: 10.1111/bju.12801
  • The changing reality of urothelial bladder cancer: should
           non‐squamous variant histology be managed as a distinct clinical
    • Authors: M. Francesca Monn; Hristos Z. Kaimakliotis, K. Clint Cary, Richard Bihrle, Jose A. Pedrosa, Timothy A. Masterson, Richard S. Foster, Thomas A. Gardner, Liang Cheng, Michael O. Koch
      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.
      PubDate: 2015-03-06T23:26:30.47661-05:0
      DOI: 10.1111/bju.12877
  • Contrast Enhanced Ultrasound Parametric Imaging for the detection of
           Prostate Cancer
    • Authors: AW Postema; PJA Frinking, M Smeenge, TM De Reijke, JJMCH De la Rosette, F Tranquart, H Wijkstra
      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.
      PubDate: 2015-03-06T09:46:50.891522-05:
      DOI: 10.1111/bju.13116
  • Observations on transatlantic renal cell cancer surgery outcomes
    • Authors: Grant D Stewart; Alexander Laird, S Alan McNeill, Bradley C Leibovich
      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.
      PubDate: 2015-03-06T09:08:15.88443-05:0
      DOI: 10.1111/bju.13117
  • Partial versus Radical Nephrectomy for T1 renal tumours:An analysis from
           the British Association of Urological Surgeons Nephrectomy Audit
    • Authors: Marios Hadjipavlou; Fahd Khan, Sarah Fowler, Adrian Joyce, Francis X. Keeley, Seshadri Sriprasad,
      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
      PubDate: 2015-03-06T09:07:55.709667-05:
      DOI: 10.1111/bju.13114
  • 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
    • Authors: S Elsen; E Lerut, B Van Cleynenbreugel, F Aa, H Van Poppel, P.A Witte
      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.
      PubDate: 2015-03-06T09:06:03.625905-05:
      DOI: 10.1111/bju.13113
  • The Diminishing Returns of Robotic Diffusion: Complications Following
           Robot‐Assisted Radical Prostatectomy
    • Authors: Jesse D. Sammon; Firas Abdollah, Dane E. Klett, Daniel Pucheril, Akshay Sood, Quoc‐Dien Trinh, Mani Menon
      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.
      PubDate: 2015-03-06T09:04:26.596376-05:
      DOI: 10.1111/bju.13111
  • Sampling of the anterior apical region results in increased cancer
           detection and upgrading in transrectal repeat saturation biopsy of the
    • Authors: Maximilian Seles; Thomas Gutschi, Kathrin Mayrhofer, Katja Fischereder, Georg Ehrlich, Guenter Gallé, Stefan Gutschi, Oliver Pachernegg, Karl Pummer, Herbert Augustin
      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.
      PubDate: 2015-02-26T02:24:36.483739-05:
      DOI: 10.1111/bju.13108
  • Continence outcomes of robot assisted radical prostatectomy in patients
           with adverse urinary continence risk factors
    • Authors: Anup Kumar; Srinivas Samavedi, Anthony S Bates, Rafael Coelho, Bernardo Rocco, Kenneth Palmer, Vipul R Patel
      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
      PubDate: 2015-02-26T02:11:06.639871-05:
      DOI: 10.1111/bju.13106
  • Pharmacological characterization of the relaxation induced by the soluble
           guanylate cyclase activator, BAY 60‐2770 in rabbit corpus cavernosum
    • Authors: Camila Stefani Estancial; Renata Lopes Rodrigues, Gilberto De Nucci, Edson Antunes, Fabiola Zakia Mónica
      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.
      PubDate: 2015-02-26T01:31:46.85697-05:0
      DOI: 10.1111/bju.13105
  • Guideline of Guidelines: Prostate Cancer Imaging
    • Authors: Daniel A Wollin; Danil V Makarov
      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.
      PubDate: 2015-02-26T01:25:53.933476-05:
      DOI: 10.1111/bju.13104
  • Salvage Radical Prostatectomy for recurrent Prostate Cancer: Verification
           of EAU guideline criteria
    • Authors: Philipp Mandel; Thomas Steuber, Sascha Ahyai, Maximilian Kriegmair, Jonas Schiffmann, Katharina Boehm, Hans Heinzer, Uwe Michl, Thorsten Schlomm, Alexander Haese, Hartwig Huland, Markus Graefen, Derya Tilki
      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.
      PubDate: 2015-02-24T11:31:46.312222-05:
      DOI: 10.1111/bju.13103
  • 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
    • Authors: Sümer Baltacı; Murat Bozlu, Asif Yildirim, Mehmet İlker Gökce, Llker Tinay, Guven Aslan, Cavit Can, Levent Türkeri, Uğur Kuyumcuoğlu, Aydin Mungan
      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.
      PubDate: 2015-02-24T11:31:24.223057-05:
      DOI: 10.1111/bju.13102
  • Diagnosis and treatment of chronic bacterial prostatitis and chronic
           prostatitis/chronic pelvic pain syndrome: a consensus guideline
    • Authors: Jon Rees; Mark Abrahams, Andrew Doble, Alison Cooper,
      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.
      PubDate: 2015-02-24T09:43:14.900182-05:
      DOI: 10.1111/bju.13101
  • The Relationship Between Illness Uncertainty, Anxiety, Fear of
           Progression, and Quality of Life in Men With Favorable Risk Prostate
           Cancer Undergoing Active Surveillance
    • Authors: Patricia A. Parker; John W. Davis, David M. Latini, George Baum, Xuemei Wang, John F. Ward, Deborah Kuban, Steven J. Frank, Andrew K. Lee, Christopher J. Logothetis, Jeri Kim
      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
      PubDate: 2015-02-24T09:27:23.628395-05:
      DOI: 10.1111/bju.13099
  • Clinical Efficacy of Collagenase Clostridium Histolyticum in the Treatment
           of Peyronie's Disease by Subgroups: Results From Two Large,
    • Authors: Larry I. Lipshultz; Irwin Goldstein, Allen D. Seftel, Gregory J. Kaufman, Ted M. Smith, James P. Tursi, Arthur L. Burnett
      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.
      PubDate: 2015-02-24T09:17:53.228323-05:
      DOI: 10.1111/bju.13096
  • 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
  • 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
  • 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
      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
  • 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
  • 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
  • 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
  • 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
  • Future directions in urological oncology
    • Authors: R. Houston Thompson
      Pages: 499 - 499
      PubDate: 2015-03-25T02:36:55.959724-05:
      DOI: 10.1111/bju.13076
  • Time to replace prostate‐specific antigen (PSA) with the Prostate
           Health Index (PHI)? Yet more evidence that the PHI consistently
           outperforms PSA across diverse populations
    • Authors: Stacy Loeb
      Pages: 500 - 500
      PubDate: 2015-03-25T02:36:53.331219-05:
      DOI: 10.1111/bju.12966
  • The need for standardised reporting of complications Re: Minimum
           5‐years follow‐up of 1138 consecutive laparoscopic radical
    • Authors: Marianne Schmid; Christian P. Meyer, Quoc‐Dien Trinh
      Pages: 501 - 502
      PubDate: 2015-03-25T02:36:49.217087-05:
      DOI: 10.1111/bju.12939
  • Cardiopulmonary exercise testing: fortune‐teller or guardian
    • Authors: John S. McGrath
      Pages: 502 - 503
      PubDate: 2015-03-25T02:36:57.785976-05:
      DOI: 10.1111/bju.12962
  • A urologists’ guide to the multi‐parametric magnetic resonance
           imaging (mpMRI)‐galaxy
    • Authors: Christof Kastner
      Pages: 503 - 504
      PubDate: 2015-03-25T02:36:53.479851-05:
      DOI: 10.1111/bju.12978
  • A three‐dimensional window into the body?
    • Authors: Matthew Bultitude
      Pages: 504 - 505
      PubDate: 2015-03-25T02:36:52.102979-05:
      DOI: 10.1111/bju.12999
  • Clinical performance of the Prostate Health Index (PHI) for the prediction
           of prostate cancer in obese men: data from the PROMEtheuS project, a
           multicentre European prospective study
    • Authors: Alberto Abrate; Massimo Lazzeri, Giovanni Lughezzani, Nicolòmaria Buffi, Vittorio Bini, Alexander Haese, Alexandre Taille, Thomas McNicholas, Joan Palou Redorta, Giulio M. Gadda, Giuliana Lista, Ella Kinzikeeva, Nicola Fossati, Alessandro Larcher, Paolo Dell'Oglio, Francesco Mistretta, Massimo Freschi, Giorgio Guazzoni
      Pages: 537 - 545
      Abstract: ObjectivesTo test serum prostate‐specific antigen (PSA) isoform [‐2]proPSA (p2PSA), p2PSA/free PSA (%p2PSA) and Prostate Health Index (PHI) accuracy in predicting prostate cancer in obese men and to test whether PHI is more accurate than PSA in predicting prostate cancer in obese patients. Patients and Methods The analysis consisted of a nested case‐control study from the pro‐PSA Multicentric European Study (PROMEtheuS) project. The study is registered at http://www.controlled‐ The primary outcome was to test sensitivity, specificity and accuracy (clinical validity) of serum p2PSA, %p2PSA and PHI, in determining prostate cancer at prostate biopsy in obese men [body mass index (BMI) ≥30 kg/m2], compared with total PSA (tPSA), free PSA (fPSA) and fPSA/tPSA ratio (%fPSA). The number of avoidable prostate biopsies (clinical utility) was also assessed. Multivariable logistic regression models were complemented by predictive accuracy analysis and decision‐curve analysis. Results Of the 965 patients, 383 (39.7%) were normal weight (BMI
      PubDate: 2015-03-25T02:36:55.112927-05:
      DOI: 10.1111/bju.12907
  • Minimum 5‐year follow‐up of 1138 consecutive laparoscopic
           radical prostatectomies
    • Authors: Ricardo Soares; Antonina Di Benedetto, Zach Dovey, Simon Bott, Roy G. McGregor, Christopher G. Eden
      Pages: 546 - 553
      Abstract: ObjectivesTo investigate the long‐term outcomes of laparoscopic radical prostatectomy (LRP). Patients and Methods In all, 1138 patients underwent LRP during a 163‐month period from 2000 to 2008, of which 51.5%, 30.3% and 18.2% were categorised into D'Amico risk groups of low‐, intermediate‐ and high‐risk, respectively. All intermediate‐ and high‐risk patients were staged by preoperative magnetic resonance imaging or computed tomography and isotope bone scanning, and had a pelvic lymph node dissection (PLND), which was extended after April 2008. The median (range) patient age was 62 (40–78) years; body mass index was 26 (19–44) kg/m2; prostate‐specific antigen level was 7.0 (1–50) ng/mL and Gleason score was 6 (6–10). Neurovascular bundle was preservation carried out in 55.3% (bilateral 45.5%; unilateral 9.8%) of patients. Results The median (range) gland weight was 52 (14–214) g. The median (range) operating time was 177 (78–600) min and PLND was performed in 299 patients (26.3%), of which 54 (18.0%) were extended. The median (range) blood loss was 200 (10–1300) mL, postoperative hospital stay was 3 (2–14) nights and catheterisation time was 14 (1–35) days. The complication rate was 5.2%. The median (range) LN count was 12 (4–26), LN positivity was 0.8% and the median (range) LN involvement was 2 (1–2). There was margin positivity in 13.9% of patients and up‐grading in 29.3% and down‐grading in 5.3%. While 11.4% of patients had up‐staging from T1/2 to T3 and 37.1% had down‐staging from T3 to T2. One case (0.09%) was converted to open surgery and six patients were transfused (0.5%). At a mean (range) follow‐up of 88.6 (60–120) months, 85.4% of patients were free of biochemical recurrence, 93.8% were continent and 76.6% of previously potent non‐diabetic men aged
      PubDate: 2015-03-25T02:36:57.311637-05:
      DOI: 10.1111/bju.12887
  • 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
      First page: 554
      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
  • In patients with a previous negative prostate biopsy and a suspicious
           lesion on magnetic resonance imaging, is a 12‐core biopsy still
           necessary in addition to a targeted biopsy?
    • Authors: Simpa S. Salami; Eran Ben‐Levi, Oksana Yaskiv, Laura Ryniker, Baris Turkbey, Louis R. Kavoussi, Robert Villani, Ardeshir R. Rastinehad
      Pages: 562 - 570
      Abstract: ObjectivesTo evaluate the performance of multiparametric magnetic resonance imaging (mpMRI) in predicting prostate cancer on repeat biopsy; and to compare the cancer detection rates (CDRs) of MRI/transrectal ultrasonography (TRUS) fusion‐guided biopsy with standard 12‐core biopsy in men with at least one previous negative biopsy. Patients and Methods We prospectively enrolled men with elevated or rising PSA levels and/or abnormal digital rectal examination into our MRI/TRUS fusion‐guided prostate biopsy trial. Participants underwent a 3 T mpMRI with an endorectal coil. Three radiologists graded all suspicious lesions on a 5‐point Likert scale. MRI/TRUS fusion‐guided biopsies of suspicious prostate lesions and standard TRUS‐guided 12‐core biopsies were performed. Analysis of 140 eligible men with at least one previous negative biopsy was performed. We calculated CDRs and estimated area under the receiver operating characteristic curves (AUCs) of mpMRI in predicting any cancer and clinically significant prostate cancer. Results The overall CDR was 65.0% (91/140). Higher level of suspicion on mpMRI was significantly associated with prostate cancer detection (P < 0.001) with an AUC of 0.744 compared with 0.653 and 0.680 for PSA level and PSA density, respectively. The CDRs of MRI/TRUS fusion‐guided and standard 12‐core biopsy were 52.1% (73/140) and 48.6% (68/140), respectively (P = 0.435). However, fusion biopsy was more likely to detect clinically significant prostate cancer when compared with the 12‐core biopsy (47.9% vs 30.7%; P < 0.001). Of the cancers missed by 12‐core biopsy, 20.9% (19/91) were clinically significant. Most cancers missed by 12‐core biopsy (69.6%) were located in the anterior fibromuscular stroma and transition zone. Using a fusion‐biopsy‐only approach in men with an MRI suspicion score of ≥4 would have missed only 3.5% of clinically significant prostate cancers. Conclusions Using mpMRI and subsequent MRI/TRUS fusion‐guided biopsy platform may improve detection of clinically significant prostate cancer in men with previous negative biopsies. Addition of a 12‐core biopsy may be needed to avoid missing some clinically significant prostate cancers.
      PubDate: 2015-03-25T02:36:54.017257-05:
      DOI: 10.1111/bju.12938
  • Three‐dimensional navigation system integrating
           position‐tracking technology with a movable tablet display for
           percutaneous targeting
    • Authors: Arnaud Marien; Andre Castro Luis Abreu, Mihir Desai, Raed A. Azhar, Sameer Chopra, Sunao Shoji, Toru Matsugasumi, Masahiko Nakamoto, Inderbir S. Gill, Osamu Ukimura
      Pages: 659 - 665
      Abstract: ObjectivesTo assess the feasibility of a novel percutaneous navigation system (Translucent Medical, Inc., Santa Cruz, CA, USA) that integrates position‐tracking technology with a movable tablet display. Materials and Methods A total of 18 fiducial markers, which served as the target centres for the virtual tumours (target fiducials), were implanted in the prostate and kidney of a fresh cadaver, and preoperative computed tomography (CT) was performed to allow three‐dimensional model reconstruction of the surgical regions, which were registered on the body intra‐operatively. The position of the movable tablet's display could be selected to obtain the best recognition of the interior anatomy. The system was used to navigate the puncture needle (with position‐tracking sensor attached) using a colour‐coded, predictive puncture‐line. When the operator punctured the target fiducial, another fiducial, serving as the centre of the ablative treatment (treatment fiducial), was placed. Postoperative CT was performed to assess the digitized distance (representing the real distance) between the target and treatment fiducials to evaluate the accuracy of the procedure. Results The movable tablet display, with position‐tracking sensor attached, enabled the surgeon to visualize the three‐dimensional anatomy of the internal organs with the help of an overlaid puncture line for the puncture needle, which also had a position‐tracking sensor attached. The mean (virtual) distance from the needle tip to the target (calculated using the computer workstation), was 2.5 mm. In an analysis of each digitalized axial component, the errors were significantly greater along the z‐axis (P < 0.01), suggesting that the errors were caused by organ shift or deformation. Conclusion This virtual navigation system, integrating a position‐tracking sensor with a movable tablet display, is a promising advancement for facilitating percutaneous interventions. The movable display over the patient shows a preoperative three‐dimensional image that is aligned to the patient. Moving the display moves the image, creating the feeling of looking through a window into the patient, resulting in instant perception and a direct, intuitive connection between the physician and the anatomy.
      PubDate: 2015-03-25T02:36:54.61537-05:0
      DOI: 10.1111/bju.12948
  • 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
  • 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
  • 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
      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
      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
  • 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
      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
  • Exploring the evidence for early unclamping during robot‐assisted
           partial nephrectomy: is it worth the time and effort?
    • Authors: Oliver Cawley; Alexandrina Roman, Matthew Brown, Ben Challacombe
      Pages: 506 - 507
      PubDate: 2014-08-13T09:41:33.083937-05:
      DOI: 10.1111/bju.12836
  • Burden of male lower urinary tract symptoms (LUTS) suggestive of benign
           prostatic hyperplasia (BPH) – focus on the UK
    • Authors: Mark Speakman; Roger Kirby, Scott Doyle, Chris Ioannou
      Pages: 508 - 519
      Abstract: Key Messages Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) can be bothersome and negatively impact on a patient's quality of life (QoL). As the prevalence of LUTS/BPH increases with age, the burden on the healthcare system and society may increase due to the ageing population. This review unifies literature on the burden of LUTS/BPH on patients and society, particularly in the UK. LUTS/BPH is associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning, and through its negative impact on QoL for patients and partners. LUTS/BPH is often underdiagnosed and undertreated. Men should be encouraged to seek medical advice for this condition and should not accept it as part of ageing, while clinicians should be more active in the identification and treatment of LUTS/BPH. To assess the burden of illness and unmet need arising from lower urinary tract symptoms (LUTS) presumed secondary to benign prostatic hyperplasia (BPH) from an individual patient and societal perspective with a focus on the UK. Embase, PubMed, the World Health Organization, the Cochrane Database of Systematic Reviews and the York Centre for Reviews and Dissemination were searched to identify studies on the epidemiological, humanistic or economic burden of LUTS/BPH published in English between October 2001 and January 2013. Data were extracted and the quality of the studies was assessed for inclusion. UK data were reported; in the absence of UK data, European and USA data were provided. In all, 374 abstracts were identified, 104 full papers were assessed and 33 papers met the inclusion criteria and were included in the review. An additional paper was included in the review upon a revision in 2014. The papers show that LUTS are common in the UK, affecting ≈3% of men aged 45–49 years, rising to >30% in men aged ≥85 years. European and USA studies have reported the major impact of LUTS on quality of life of the patient and their partner. LUTS are associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning. While treatment costs in the UK are relatively low compared with other countries, the burden on health services is still substantial. LUTS associated with BPH is a highly impactful condition that is often undertreated. LUTS/BPH have a major impact on men, their families, health services and society. Men with LUTS secondary to BPH should not simply accept their symptoms as part of ageing, but should be encouraged to consult their physicians if they have bothersome symptoms.
      PubDate: 2014-10-16T21:59:07.742372-05:
      DOI: 10.1111/bju.12745
  • Preferences in the management of high‐risk prostate cancer among
           urologists in Europe: results of a web‐based survey
    • Authors: Cristian I. Surcel; Prasanna Sooriakumaran, Alberto Briganti, Pieter J.L. De Visschere, Jurgen J. Fütterer, Pirus Ghadjar, Hendrik Isbarn, Piet Ost, Guillaume Ploussard, Roderick C.N. Bergh, Inge M. Oort, Ofer Yossepowitch, J.P. Michiel Sedelaar, Gianluca Giannarini,
      Pages: 571 - 579
      Abstract: ObjectiveTo explore preferences in the management of patients with newly diagnosed high‐risk prostate cancer (PCa) among urologists in Europe through a web‐based survey.Materials and MethodsA web‐based survey was conducted between 15 August and 15 September 2013 by members of the Prostate Cancer Working Group of the Young Academic Urologists Working Party of the European Association of Urology (EAU). A specific, 29‐item multiple‐choice questionnaire covering the whole spectrum of diagnosis, staging and treatment of high‐risk PCa was e‐mailed to all urologists included in the mailing list of EAU members. Europe was divided into four geographical regions: Central‐Eastern Europe (CEE), Northern Europe (NE), Southern Europe (SE) and Western Europe (WE). Descriptive statistics were used. Differences among sample segments were obtained from a z‐test compared with the total sample.ResultsOf the 12 850 invited EAU members, 585 urologists practising in Europe completed the survey. High‐risk PCa was defined as serum PSA ≥20 ng/mL or clinical stage ≥ T3 or biopsy Gleason score ≥ 8 by 67% of responders, without significant geographical variations. The preferred single‐imaging examinations for staging were bone scan (74%, 81% in WE and 70% in SE; P = 0.02 for both), magnetic resonance imaging (53%, 72% in WE and 40% in SE; P = 0.02 and P = 0.01, respectively) and computed tomography (45%, 60% in SE and 23% in WE; P = 0.01 for both). Pre‐treatment predictive tools were routinely used by 62% of the urologists, without significant geographical variations. The preferred treatment was radical prostatectomy as the initial step of a multiple‐treatment approach (60%, 40% in NE and 70% in CEE; P = 0.02 and P < 0.01, respectively), followed by external beam radiation therapy with androgen deprivation therapy (29%, 45% in NE and 20% in CEE; P = 0.01 and P = 0.02, respectively), and radical prostatectomy as monotherapy (4%, 7% in WE; P = 0.04). When surgery was performed, the open retropubic approach was the most popular (58%, 74% in CEE, 37% in NE; P < 0.01 for both). Pelvic lymph node dissection was performed by 96% of urologists, equally split between a standard and extended template. There was no consensus on the definition of disease recurrence after primary treatment, and much heterogeneity in the administration of adjuvant and salvage treatments.ConclusionWith the limitation of a low response rate, the present study is the first survey evaluating preferences in the management of high‐risk PCa among urologists in Europe. Although the definition of high‐risk PCa was fairly uniform, wide variations in patterns of primary and adjuvant/salvage treatments were observed. These differences might translate into variations in quality of care with a possible impact on ultimate oncological outcome.
      PubDate: 2014-08-11T06:08:24.32607-05:0
      DOI: 10.1111/bju.12796
  • 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
      First page: 580
      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
  • 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
      First page: 595
      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
  • Repeated biopsies in patients with prostate cancer on active surveillance:
           clinical implications of interobserver variation in histopathological
    • Authors: Frederik B. Thomsen; Niels Marcussen, Kasper D. Berg, Ib J. Christensen, Ben Vainer, Peter Iversen, Klaus Brasso
      Pages: 599 - 605
      Abstract: ObjectiveTo investigate the clinical implications of interobserver variation in the assessment of re‐biopsies obtained during active surveillance (AS) of prostate cancer. Patients and Methods In all, 107 patients with low‐risk prostate cancer with 93 diagnostic biopsy sets and 109 re‐biopsy sets were included. The International Society of Urological Pathology 2005 Gleason scoring system was used for the histopathological assessment of all biopsies. Three different definitions of histopathological progression were applied. Unweighted and linear weighted Kappa (κ) statistics were used to compare the interobserver agreement. Results The overall Gleason score agreement was 68.8% with a weighted κ of 0.670. The interobserver agreement was 79.6% for meeting the AS selection criteria. According to the three progression definitions applied, overall agreement was between 80.7% and 89.0% with weighted κ values of 0.746–0.791. Treatment recommendations would have changed in up to 10.1% (95% confidence interval 5.4–17.7%) of the 109 re‐biopsy sets. Conclusion Kappa statistics showed strong agreement between the histological evaluations. However, up to 10% of patients on AS would receive a different treatment recommendation depending upon which histopathological evaluation of re‐biopsies was used for treatment planning.
      PubDate: 2014-08-16T11:18:20.138744-05:
      DOI: 10.1111/bju.12820
  • Evaluation of functional outcomes after laparoscopic partial nephrectomy
           using renal scintigraphy: clamped vs clampless technique
    • Authors: Francesco Porpiglia; Riccardo Bertolo, Daniele Amparore, Valerio Podio, Tiziana Angusti, Andrea Veltri, Cristian Fiori
      Pages: 606 - 612
      Abstract: ObjectivesTo examine differences in postoperative renal functional outcomes when comparing clampless with conventional laparoscopic partial nephrectomy (LPN) by using renal scintigraphy, and to identify the predictors of poorer postoperative renal functional outcomes after clampless LPN. Patients and Methods Between September 2010 and September 2012, 87 patients with renal masses suitable for LPN were prospectively enrolled in the study. From September 2010 to September 2011, LPN with renal artery clamping was performed and from September 2011 to September 2012 clampless LPN (no clamping of renal artery) was performed. Patients who underwent clampless LPN were unselected and consecutive, and the procedure was performed at the end of surgeon's learning curve. Patients were divided into two groups according to warm ischaemia time (WIT): group A, conventional LPN and group B, clampless‐LPN (WIT = 0 min). Demographic and peri‐operative data were collected and analysed and functional outcomes were evaluated using biochemical markers and renal scintigraphy at baseline and at 3 months after surgery. The percentage loss of renal function, evaluated according to renal scintigraphy, was calculated. Chi‐squared and Student's t‐tests were carried out and regression analysis was performed. Results Group A was found to be similar to group B in all variables measured except for WIT and blood loss (P < 0.001). The percentage reduction in renal scintigraphy values was not significantly different between the groups (reductions of 5% in group A and 6% in group B for split renal function [SRF] and 12% in group A and 17% in group B for estimated renal plasmatic flow [ERPF]; P = 0.587 and P = 0.083, respectively). Multivariate analysis in group B showed that the lower the baseline values of SRF and ERPF, the poorer the postoperative functional outcome of the treated kidney. Conclusions In our experience, even clampless LPN was not found to be functionally harmless. The patients who benefitted most from a clampless approach were those with the poorest baseline renal function.
      PubDate: 2014-10-22T22:36:10.60907-05:0
      DOI: 10.1111/bju.12834
  • Preservation of the saphenous vein during laparoendoscopic
           single‐site inguinal lymphadenectomy: comparison with the
           conventional laparoscopic technique
    • Authors: Jun‐Bin Yuan; Min‐Feng Chen, Lin Qi, Yuan Li, Yang‐Le Li, Cheng Chen, Jin‐bo Chen, Xiong‐Bing Zu, Long‐Fei Liu
      Pages: 613 - 618
      Abstract: ObjectiveTo prospectively study the surgical strategies and clinical efficacy of laparoendoscopic single‐site (LESS) inguinal lymphadenectomy compared with conventional endoscopic inguinal lymphadenectomy for the management of inguinal nodes. Patients and Methods A total of 12 patients with squamous cell carcinoma of the penis who underwent penectomy between February and July 2013 were enrolled in the study. All 12 patients underwent bilateral inguinal lymphadenectomy (LESS inguinal lymphadenectomy in one limb and conventional endoscopic inguinal lymphadenectomy in the other) with preservation of the saphenous vein. All lymphatic tissue in the boundaries of the adductor longus muscle (medially), the sartorius muscle (laterally), 2 cm above the inguinal ligament (superiorly), the Scarpa fascia (superficially) and femoral vessels (deeply) was removed in both surgical techniques. All 24 procedures were performed by one experienced surgeon. Results All 24 procedures (12 LESS and 12 conventional endoscopic inguinal lymphadenectomies) were completed successfully without conversion to open surgery. For LESS inguinal lymphadenectomy and conventional endoscopic inguinal lymphadenectomy groups, the mean ± sd operating time was 94.6 ± 14.8 min and 90.8 ± 10.6 min, respectively (P = 0.145). No significant differences in the incidence of postoperative complications (skin‐related problems, hecatomb, lower extremity oedema, lymphatic complications and overall complications) were noted between the two groups (P > 0.05). No lower extremity oedema occurred in any limbs of the two groups. No significant differences were observed in either lymph node clearance rate or detection rate of histologically positive lymph nodes (P > 0.05). The patient satisfaction rate with scar appearance and cosmetic results was significantly better in the LESS inguinal lymphadenectomy group than in the conventional endoscopic inguinal lymphadenectomy group of (75 vs 25%; P = 0.039). Conclusions This preliminary study suggests that both LESS inguinal lymphadenectomy and conventional endoscopic inguinal lymphadenectomy are safe and feasible procedures for inguinal lymphadenectomy. Preservation of the saphenous vein during LESS inguinal lymphadenectomy/conventional endoscopic inguinal lymphadenectomy can effectively reduce the incidence of postoperative lower extremity oedema. LESS inguinal lymphadenectomy seems to provide better cosmetic results than conventional endoscopic inguinal lymphadenectomy.
      PubDate: 2014-08-16T11:40:46.75214-05:0
      DOI: 10.1111/bju.12838
  • Differences in 24‐h urine composition between nephrolithiasis
           patients with and without diabetes mellitus
    • Authors: Christopher Hartman; Justin I. Friedlander, Daniel M. Moreira, Sammy E. Elsamra, Arthur D. Smith, Zeph Okeke
      Pages: 619 - 624
      Abstract: ObjectivesTo examine the differences in 24‐h urine composition between nephrolithiasis patients with and without diabetes mellitus (DM) in a large cohort of stone‐formers and to examine differences in stone composition between patients with and without DM. Patients and Methods A retrospective review of 1117 patients with nephrolithiasis and a 24‐h urine analysis was completed. Univariable analysis of 24‐h urine profiles and multivariable linear regression models were performed, comparing patients with and without DM. A subanalysis of patients with stone analysis data available was performed, comparing the stone composition of patients with and without DM. Results Of the 1117 patients who comprised the study population, 181 (16%) had DM and 936 (84%) did not have DM at the time of urine analysis. Univariable analysis showed significantly higher total urine volume, citrate, uric acid (UA), sodium, potassium, sulphate, oxalate, chloride, and supersaturation (SS) of UA in individuals with DM (all P < 0.05). However, patients with DM had significantly lower SS of calcium phosphate and pH (all P < 0.05). Multivariable analysis showed that patients with DM had significantly lower urinary pH and SS of calcium phosphate, but significantly greater citrate, UA, sulphate, oxalate, chloride, SSUA, SS of calcium oxalate, and volume than patients without DM (all P < 0.05). Patients with DM had a significantly greater proportion of UA in their stones than patients without DM (50.2% vs 13.5%, P < 0.001). Conclusions DM was associated with multiple differences on 24‐h urine analysis compared with those without DM, including significantly higher UA and oxalate, and lower pH. Control of urinary UA and pH, as well as limiting intake of dietary oxalate may reduce stone formation in patients with DM.
      PubDate: 2014-08-13T09:16:35.2424-05:00
      DOI: 10.1111/bju.12807
  • Safety and diagnostic accuracy of percutaneous biopsy in upper tract
           urothelial carcinoma
    • Authors: Steven Y. Huang; Kamran Ahrar, Sanjay Gupta, Michael J. Wallace, Joe E. Ensor, Savitri Krishnamurthy, Surena F. Matin
      Pages: 625 - 632
      Abstract: ObjectiveTo assess the diagnostic accuracy and safety of percutaneous biopsy for upper tract urothelial carcinoma (UTUC). Patients and Methods From 2002 to 2013, 26 upper tract lesions in 24 patients (20 men; median [range] age 67.8 [51.7–85.9] years) were percutaneously biopsied. Analysis was separated based on lesion appearance: (i) mass infiltrating renal parenchyma, (ii) filling defect in the collecting system, (iii) urothelial wall thickening. We tracked immediate complications and tract seeding on follow‐up imaging. Results Of the 26 upper tract lesions, 15 (58%) were masses infiltrating the renal parenchyma (mean [range] size 5.4 [1.1–14.0] cm), six (23%) were urothelial wall thickenings (mean [range] size 0.8 [0.4–1.1] cm), and five (19%) were filling defects within the renal pelvis or calyx (mean [range] size 2.7 [1.0–4.6] cm). Definitive diagnosis of UTUC was made by biopsy in 22 of 26 lesions (85%). Biopsy characterised 14 of 15 infiltrative masses and five of five filling defects; biopsy characterised three of six cases of urothelial wall thickening. CT follow‐up was available for 19 patients (73%) at a median (range) of 13.6 (1.0–98.9) months. Three patients (11%) developed recurrence in the nephrectomy bed at 5.6, 9.7, and 29.0 months after biopsy; none were attributed to tract seeding after independent review, because recurrence was remote from the biopsy site. Conclusion Percutaneous biopsy is effective for diagnosis of UTUC, providing tissue diagnosis in 85% of cases. While case reports cite a risk of tract seeding, no cases of recurrence were definitely attributable to percutaneous biopsy. Thus, for upper tract urothelial lesions, which are not amenable to endoscopic biopsy, percutaneous biopsy is a safe and effective technique.
      PubDate: 2014-10-20T22:05:10.22679-05:0
      DOI: 10.1111/bju.12824
  • Sexual function and health‐related quality of life in women with
           classic bladder exstrophy
    • Authors: Rebecca Deans; Lih‐Mei Liao, Dan Wood, Christopher Woodhouse, Sarah M. Creighton
      Pages: 633 - 638
      Abstract: ObjectiveTo investigate sexual function and quality of life in adolescent and adult women with classic bladder exstrophy (BE). Materials and Methods A two‐part observational cross‐sectional study with a questionnaire arm and a retrospective case review arm was performed. The study was undertaken in a centre providing a tertiary referral gynaecology and urology service. Outcomes were sexual function and quality‐of‐life scores. Results A total of 44 patients with BE were identified from departmental databases and included in the study, of whom 28 (64%) completed postal questionnaires. Sexual function scores and quality‐of‐life visual analogue scales were significantly poorer compared with normative data. Conclusions Bladder exstrophy has a detrimental psychological impact on women. In future, methodical multidisciplinary paediatric follow‐up research will help to identify predictors of better and worse adolescent and adult outcomes. Development and evaluation of cost‐effective psychological interventions to target specific problems is also warranted.
      PubDate: 2014-08-11T06:10:13.126621-05:
      DOI: 10.1111/bju.12811
  • Lack of association of joint hypermobility with urinary incontinence
           subtypes and pelvic organ prolapse
    • Authors: Alex Derpapas; Rufus Cartwright, Purnima Upadhyaya, Alka A. Bhide, Alex G. Digesu, Vik Khullar
      Pages: 639 - 643
      Abstract: ObjectiveTo test the hypothesis that joint hypermobility (JHM) is associated with specific urinary incontinence (UI) subtypes and uterovaginal prolapse. Patients and Methods In all, 270 women scheduled to undergo urodynamic investigations were invited to self‐complete a validated five‐item JHM questionnaire. Women underwent history taking, symptoms assessing via the King's Health Questionnaire and clinical examination using the Pelvic Organ Prolapse Quantification system. Associations between JHM and pelvic floor disorders in univariate and multivariate ordinal regression were reported using odds ratios (ORs) and 95% confidence intervals (CIs). Results The prevalence of JHM was 31.1%. JHM had a negative association with age (OR 0.98/year, P = 0.04). There was no association between JHM and either urodynamic (P = 0.41), or symptomatic stress UI (P = 0.48). Nor was there association with detrusor overactivity or symptomatic urgency UI. Multivariate ordinal regression of JHM with maximum prolapse stage, adjusting for age, showed a significant relationship (OR 1.26/stage, 95% CI 1.06–1.46, P < 0.05). Conclusion Although JHM is highly prevalent amongst women with lower urinary tract symptoms (LUTS), there is no strong association of JHM with any UI subtype. There is a trend towards higher prolapse staging in women with JHM, which becomes significant only after adjustment for the confounding negative association between age and JHM.
      PubDate: 2014-10-20T22:06:56.951793-05:
      DOI: 10.1111/bju.12823
  • 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
      First page: 644
      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
  • A new one‐layer epididymovasostomy technique
    • Authors: Alayman Hussein
      Pages: 653 - 658
      Abstract: ObjectivesTo describe and evaluate the outcomes of a new epididymovasostomy technique. Patients and Methods Nine patients with obstructive azoospermia were treated at the Minia University Hospital using a new microsurgical bilateral epididymovasostomy technique. The technique involved the opening of a small window in the tunica of the epididymis, making an opening in the underneath epididymal tubule and keeping it open by fixing the edges of the epididymal opening to the edge of the epididymal tunica with four 10/0 nylon sutures. The abdominal cut end of the vas deferens was then anastomosed to the epididymal opening by suturing the epididymal tubule, fixed to its tunica in one layer, to the full thickness vas deferens. The main outcome measure was finding sperm in the ejaculate. Results Sperm was found in the ejaculate in six out of nine patients after our new, one‐layer, epididymovasostomy technique. Mean ± sd operating time was 176 ± 23 min. Conclusions This new, one‐layer, epididymovasostomy technique provides a simple alternative method of epididymovasostomy, with reasonable outcomes. More cases and follow‐up are needed to make meaningful comparisons with conventional epididymovasostomy.
      PubDate: 2014-10-20T02:58:45.271142-05:
      DOI: 10.1111/bju.12839
  • Preventable mortality after common urological surgery: failing to
    • Authors: Jesse D. Sammon; Daniel Pucheril, Firas Abdollah, Briony Varda, Akshay Sood, Naeem Bhojani, Steven L. Chang, Simon P. Kim, Nedim Ruhotina, Marianne Schmid, Maxine Sun, Adam S. Kibel, Mani Menon, Marcus E. Semel, Quoc‐Dien Trinh
      Pages: 666 - 674
      Abstract: ObjectiveTo assess in‐hospital mortality in patients undergoing many commonly performed urological surgeries in light of decreasing nationwide perioperative mortality over the past decade. This phenomenon has been attributed in part to a decline in ‘failure to rescue’ (FTR) rates, e.g. death after a complication that was potentially recognisable/preventable. Patients and Methods Discharges of all patients undergoing urological surgery between 1998 and 2010 were extracted from the Nationwide Inpatient Sample and assessed for overall and FTR mortality. Admission trends were assessed with linear regression. Logistic regression models fitted with generalised estimating equations were used to estimate the impact of primary predictors on over‐all and FTR mortality and changes in mortality rates. Results Between 1998 and 2010, an estimated 7 725 736 urological surgeries requiring hospitalisation were performed in the USA; admissions for urological surgery decreased 0.63% per year (P = 0.008). Odds of overall mortality decreased slightly (odds ratio [OR] 0.990, 95% confidence interval [CI] 0.988–0.993), yet the odds of mortality attributable to FTR increased 5% every year (OR 1.050, 95% CI 1.038–1.062). Patient age, race, Charlson Comorbidity Index, public insurance status, as well as urban hospital location were independent predictors of FTR mortality (P < 0.001). Conclusion A shift from inpatient to outpatient surgery for commonly performed urological procedures has coincided with increasing rates of FTR mortality. Older, sicker, minority group patients and those with public insurance were more likely to die after a potentially recognisable/preventable complication. These strata of high‐risk individuals represent ideal targets for process improvement initiatives.
      PubDate: 2014-08-19T01:02:04.688454-05:
      DOI: 10.1111/bju.12833
  • Effect of surgical approach on erectile function recovery following
           bilateral nerve‐sparing radical prostatectomy: an evaluation
           utilising data from a randomised, double‐blind, double‐dummy
           multicentre trial of tadalafil vs placebo
    • 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 multicentre, randomised, double‐blind, double‐dummy REACTT trial of tadalafil (once a day [OaD] or on‐demand [pro‐re‐nata, PRN]) vs placebo. Patients and Methods Patients aged
  • Determination of optimal drug dose and light dose index to achieve
           minimally invasive focal ablation of localised prostate cancer using
           WST11‐vascular‐targeted photodynamic (VTP) therapy
    • Abstract: Objective To determine the optimal drug and light dose for prostate ablation using WST11 (TOOKAD® Soluble) for vascular‐targeted photodynamic (VTP) therapy in men with low‐risk prostate cancer. Patients and Methods In all, 42 men with low‐risk prostate cancer were enrolled in the study but two who underwent anaesthesia for the procedure did not receive the drug or light dose. Thus, 40 men received a single dose of 2, 4 or 6 mg/kg WST11 activated by 200 J/cm light at 753 nm. WST11 was given as a 10‐min intravenous infusion. The light dose was delivered using cylindrical diffusing fibres within hollow plastic needles positioned in the prostate using transrectal ultrasonography (TRUS) guidance and a brachytherapy template. Magnetic resonance imaging (MRI) was used to assess treatment effect at 7 days, with assessment of urinary function (International Prostate Symptom Score [IPSS]), sexual function (International Index of Erectile Function [IIEF]) and adverse events at 7 days, 1, 3 and 6 months after VTP. TRUS‐guided biopsies were taken at 6 months. Results In all, 39 of the 40 treated men completed the follow‐up. The Day‐7 MRI showed maximal treatment effect (95% of the planned treatment volume) in men who had a WST11 dose of 4 mg/kg, light dose of 200 J/cm and light density index (LDI) of >1. In the 12 men treated with these parameters, the negative biopsy rate was 10/12 (83%) at 6 months, compared with 10/26 (45%) for the men who had either a different drug dose (10 men) or an LDI of 1 resulted in treatment effect in 95% of the planned treatment volume and a negative biopsy rate at 6 months of 10/12 men (83%).
  • Minimally invasive partial nephrectomy in the age of the
  • Enhancer of zeste homolog 2 (EZH2) promotes tumour cell migration and
           invasion via epigenetic repression of E‐cadherin in renal cell
    • Abstract: Objective To investigate the molecular mechanism and clinical significance for an oncogenic role of enhancer of zeste homolog 2 (EZH2) in renal cell carcinoma (RCC). Materials and Methods Immunohistochemistry analyses of EZH2, histone H3 trimethyl Lys27 (H3K27me3) and E‐cadherin were performed in tumour tissue samples from 257 patients with RCC. Regulatory effects of EZH2 on E‐cadherin expression were examined by quantitative real‐time polymerase chain reaction, Western blot, chromatin immunoprecipitation assay and immunohistochemical staining. Migration and invasion assays were performed in RCC cell lines. Tumour xenograft experiments with RCC cells were carried out in nude mice. Results EZH2 promoted migration and invasion in RCC cell lines. Silencing EZH2 with short‐hairpin EZH2 (shEZH2) or 3‐deazaneplanocin A (DZNep) inhibited migration and invasion (P < 0.001), up‐regulated the expression of E‐cadherin in vitro, inhibited tumour growth, and prolonged survival in vivo (P = 0.022). EZH2 expression accompanied with E‐cadherin repression was associated with advanced disease stage (P = 0.004) and poor overall (P < 0.001) and disease‐free survival (P < 0.001). Conclusion EZH2 may contribute to RCC progression and is a potential therapeutic target for advanced RCC.
  • The efficacy of irinotecan, paclitaxel, and oxaliplatin (IPO) in relapsed
           germ cell tumors with high dose chemotherapy as consolidation‐ a
           non‐cisplatin‐ based induction approach
    • Abstract: Objectives To determine the outcome of an expanded cohort of patients with relapsed germ cell tumors (GCT) treated with a salvage chemotherapy regimen consisting of irinotecan, paclitaxel and oxaliplatin (IPO) and assess the role of IPO as an alternative to standard cisplatin‐based chemotherapy regimens in this setting. Patients and methods The results of 72 consecutive patients were reviewed retrospectively. IPO was used either as a second‐line treatment (n=29), of which 20 patients subsequently received high‐dose chemotherapy (HDCT), or third‐line (n=43), of which 32 patients proceeded to HDCT. Results The 2‐year PFS and 3‐year OS rates for the whole cohort were 30.2% (95%CI 17.3‐40.5%) and 33.4% (95%CI: 20.1‐43.8 %) respectively. CR was achieved in 3%, m‐ve PR in 41%, m+ve PR in 18%, SD in 17% and PD in 20%. In the second‐line setting, the 2‐year PFS rate was 43.5% (95%CI: 21.7‐60.8%) and 3‐year OS 49.1% (95%CI: 24.2‐65.1%). In the third‐line setting, the 2‐year PFS rate was 21.0% (95%CI 9.5‐35.4%) and the 3‐year OS rate was 23.9% (95%CI 11.7‐38.2).According to the current international prognostic factor study group criteria for first relapse for the high and very high risk group the 2 year PFS rates were 50% and 30% respectively. There were 2 treatment related deaths from IPO, and 4 from HDCT. Grade 3 or 4 toxicities included neutropenia (35%), thrombocytopenia (18%), infection (15%), diarrhea (11%) and lethargy (8%).  Conclusions IPO offers an effective, well‐tolerated, non‐nephrotoxic alternative to cisplatin‐based salvage regimens for patients with relapsed GCT. It appears particularly useful in high risk patients and for those in whom cisplatin is ineffective or contra‐indicated.
  • “Percutaneous Nephrolithotomy in the Super Obese (BMI
           ≥ 50):Overcoming the Challenges.”
    • Abstract: Objective To analyze our experience, outcomes and lessons learned with percutaneous nephrolithotomy (PCNL) in the super obese (body mass index ≥ 50 kg/m2). Materials and Methods In this institutional review board approved study we retrospectively reviewed our PCNL database between July 2011 and September 2014 and identified all patients with a BMI ≥ 50 kg/m2. Patient demographics, perioperative outcomes and complications were determined. Additionally, a number of special PCNL considerations in the super obese that can maximize safe outcomes are outlined. Results Twenty‐one PCNLs performed on 17 super obese patients were identified. Mean patient age was 54.8 years. Mean body mass index (BMI) was 57.2 kg/m2. Mean stone area was 1037 mm2. Full staghorn stones were appreciated in 6 patients and partial staghorns in 4 patients. Mean operative time was 106 minutes and mean hemoglobin drop was 1.2 g/dl. Overall stone free rate was 87%. There were four total complications: two Clavien grade II, one Clavien IIIb and one Clavien IVb. We identified several special considerations for safely preforming PCNL in the suber obese including using extra‐long nephroscopes and graspers, using custom cut extra long access sheaths with suture “tails” secured to easily retrieve the sheath, choosing the shortest possible access tract, readily employing flexible nephroscopes, placing nephroureteral tubes rather than nephrostomy tubes postoperatively, and meticulous patient positioning and padding. Conclusion With appropriate perioperative considerations and planning, PCNL is feasible and safe in the super obese. Stone clearance is comparable to that of prior reported PCNL series in the morbidly obese, and is achievable with few complications. This article is protected by copyright. All rights reserved.
  • Emerging trends in prostate cancer literature: medical progress or
           marketing hype'
    • 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
  • Comparison of systematic transrectal biopsy to transperineal
           MRI/ultrasound‐fusion biopsy for the diagnosis of prostate cancer
    • 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.
  • Transperineal template‐guided prostate biopsy: 10 years of
    • 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.
  • Utilization of pre‐operative imaging for muscle‐invasive
           bladder cancer: a population‐based study
    • 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
  • Long‐term outcomes of high risk bladder cancer screening cohort
    • Abstract: Purpose To evaluate long‐term outcomes of patients at high risk of bladder cancer (BC) who participated in a BC screening trial. Materials and methods High‐risk patients based on age ≥50 years, ≥10 pack‐years smoking, and/or ≥15 years environmental exposure enrolled in one‐time screening trial using NMP‐22 assay (3/2006‐11/2007) at Dallas VA hospital. Subsequent detection of smoking related malignancies (Bladder, lung and renal cell carcinoma) was determined through Jan 31, 2014. Multivariable regression analysis was used to determine factors associated with BC diagnosis and survival. Results Cohort included 925 subjects: 886 patients (95.8%) were smokers and 613 (66.3%) had hazardous occupational exposure. At initial screen, 57 patients had positive NMP22 test and 2 had BC. Another 9 (1.0%) patients were diagnosed with BC during median follow‐up of 78.4 months. All BCs were non‐invasive (Ta); low grade (n=7) and high grade (n=4). RCC and lung cancer were diagnosed in 10 (1.1%) and 18 (1.9%) patients, respectively. 134 patients died including 3 from RCC and 12 from lung cancer, but none from BC. Factors associated with worse overall survival on MVA: lung cancer (HR 5.06, p60 pack years smoking history (HR 4.51, p=0.037). Conclusion At 6.5 years of follow‐up, no patients in this high‐risk cohort developed muscle invasive BC. Lung cancer, hematuria and >60 pack years smoking history are independent predictors of mortality. Other cause mortality is an important consideration in patients undergoing BC screening. This article is protected by copyright. All rights reserved.
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