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J. of Medical Imaging and Radiation Oncology     Hybrid Journal   (Followers: 2, SJR: 0.378, h-index: 23)
J. of Medical Primatology     Hybrid Journal   (Followers: 1, SJR: 0.473, h-index: 28)
J. of Medical Radiation Sciences     Open Access   (Followers: 2)
J. of Medical Virology     Hybrid Journal   (Followers: 6, SJR: 0.936, h-index: 82)
J. of Metamorphic Geology     Hybrid Journal   (Followers: 6, SJR: 2.003, h-index: 72)
J. of Microscopy     Hybrid Journal   (Followers: 2, SJR: 0.655, h-index: 70)
J. of Midwifery & Women's Health     Hybrid Journal   (Followers: 21, SJR: 0.439, h-index: 32)
J. of Molecular Recognition     Hybrid Journal   (Followers: 2, SJR: 0.986, h-index: 56)
J. of Money, Credit and Banking     Hybrid Journal   (Followers: 17, SJR: 2.196, h-index: 55)
J. of Morphology     Hybrid Journal   (Followers: 3, SJR: 0.602, h-index: 44)
J. of Multi-Criteria Decision Analysis     Hybrid Journal   (Followers: 1)
J. of Multicultural Counseling and Development     Hybrid Journal   (Followers: 1, SJR: 0.314, h-index: 23)
J. of Muscle Foods     Hybrid Journal   (Followers: 4)
J. of Neurochemistry     Hybrid Journal   (SJR: 1.754, h-index: 162)
J. of Neuroendocrinology     Hybrid Journal   (Followers: 4, SJR: 1.038, h-index: 75)
J. of Neuroimaging     Hybrid Journal   (Followers: 1, SJR: 0.597, h-index: 39)
J. of Neuroscience Research     Hybrid Journal   (Followers: 8, SJR: 1.218, h-index: 113)
J. of Nursing and Healthcare of Chronic Illne Ss: An Intl. Interdisciplinary J.     Hybrid Journal   (Followers: 2)
J. of Nursing Management     Hybrid Journal   (Followers: 18, SJR: 1.028, h-index: 34)
J. of Nursing Scholarship     Hybrid Journal   (Followers: 3, SJR: 0.903, h-index: 45)
J. of Obstetric, Gynecologic, & Neonatal Nursing     Hybrid Journal   (Followers: 18, SJR: 0.499, h-index: 37)
J. of Obstetrics and Gynaecology Research     Hybrid Journal   (Followers: 13, SJR: 0.371, h-index: 30)
J. of Oral Pathology & Medicine     Hybrid Journal   (Followers: 3, SJR: 0.632, h-index: 51)
J. of Oral Rehabilitation     Hybrid Journal   (Followers: 2, SJR: 0.729, h-index: 51)
J. of Organizational Behavior     Hybrid Journal   (Followers: 21, SJR: 2.541, h-index: 83)
J. of Orthopaedic Research     Hybrid Journal   (Followers: 14, SJR: 1.246, h-index: 96)
J. of Paediatrics and Child Health     Hybrid Journal   (Followers: 14, SJR: 0.439, h-index: 46)
J. of Pathology     Hybrid Journal   (Followers: 8, SJR: 3.025, h-index: 122)
J. of Peptide Science     Hybrid Journal   (Followers: 15, SJR: 0.662, h-index: 42)
J. of Periodontal Research     Hybrid Journal   (SJR: 0.596, h-index: 53)
J. of Personality     Hybrid Journal   (Followers: 11, SJR: 1.803, h-index: 75)
J. of Petroleum Geology     Hybrid Journal   (Followers: 4, SJR: 0.471, h-index: 22)
J. of Pharmaceutical Sciences     Hybrid Journal   (Followers: 221, SJR: 1.206, h-index: 102)
J. of Philosophy of Education     Hybrid Journal   (Followers: 7, SJR: 0.491, h-index: 17)
J. of Phycology     Hybrid Journal   (Followers: 5, SJR: 0.864, h-index: 77)
J. of Physical Organic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.603, h-index: 45)
J. of Phytopathology     Hybrid Journal   (Followers: 2, SJR: 0.513, h-index: 33)
J. of Pineal Research     Hybrid Journal   (SJR: 1.435, h-index: 73)
J. of Plant Nutrition and Soil Science     Hybrid Journal   (Followers: 3, SJR: 0.732, h-index: 44)
J. of Policy Analysis and Management     Hybrid Journal   (Followers: 14, SJR: 1.297, h-index: 43)
J. of Policy and Practice In Intellectual Disabilities     Hybrid Journal   (Followers: 5, SJR: 0.684, h-index: 8)
J. of Political Philosophy     Hybrid Journal   (Followers: 29, SJR: 1.774, h-index: 26)
J. of Polymer Science Part A: Polymer Chemistry     Hybrid Journal   (Followers: 171, SJR: 1.281, h-index: 98)
J. of Polymer Science Part B: Polymer Physics     Hybrid Journal   (Followers: 22, SJR: 0.932, h-index: 87)
J. of Polymer Science Part C : Polymer Letters     Hybrid Journal   (Followers: 5)
J. of Popular Music Studies     Hybrid Journal   (Followers: 8, SJR: 0.142, h-index: 2)
J. of Product Innovation Management     Hybrid Journal   (Followers: 13, SJR: 2.157, h-index: 72)
J. of Prosthodontics     Hybrid Journal   (SJR: 0.358, h-index: 28)
J. of Psychiatric and Mental Health Nursing     Hybrid Journal   (Followers: 40, SJR: 0.473, h-index: 35)
J. of Psychological Issues in Organizational Culture     Hybrid Journal   (Followers: 1)
J. of Public Affairs     Hybrid Journal   (Followers: 2, SJR: 0.294, h-index: 5)
J. of Public Economic Theory     Hybrid Journal   (Followers: 4, SJR: 0.628, h-index: 8)
J. of Public Health Dentistry     Hybrid Journal   (Followers: 1, SJR: 0.546, h-index: 38)
J. of Quaternary Science     Hybrid Journal   (Followers: 23, SJR: 1.543, h-index: 59)
J. of Raman Spectroscopy     Hybrid Journal   (Followers: 10, SJR: 1.138, h-index: 62)
J. of Rapid Methods and Automation In Microbiology     Hybrid Journal   (Followers: 2)
J. of Regional Science     Hybrid Journal   (Followers: 6, SJR: 1.961, h-index: 36)
J. of Religious Ethics     Hybrid Journal   (Followers: 5, SJR: 0.189, h-index: 8)
J. of Religious History     Hybrid Journal   (Followers: 17, SJR: 0.133, h-index: 7)
J. of Renal Care     Hybrid Journal   (Followers: 1, SJR: 0.32, h-index: 11)
J. of Research In Reading     Hybrid Journal   (Followers: 10, SJR: 0.81, h-index: 19)
J. of Research in Science Teaching     Hybrid Journal   (Followers: 11, SJR: 2.998, h-index: 62)
J. of Research in Special Educational Needs     Hybrid Journal   (Followers: 3, SJR: 0.349, h-index: 8)
J. of Research on Adolescence     Hybrid Journal   (Followers: 4, SJR: 1.634, h-index: 47)
J. of Risk & Insurance     Hybrid Journal   (Followers: 9, SJR: 1.138, h-index: 32)
J. of School Health     Hybrid Journal   (Followers: 7, SJR: 0.79, h-index: 47)
J. of Sensory Studies     Hybrid Journal   (Followers: 2, SJR: 0.65, h-index: 27)
J. of Separation Science     Hybrid Journal   (Followers: 7, SJR: 1.092, h-index: 55)
J. of Sexual Medicine     Hybrid Journal   (Followers: 6, SJR: 1.006, h-index: 57)
J. of Sleep Research     Hybrid Journal   (Followers: 11, SJR: 1.05, h-index: 67)
J. of Small Animal Practice     Hybrid Journal   (Followers: 8, SJR: 0.737, h-index: 39)
J. of Small Business Management     Hybrid Journal   (Followers: 10, SJR: 0.988, h-index: 42)
J. of Social Issues     Hybrid Journal   (Followers: 16, SJR: 1.532, h-index: 63)
J. of Social Philosophy     Hybrid Journal   (Followers: 16, SJR: 0.118, h-index: 3)
J. of Sociolinguistics     Hybrid Journal   (Followers: 13, SJR: 1.511, h-index: 18)
J. of Software : Evolution and Process     Hybrid Journal   (Followers: 2)
J. of Supreme Court History     Hybrid Journal   (Followers: 7)
J. of Surgical Oncology     Hybrid Journal   (Followers: 1, SJR: 1.024, h-index: 69)
J. of Synthetic Lubrication     Hybrid Journal  
J. of Systematics Evolution     Open Access   (Followers: 4, SJR: 0.933, h-index: 19)
J. of Texture Studies     Hybrid Journal   (Followers: 2, SJR: 0.601, h-index: 29)
J. of the American Association of Nurse Practitioners     Partially Free   (Followers: 3, SJR: 0.36, h-index: 23)
J. of the American Ceramic Society     Hybrid Journal   (Followers: 22, SJR: 1.167, h-index: 119)
J. of the American Geriatrics Society     Hybrid Journal   (Followers: 13, SJR: 1.673, h-index: 138)
J. of the American Society for Information Science and Technology     Hybrid Journal   (Followers: 169, SJR: 1.555, h-index: 74)
J. of the American Water Resources Association     Hybrid Journal   (Followers: 18, SJR: 0.817, h-index: 56)
J. of the Association for Information Science and Technology     Hybrid Journal   (Followers: 4)
J. of the CardioMetabolic Syndrome     Hybrid Journal  
J. of the European Academy of Dermatology and Venereology     Hybrid Journal   (Followers: 9, SJR: 1.211, h-index: 51)
J. of the Experimental Analysis of Behavior     Hybrid Journal   (Followers: 2, SJR: 0.535, h-index: 35)
J. of the History of the Behavioral Sciences     Hybrid Journal   (Followers: 1, SJR: 0.46, h-index: 13)
J. of the Institute of Brewing     Free   (SJR: 0.528, h-index: 25)
J. of the Peripheral Nervous System     Hybrid Journal   (Followers: 2, SJR: 0.935, h-index: 40)
J. of the Royal Anthropological Institute     Hybrid Journal   (Followers: 29, SJR: 1.128, h-index: 25)
J. of the Royal Statistical Society Series A (Statistics in Society)     Hybrid Journal   (Followers: 9, SJR: 1.258, h-index: 44)
J. of the Royal Statistical Society Series B (Statistical Methodology)     Hybrid Journal   (Followers: 20, SJR: 5.518, h-index: 75)
J. of the Royal Statistical Society Series C (Applied Statistics)     Hybrid Journal   (Followers: 13, SJR: 0.877, h-index: 47)
J. of the Science of Food and Agriculture     Hybrid Journal   (Followers: 21, SJR: 0.781, h-index: 80)
J. of the Society for Information Display     Hybrid Journal   (Followers: 1, SJR: 0.521, h-index: 30)
J. of the Society for the Anthropology of Europe     Hybrid Journal   (Followers: 8)

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Journal Cover BJU International
   Journal TOC RSS feeds Export to Zotero [208 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  [1604 journals]   [SJR: 1.381]   [H-I: 96]
  • Sunitinib‐induced hypertension, neutropenia and thrombocytopenia as
           predictors of good prognosis in metastatic renal cell carcinoma patients
    • Authors: Juhana Rautiola; Frede Donskov, Katriina Peltola, Heikki Joensuu, Petri Bono
      Pages: n/a - n/a
      Abstract: Objectives To evaluate the clinical significance of hypertension, neutropenia and thrombocytopenia as possible new biomarkers of sunitinib efficacy in non‐trial metastatic renal cell carcinoma (mRCC) patients. Materials and methods 181 consecutive mRCC patients were treated with sunitinib. Thirty‐nine (22%) patients received sunitinib 50 mg/day 4 weeks on/ 2 weeks off, 80 patients (44%) 37.5 mg/day continuously and 62 (34%) 25 mg/day continuously as their starting dose. Treatment‐induced adverse events (AE) and their impact on outcome were analysed on multiple sunitinib doses. Results During sunitinib treatment 60 patients (33%) developed ≥grade 2 hypertension, 88 (49%) ≥grade 2 neutropenia and 135 (75%) ≥grade 1 thrombocytopenia. These AEs were associated significantly with longer progression‐free survival (PFS; 15.7 vs. 6.7; 14.6 vs. 6.9; 10.4 vs. 4.2 months, respectively; P
      PubDate: 2014-09-23T06:54:36.400177-05:
      DOI: 10.1111/bju.12940
  • In patients with a previous negative prostate biopsy and a suspicious
           lesion on MRI, 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: n/a - n/a
      Abstract: Objectives To evaluate the performance of multiparametric MRI (MP‐MRI) in predicting CaP on repeat biopsy; and to compare the cancer detection rates (CDR) of MRI/TRUS fusion‐guided biopsy with standard 12‐core biopsy in men with at least one previous negative biopsy. Materials and Methods We prospectively enrolled men with elevated or rising PSA and/or abnormal DRE into our MRI/TRUS fusion‐guided prostate biopsy trial. Participants underwent a 3T MP‐MRI 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 CDR and estimated area under curves (AUCs) of MP‐MRI in predicting any and clinically significant CaP. Results The overall CDR was 65.0% (91/140). Higher level of suspicion on MP‐MRI 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 and PSA density respectively. The CDRs of MRI/TRUS fusion‐guided and standard 12‐core biopsy modalities were 52.1% (73/140) and 48.6% (68/140) respectively (p = 0.435). However, fusion biopsy was more likely to detect clinically significant CaP when compared with the 12‐core modality (47.9% vs. 30.7%; p < 0.001). Of the cancers missed by 12‐core, 20.9% (19/91) were clinically significant. Most cancers missed by 12‐core (69.6%) were located in the anterior fibromuscular stroma and central gland. Using a Fusion biopsy only approach in men with an MRI suspicion score of ≥ 4 would have missed only 3.5% of clinically significant CaP. Conclusions MP‐MRI and subsequent MRI/TRUS fusion‐guided biopsy platform may improve detection of clinically significant CaP in men with previous negative biopsies. Addition of a 12‐core biopsy may be needed to avoid missing some clinically significant CaP.
      PubDate: 2014-09-23T06:54:29.313112-05:
      DOI: 10.1111/bju.12938
  • Trans‐Pacific Variation in Outcomes for Men Treated With Primary
           Androgen Deprivation Therapy for Prostate Cancer
    • Authors: Matthew R. Cooperberg; Shiro Hinotsu, Mikio Namiki, Peter R. Carroll, Hideyuki Akaza
      Abstract: Objectives To compare directly survival outcomes of primary androgen deprivation therapy (PADT) in Japan, where this treatment is endorsed by guidelines, with outcomes in the U.S., where it is not. Patients and Methods Data were compared between men receiving PADT in the US CaPSURE registry and the Japanese J‐CaP database. Competing risks regression was used to assess prostate cancer‐specific mortality (CSM), adjusting for age, Japan Cancer of the Prostate Risk Assessment (J‐CAPRA) score, diagnosis year, and treatment type (combined androgen blockade [CAB] vs. castration monotherapy), comorbidity, and practice type. Results Men on PADT in J‐CaP (N=13,880) were older than those in CaPSURE (N=1633), and had higher‐risk disease (mean J‐CAPRA score 3.8 vs. 2.1, p
      PubDate: 2014-09-19T06:04:50.871524-05:
      DOI: 10.1111/bju.12937
  • Association between metabolic syndrome and severity of lower urinary tract
           symptoms: observational study in a 4,666 European men cohort
    • Authors: Pourya Pashootan; Guillaume Ploussard, Arnaud Cocaul, Armaury De Gouvello, François Desgrandchamps
      Pages: n/a - n/a
      Abstract: Objectives To evaluate the relationship between metabolic syndrome (MS) and the frequency and severity of lower urinary tract symptoms (LUTS) Patients and Methods 4,666 male patients from 55 to 100 years old consulting a general practitioner (GP) on a 12‐days period in December 2009 have been included into an observational study. LUTS were defined according to the I‐PSS score and metabolic syndrome with the NECP/ATP III definition. We studied the correlation between MS and its individual component, and the severity of LUTS (I‐PSS and treatment for LUTS). Analyses were adjusted on BMI, age, and PSA level. Results MS was reported in 51.5 % of the patients and 47% were treated for LUTS. There was a significant link between MS and treated LUTS (p
      PubDate: 2014-09-17T04:13:12.936292-05:
      DOI: 10.1111/bju.12931
  • An investigation into the relationship between Statins and Cancer using
           population‐based data
    • Authors: Jennifer C Melvin; Hans Garmo, Rhian Daniel, Thurkaa Shanmugalingam, Pär Stattin, Christel Häggström, Sarah Rudman, Lars Holmberg, Mieke Van Hemelrijck
      Pages: n/a - n/a
      Abstract: Background Results to date for the association between use of statins and prostate cancer (PCa) death in observational studies are inconsistent. We investigated the application of causal inference methods, which aim to address observational data as if they were from a randomised clinical trial (RCT). Material and Methods We examined the association between statins and PCa‐death in 14,926 men in PCBaSe Sweden. We used inverse probability weighted (IPW) estimation of marginal structural models (MSM), as well incorporating truncated IPW in the presence of time‐dependent confounders (TDC) (e.g., disease severity), affected by the exposure. Results The baseline adjusted odds ratio (OR) was 0.62 (95%CI: 0.51‐0.75), which compared risk of PCa‐death between men on statins and men not on statins. The calculated IPW for the MSM were highly variable, with the smallest weight at 0.0019 and the largest at 13,574, resulting in an OR of 0.89 (95%CI: 0.69‐1.14). Truncating the weights improved variability, reducing the largest weight to 13.16. The truncated MSM OR was 0.86 (95%CI: 0.81‐0.91). Conclusion An association of statins and risk of PCa‐death could not be reliably discerned, due to lack of data on essential confounders, namely serum cholesterol levels and disease severity. No observational studies on statin‐use to date present information on serum cholesterol levels and disease severity in one setting, highlighting the need for careful interpretation of investigations into drugs in relation to diseases other than their intended purpose in observational settings.
      PubDate: 2014-09-16T04:27:00.887158-05:
      DOI: 10.1111/bju.12935
  • Diagnostic value of biparametric magnetic resonance imaging (MRI) as an
           adjunct to prostate‐specific antigen (PSA)‐based detection of
           prostate cancer in men without prior biopsies
    • Authors: Soroush Rais‐Bahrami; M. Minhaj Siddiqui, Srinivas Vourganti, Baris Turkbey, Ardeshir R. Rastinehad, Lambros Stamatakis, Hong Truong, Annerleim Walton‐Diaz, Anthony N. Hoang, Jeffrey W. Nix, Maria J. Merino, Bradford J. Wood, Richard M. Simon, Peter L. Choyke, Peter A. Pinto
      Pages: n/a - n/a
      Abstract: Objectives To determine the diagnostic yield of analysing biparametric (T2‐ and diffusion‐weighted) magnetic resonance imaging (B‐MRI) for prostate cancer detection compared with standard digital rectal examination (DRE) and prostate‐specific antigen (PSA)‐based screening. Patients and Methods Review of patients who were enrolled in a trial to undergo multiparametric‐prostate (MP)‐MRI and MR/ultrasound fusion‐guided prostate biopsy at our institution identified 143 men who underwent MP‐MRI in addition to standard DRE and PSA‐based prostate cancer screening before any prostate biopsy. Patient demographics, DRE staging, PSA level, PSA density (PSAD), and B‐MRI findings were assessed for association with prostate cancer detection on biopsy. Results Men with detected prostate cancer tended to be older, with a higher PSA level, higher PSAD, and more screen‐positive lesions (SPL) on B‐MRI. B‐MRI performed well for the detection of prostate cancer with an area under the curve (AUC) of 0.80 (compared with 0.66 and 0.74 for PSA level and PSAD, respectively). We derived combined PSA and MRI‐based formulas for detection of prostate cancer with optimised thresholds. (i) for PSA and B‐MRI: PSA level + 6 x (the number of SPL) > 14 and (ii) for PSAD and B‐MRI: 14 × (PSAD) + (the number of SPL) >4.25. AUC for equations 1 and 2 were 0.83 and 0.87 and overall accuracy of prostate cancer detection was 79% in both models. Conclusions The number of lesions positive on B‐MRI outperforms PSA alone in detection of prostate cancer. Furthermore, this imaging criteria coupled as an adjunct with PSA level and PSAD, provides even more accuracy in detecting clinically significant prostate cancer.
      PubDate: 2014-09-15T04:54:55.847952-05:
      DOI: 10.1111/bju.12639
  • Effective Non‐Technical Skills are Imperative to Robot Assisted
    • Authors: Oliver Brunckhorst; Muhammad Shamim Khan, Prokar Dasgupta, Kamran Ahmed
      Pages: n/a - n/a
      PubDate: 2014-09-15T02:26:11.067214-05:
      DOI: 10.1111/bju.12934
  • Trifecta and Optimal Peri‐operative outcomes of Robotic and
           Laparoscopic Partial Nephrectomy In Surgical Treatment Of Small Renal
           Masses: A Multi‐Institutional Study
    • Authors: Homayoun Zargar; M. Allaf, Sam Bhayani, Michael Stifelman, Craig Rogers, Mark Ball, Jeffrey Larson, Susan Marshall, Ramesh Kumar, Jihad Kaouk
      Pages: n/a - n/a
      Abstract: Objective To compare the perioperative outcomes of RPN with LPN performed for SRMs, in a large multi‐institutional series. To define a new composite outcome measure, termed “ optimal outcome” for the RPN group. Patients and Methods Retrospective review of 2392 consecutive cases of RPN and LPN performed in 5 high volume centres from 2004 to mid 2013. We limited our study to SRMs and cases performed by surgeons with significant expertise with the technique. The Trifecta was defined as negative surgical margin, zero perioperative complications and warm ischemia ≤ 25. The “optimal outcome” was defined as achievement of Trifecta with addition of 90% eGFR preservation and no CKD stage upgrading. Univariable and multivariable analysis were performed to identify factors predicting Trifecta and “optimal outcome” achievement. Results Total of 1185 RPN and 646 LPN met our inclusion criteria. Patients in the RPN group were older and had higher median CCI and higher RENAL scores. The RPN group had lower warm ischemia time (18 vs. 26), overall complication rate (16.2 vs. 25.9%), and PSM (3.2% vs. 9.7%). A significantly higher Trifecta rate was observed for RPN (70% vs. 33%). The rate of achievement of “optimal outcome” for RPN group was 38.5%. Conclusions In this large multi‐institutional series RPN was superior to LPN in terms of peri‐operative surgical outcomes measured by Trifecta. Patients in the RPN group had better outcomes for all three components of Trifecta compared to their LPN counterparts. Our more strict definition for “optimal outcome” might be a better tool for assessing peri‐operative and functional outcomes after minimally invasive partial nephrectomy. This tool needs to be externally validated.
      PubDate: 2014-09-15T02:25:58.183976-05:
      DOI: 10.1111/bju.12933
  • Salvage micro‐dissection testicular sperm extraction; Outcome in men
           with Non obstructive azoospermia with previous failed sperm retrievals
    • Authors: J. S. Kalsi; P. Shah, Y. Thum, A. Muneer, D. J. Ralph, S. Minhas
      Pages: n/a - n/a
      Abstract: Objective To assess the outcome of m‐TESEas a salvage treatment in men withnon‐obstructive azoospermia (NOA) in whom no sperm was previously found on single/multiple TESE or TESA. Materials and Methods A total of 58 men with NOA underwent micro‐dissection testicular sperm extraction. All patients had previously undergone either single/multiple TESE or TESA with no sperm found. All patients underwent an m‐TESE using a standard technique. Serum follicle‐stimulating hormone, Testosterone and histopathological diagnosis were examined as predictive factors for sperm recovery. All patients underwent pre‐operative genetic screening.One patient was found to havean AZFc micro‐deletion and 5 werediagnosed with Kleinfelter's syndrome. Results The mean age of patients was39.0 years (range 26‐57).Spermatozoa were successfully retrieved in 27men by m‐TESE (46.5%).The mean FSH level was 19.4 (range 1.6‐ 58.5). There was no correlation in age (retrieved 38.1, not retrieved 39.7 p=0.38) FSH levels (Mean FSH retrieved 21.4, not retrieved 17.7p=0.3) and the ability to find sperm by m‐TESE. However, there was a significant difference with respect to testosterone and sperm retrieval (Mean testosterone retrieved 14.99, not retrieved 11.39 p
      PubDate: 2014-09-15T02:25:49.619319-05:
      DOI: 10.1111/bju.12932
  • Ureteroscopy for stone disease in the paediatric population – A
           systematic review
    • Authors: Ishii H; Griffin S, Somani BK
      Abstract: Objectives To look at the role of ureteroscopy for treatment of paediatric stone disease. Materials and Methods We conducted a systematic review using studies identified by a literature search between January 1990 and May 2013. All English language articles reporting on a minimum of 50 patients ≤18 years treated with ureteroscopy for stone disease were included. Two reviewers independently extracted the data from each study. Results A total of 14 studies (1718 procedures) were reported with a mean age of 7.8 years (0.25‐18 years). The mean stone burden was 9.8mm (1‐30mm) with a stone free rate (SFR) of 87.5% (58‐100%) with initial therapeutic ureteroscopy. Majority of these stones were in the ureter (n=1427, 83.4%). There were 180 (10.5%) clavien I‐III complications and 38 cases (2.2%) where there was a failure to complete the initial ureteroscopic procedure and an alternative procedure was performed. To assess the impact of age on failure rate and complications, studies were subcategorised into children below and above a mean age of 6 years. Four studies (341 procedures) and 10 studies (1377 procedures) respectively were reported in studies with children below and above mean age of 6 years. A higher failure rate (4.4% versus1.7%) and a higher complication rate (24% versus 7.1%) were observed in children with a mean age under the age of 6 years. Conclusion Ureteroscopy for paediatric stone disease is a relatively safe procedure with a reasonably good stone free rate, however there seems to be a higher failure rate and complication in children less than 6 years of age.
      PubDate: 2014-09-09T06:56:26.67629-05:0
      DOI: 10.1111/bju.12927
  • Proportion of tadalafil‐treated patients with clinically meaningful
           improvement in lower urinary tract symptoms associated with benign
           prostatic hyperplasia – integrated data from 1499 study participants
    • Authors: J. Curtis Nickel; Gerald B. Brock, Sender Herschorn, Ruth Dickson, Carsten Henneges, Lars Viktrup
      Abstract: Objectives •  To evaluate the proportion of patients achieving clinically meaningful improvement of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH‐LUTS) with tadalafil using two definitions of response. Patients and Methods •  Post‐hoc integrated analysis of four placebo‐controlled studies in men (≥45 years old; International Prostate Symptom Score [IPSS] ≥13; Qmax ≥4 to ≤15 mL/sec) with BPH‐LUTS randomized to tadalafil 5mg (N=752) or placebo (N=747) for 12 weeks following a 4‐week placebo run‐in. •  Responders were defined as having a total IPSS improvement of ≥3 points or ≥25% from randomization to endpoint (Week 12). •  Response status was calculated per patient, and relative benefit and odds ratios (95% CI) of tadalafil versus placebo was calculated using a logistic Generalized Mixed Model for Repeated Measures. Results •  Tadalafil 5mg once daily resulted in a significantly greater proportion of: 1. Patients achieving ≥3‐point IPSS improvement: 71.1% and 56.0% for tadalafil and placebo patients, respectively (odds ratio [95% CI]: 1.9 (1.5, 2.4); p
      PubDate: 2014-09-05T03:41:04.511326-05:
      DOI: 10.1111/bju.12926
  • ANZUP – a new co‐operative cancer trials group in
           genito‐urinary oncology
    • Authors: Shomik Sengupta; Peter Grimison, Dickon Hayne, Scott Williams, Suzanne Chambers, Paul Souza, Martin Stockler, Margaret McJannett, Guy Toner, Ian D. Davis
      Abstract: Shomik Sengupta reports grants from Cancer Australia, during the conduct of the study; and is unremunerated deputy‐chair of the bladder cancer subcommittee of the ANZUP Cancer Trials Group Ltd. Peter Grimison reports grants from Cancer Australia, during the conduct of the study; and is unremunerated Chair of the Germ Cell Subcommittee of the ANZUP Cancer Trials Group Ltd. Dickon Hayne reports grants from Cancer Australia, during the conduct of the study; and is unremunerated chair of the bladder cancer subcommittee of the ANZUP Cancer Trials Group Ltd. Scott Williams is unremunerated chair of the prostate cancer subcommittee the ANZUP Cancer Trials Group Ltd. Suzanne Chambers is unremunerated chair of the Quality of Life and Supportive Care Subcommittee of the ANZUP Cancer Trials Group Ltd. Paul DeSouza is unremunerated Chair of the Translational and Correlative Research Subcommittee of the ANZUP Cancer Trials Group Ltd. Martin Stockler reports reports grants from Cancer Australia, during the conduct of the study; Margaret McJannett is an employee of the ANZUP Cancer Trials Group Ltd. Guy Toner reports grants from Cancer Australia, during the conduct of the study; and is unremunerated Deputy‐Chair of the Board of ANZUP Cancer Trials Group Ltd Ian Davis reports grants from Cancer Australia, during the conduct of the study; and is unremunerated Chair of the Board of ANZUP Cancer Trials Group Ltd
      PubDate: 2014-09-05T03:40:53.932513-05:
      DOI: 10.1111/bju.12925
  • Radiation exposure to a pregnant urological surgeon – what is
    • Authors: AM Birnie; SR Keoghane
      PubDate: 2014-09-05T03:40:44.726156-05:
      DOI: 10.1111/bju.12923
  • Nomogram to predict the benefit from salvage systemic therapy for advanced
           urothelial carcinoma
    • Authors: Guru Sonpavde; Gregory R. Pond, Ronan Fougeray, Joaquim Bellmunt
      PubDate: 2014-09-05T03:40:35.972012-05:
      DOI: 10.1111/bju.12922
  • Retrograde ureteric stent insertion in the management of infected
           obstructed kidneys
    • Authors: Stephanie Flukes; Dickon Hayne, Melvyn Kuan, Michael Wallace, Kevin McMillan, Nicholas John Rukin
      Pages: n/a - n/a
      Abstract: Objectives To quantify the outcomes of retrograde ureteric stenting in the setting of infected hydronephrosis secondary to ureteric calculi. Patients and methods Prospective analysis of all patients over 15 month period admitted with an infected obstructed kidneys secondary to ureteric calculi. Inclusion criteria were based on clinical evidence of systemic inflammatory response syndrome (SIRS) and radiological evidence of obstructing ureteric calculi. Outcome measures included success of procedure, admission to intensive care unit (ICU), length of hospital stay, morbidity, and all‐cause mortality during hospital admission. Results 52 patients included. Success of retrograde ureteric stenting was 98%. Seventeen per cent of patients required an ICU admission, with a post ureteric instrumentation ICU admissions rate of 6%. Mean white cell count and serum creatinine improved significantly post‐procedure. Major complication rate included septic shock 6%, but there were no episodes of major haemorrhage and no deaths. Conclusion Retrograde ureteric stenting is safe and effective in infected obstructed kidneys. Results are comparable to percutaneous nephrostomy tube insertion. Post instrumentation ICU admissions occur in 6% of retrograde stentings.
      PubDate: 2014-09-01T02:36:22.216154-05:
      DOI: 10.1111/bju.12918
  • Is it Safe to Insert a Testicular Prosthesis at the Time of Radical
           Orchidectomy for Testis Cancer – an Audit of 904 Men Undergoing
           Radical Orchidectomy
    • Authors: R Robinson; CD Tait, NW Clarke, VAC Ramani
      Pages: n/a - n/a
      Abstract: Objective To compare the complication rate associated with synchronous prosthesis insertion at the time of radical orchidectomy with orchidectomy alone. Patient and Methods All men undergoing radical orchidectomy for testis cancer in the North West Region of England between April 1999 – July 2005 and November 2007 – November 2009 were included. Data on post‐operative complications, length of stay (LOS), re‐admission rate and return to theatre rate was collected. Results 904 men (median age of 35 years, range 14 ‐ 88), underwent a radical orchidectomy during the study period. 413 (46.7%) were offered a prosthesis, of whom 55.2% chose to receive one. Those offered a prosthesis were significantly younger (p=0.0003), median age of 33 vs 37 years respectively. There was no significant difference between the 2 groups in LOS (p=0.387), hospital re‐admission rates (p=0.539) or return to theatre rate (p=>0.999). 33/885 patients were readmitted within 30 days of orchidectomy, with 1/236 prosthesis patients requiring prosthesis removal (0.4%). Older age at orchidectomy was associated with an increased risk of 30‐day hospital re‐admission (OR 1.032, p=0.016). Conclusions Concurrent insertion of a testicular prosthesis does not increase the complication rate of radical orchidectomy as determined by LOS, re‐admission or the need for further surgery. Prosthesis insertion at the time of orchidectomy for testis cancer is a safe and concerns about increased complications should not constrain the offer of testicular prosthesis insertion concurrently with primary surgery.
      PubDate: 2014-08-28T06:28:15.212835-05:
      DOI: 10.1111/bju.12920
  • Is continent cutaneous urinary diversion a suitable alternative to
           orthotopic bladder substitute and ileal conduit after cystectomy?
    • Authors: Bashir Al Hussein Al Awamlh; Lily C. Wang, Daniel P. Nguyen, Malte Rieken, Richard K. Lee, Daniel J. Lee, Thomas Flynn, James Chrystal, Shahrokh F. Shariat, Douglas S. Scherr
      Pages: n/a - n/a
      Abstract: Objective ● To evaluate functional outcomes of continent cutaneous urinary diversion (CCUD) after cystectomy. ● To compare diversion‐related complications and long‐term renal function in a contemporary cohort of patients undergoing urinary diversion with CCUD, orthotopic bladder substitute (OBS) and ileal conduit (IC). Patients and Methods ● 322 patients underwent cystectomy and CCUD, OBS or IC from January 2002 to June 2013. CCUD was performed using either a modified Indiana pouch or an appendiceal stoma. ● For patients with CCUD, continence status and time intervals between clean intermittent catheterisations at last follow‐up were recorded. ● For all three diversion types, diversion‐related complications and renal function outcome as determined by the estimated glomerular filtration rate (eGFR) at baseline and at different time intervals after surgery were evaluated. ● Multivariate regression analysis was used to evaluate the association of diversion type, baseline variables and diversion‐related complications with renal function over time. Results ● Of all 322 patients, 73 (23%) received CCUD, 79 (25%) received OBS, and 170 (53%) received IC. ● After a median follow‐up of 36 months, the continence rate for patients with CCUD was 89%. Sixty‐four (88%) patients with CCUD were able to catheterise every 4‐8 hours and 5 (7%) were able to catheterise every 8‐10 hours. ● After a median follow‐up of 35 months, rates of diversion‐related complications were similar among patients who underwent CCUD, OBS or IC. ● Patients who received IC had poorer renal function preoperatively than those who received CCUD or OBS. However, at one year after surgery and thereafter, the three groups had comparable renal function. ● On multivariate analysis, the type of urinary diversion was not associated with decline in renal function. However, patient age at surgery, diabetes mellitus, baseline eGFR, postoperative non obstructive hydronephrosis and uretero‐enteric stricture were associated with decline in renal function. Conclusions ● CCUD is associated with excellent functional outcomes. ● Rates of diversion‐related complications and renal function outcomes are comparable with those from OBS and IC. ● CCUD should be considered a valid alternative for patients who undergo cystectomy and require urinary diversion.
      PubDate: 2014-08-28T06:28:07.711336-05:
      DOI: 10.1111/bju.12919
  • Oncologic Outcomes of Cryosurgery as Primary Treatment in T3 Prostate
           Cancer: Experience of a Single Center
    • Authors: Zhi Guo; Tongguo Si, Xueling Yang, Yan Xu
      Pages: n/a - n/a
      Abstract: Objective To access the oncologic outcomes and to determine prognostic factors for overall survival (OS), cancer‐specific survival (CSS), and biochemical progression‐free survival (BPFS) after cryosurgery for clinical stage T3 prostate cancer (PCa). Methods Between 2002 and 2007, 75 patients with clinical stage T3 prostate cancer received cryosurgery as primary treatment in our institution. No adjuvant treatment was provided until biochemical failure. After biochemical failure, hormone therapy was administered. Kaplan‐Meier analysis was used to calculate the OS, CSS, and BPFS. Cox regression was used to identify factors predictive of survival. Results cT3a was detected in 60% (45/75) of patients, and cT3b was detected in 40% (30/75) of cases. The five‐year OS, CSS, and BPFS rates were 85.3, 92.0, and 48%, respectively. There was a significant difference when comparing the pT3a to pT3b groups for 5‐year OS (88.9 vs. 80%, P=0.02) and BPFS (55.6 vs. 36.7%, P=0.01), but there was no difference in CSS (93.3 vs. 90%, P=0.63). Stage, Gleason score, and nadir PSA were associated with BPFS, while Gleason score and nadir PSA were the most significant predictors for CSS. Conclusions Cryosurgery could offer good 5‐year OS, CSS, and BPFS rates for cT3 PCa, and there was no difference between T3a and T3b for CSS. Gleason score and nadir PSA were the most significant predictors of survival. Further clinical trials are warranted for evaluating the role of cryosurgery for cT3 prostate cancer.
      PubDate: 2014-08-28T06:27:27.692528-05:
      DOI: 10.1111/bju.12914
  • Pathologic Factors Associated with Survival Benefit From Adjuvant
           Chemotherapy: A Population‐Based Study of Bladder Cancer
    • Authors: Christopher M. Booth; D. Robert Siemens, Xuejiao Wei, Yingwei Peng, David M. Berman, William J. Mackillop
      Pages: n/a - n/a
      Abstract: Objective To evaluate whether pathologic factors are associated with differential effect of ACT. Patients and Methods In this population‐based retrospective cohort study we linked electronic records of treatment and surgical pathology to the Ontario Cancer Registry. The study population included all patients with MIBC undergoing cystectomy in Ontario 1994‐2008. Factors associated with overall (OS) and cancer‐specific survival (CSS) were evaluated using Cox proportional hazards. We tested for interaction between the following variables and ACT effect‐size: N stage, margin status, T stage, and lymphovascular invasion (LVI). Results The study population included 2802 patients; 19% were treated with ACT. Interaction terms with ACT for OS/CSS are: N stage (p
      PubDate: 2014-08-28T06:27:18.862634-05:
      DOI: 10.1111/bju.12913
  • Extended Pelvic Lymph Node Dissection in Prostate Cancer Patients
           Previously Treated With Surgery for Lower Urinary Tract Symptoms
    • Authors: Nicola Fossati; Daniel D Sjoberg, Umberto Capitanio, Giorgio Gandaglia, Alessandro Larcher, Alessandro Nini, Vincenzo Mirone, Andrew J Vickers, Francesco Montorsi, Alberto Briganti
      Pages: n/a - n/a
      Abstract: Objectives To evaluate the effect of previous prostate surgery performed for lower urinary tract symptoms (LUTS) on the ability to predict lymph node invasion (LNI) in patients subsequently diagnosed with prostate cancer, testing two widely used LNI predictive models. Subject / Patients and Methods From 1990 to 2012, we collected data on 4734 prostate cancer patients treated with radical prostatectomy and extended pelvic lymph node dissection. Of these, 4453 (94%) had no prior prostate surgery (“naïve patients”), while 286 (6%) had previously undergone surgery for LUTS. Two LNI prediction models based on patients treated with extended pelvic lymph node dissection were evaluated using the area under the receiver operating characteristics (ROC) curve, the calibration plot method, and decision curve analyses. Results The rate of LNI was 12%, while the median number of lymph nodes removed was 15 in both groups (p=0.9). The two tested nomograms provided more accurate prediction in naïve patients relative to patients previously treated with prostate surgery for LUTS (AUC: 82% and 81% vs. 68% and 71%, p=0.01 and p=0.04 respectively). In naïve patients the surgeon would have missed one LNI for every 53 and 34 avoided ePLND using the Briganti and Godoy nomograms, respectively; in patients previously treated with surgery for LUTS, a LNI would have been missed in 13 and 21 patients not undergoing ePLND. Conclusion The accuracy and the clinical net‐benefit of LNI prediction tools decrease importantly in patients with prior prostate surgery for LUTS. These models should be avoided in such patients, who should instead be subject to routine pelvic lymph node dissection.
      PubDate: 2014-08-28T06:27:09.595269-05:
      DOI: 10.1111/bju.12912
  • The impact of robotic surgery on the surgical management of prostate
           cancer in the USA
    • Authors: Steven L. Chang; Adam S. Kibel, James D. Brooks, Benjamin I. Chung
      Pages: n/a - n/a
      Abstract: Objective To describe the surgeon characteristics associated with robot‐assisted radical prostatectomy (RARP) adoption and determine the possible impact of this adoption on practice patterns and cost. Patients and Methods A retrospective cohort study with a weighted sample size of 489 369 men who underwent non‐RARP (i.e., open or laparoscopic RP) or RARP in the USA from 2003 to 2010 was performed. We evaluated predictors for RARP adoption, defined as performing >50% of annual RP using the robotic approach. Additionally, we identified the resulting changes in prostate cancer surgery practice patterns and expenditures. Results From 2003 to 2010, RARP adoption increased from 0.7% to 42% of surgeons performing RP. High‐volume surgeons, defined as performing >24 RPs annually, had statically significantly higher odds of adopting RARP throughout the study period. From 2005 to 2007, adoption was more common among surgeons at teaching (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.7–3.4), intermediate‐ (200–399 beds; OR 5.96, 95% CI 1.3–26.5) and large‐sized hospitals (≥400 beds; OR 6.1, 95% CI 1.4–25.8); after 2007, adoption was more common among surgeons at urban hospitals (OR 3.3, 95% CI 1.7–6.4). RARP adoption was generally associated with increased RP volume, greatest for high‐volume surgeons and least for low‐volume surgeons (
      PubDate: 2014-08-26T00:52:13.437319-05:
      DOI: 10.1111/bju.12850
  • Evidence of increased centrally enhanced bladder compliance with ageing in
           a mouse model
    • Authors: Phillip P. Smith; Anthony DeAngelis, Richard Simon
      Pages: n/a - n/a
      Abstract: Objective To test the hypothesis that ageing is associated with increasing neurogenic enhancement of bladder filling compliance. Materials and Methods Female B6 mice (aged 2, 12, 22 and 26 months) underwent cystometry while alive and immediately after death. Bladder compliance was calculated from pressure‐time data. Pressure data were transformed using Fast Fourier Transform to obtain power spectra of bladder pressure variations attributable to contractile activity during filling in both alive and dead mice. A cut‐off frequency (CF) was determined for each mouse, above which any power content would be primarily neurogenic. Compliance and power spectra results were compared among age groups, and correlations sought. Results A reversible loss of bladder compliance and non‐voiding contractile (NVC) activity followed abolition of voiding reflexes in female colony mice in all age groups. Bladder filling compliance increased with age in urethane‐anaesthetised and post‐mortem conditions, and more so in the former. Power below the CF did not significantly vary with age. Neurogenic power increased with age, and significantly correlated with compliance. Conclusions An increase in neurogenic power during filling accompanies increased centrally mediated compliance enhancement with age. A bladder control model in which brain processes related to micturition may compensate for age‐associated changes; thereby preserving voiding function is suggested. Urinary dysfunction could be viewed as the result of homeostatic failure rather than strictly end‐organ pathology.
      PubDate: 2014-08-19T21:12:31.675268-05:
      DOI: 10.1111/bju.12669
  • Extraprostatic Extension of Prostatic Carcinoma: Is its Proximity to
           Surgical margin or Gleason Score Important?
    • Authors: Ruta Gupta; Rachel O'Connell, Anne‐Maree Haynes, Phillip D Stricker, Wade Barrett, Jennifer J Turner, Warick Delprado, Lisa G Horvath, James G Kench
      Pages: n/a - n/a
      Abstract: Objective To examine the association between histopathological factors of extraprostatic cancer and outcome. Materials and methods Patients with EPE without positive margins, seminal vesicle or lymph node involvement were analyzed from a consecutive radical prostatectomy cohort of 1136 (2002‐2006) for: 1) measurement of distance of EPE from the margin; 2) Gleason score of the EPE; 3) extent of EPE. Log‐rank, Kaplan‐Meier, Cox regression analyses were performed. Results This study includes 194 pT3a, pN0, R0 cases with a median follow up of 5.4 years with 37 (19%) patients experiencing biochemical relapse (BCR). On univariable analysis, patients with Gleason score >8 in the extraprostatic portion showed increased incidence of BCR compared to those with Gleason scores of 8 within EPE is associated with an increased BCR risk on univariable analysis, but larger studies are required to confirm whether extensive Gleason pattern 4 in an EPE indicates increased risk in an otherwise overall Gleason score 7 cancer.
      PubDate: 2014-08-19T19:45:44.389508-05:
      DOI: 10.1111/bju.12911
  • 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: n/a - n/a
      Abstract: Objective To 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
  • The social media revolution is changing the conference experience:
           analytics and trends from eight international meetings
    • Authors: Sarah E. Wilkinson; Marnique Y. Basto, Greta Perovic, Nathan Lawrentschuk, Declan G. Murphy
      Pages: n/a - n/a
      Abstract: Objective To analyse the use of Twitter at urology conferences to enhance the social media conference experience. Materials and methods We prospectively registered the hashtags of eight international urology conferences taking place in 2013, using the social media metrics website, In addition, we prospectively registered the hashtag for the European Association of Urology Annual Meeting for three consecutive years (2012‐14) to analyse the trend in the use of Twitter at a particular meeting. Metrics including number of tweets, number of participants, tweet traffic per day, and overall digital impressions were captured for five days prior to each conference, the conference itself, and the following two days. We also measured corresponding social media activity at a very large non‐urology meeting (the American Society of Clinical Oncology) for comparative purposes. Results Twitter activity was noted at all eight conferences in 2013. In total, 12,363 tweets were sent generating over 14 million impressions. The number of participants tweeting at each meeting varied from 80 (#SIU2013) to 573 (#AUA13). Overall, the American Urological Association meeting (#AUA13) generated the most Twitter activity with over 8.6 million impressions and a total of 4,663 tweets over the peri‐conference period. It also had the highest number of impressions and tweets per day over this period – 717 thousand and 389 respectively. The EAU Annual Meeting 2013 (#EAU13) generated 1.74 million impressions from a total of 1,762 tweets from 236 participants. Regarding trends in Twitter use, there was a very sharp rise in Twitter activity at the EAU Annual Meeting between 2012‐2014. Over this three‐year period, the number of participants increasing almost ten‐fold, leading to an increase in the number of tweets from 347 to almost 6,000. At #EAU14, digital impressions reached 7.35 million with 5,903 tweets sent by 797 participants. Conclusions Urological conferences, to a varying extent, have adopted social media as a means of amplifying the conference experience to a wider audience, generating international engagement and global reach. Twitter is a very powerful tool that amplifies the content of scientific meetings, and conference organisers should put in place strategies to capitalise on this.
      PubDate: 2014-08-18T01:56:02.342987-05:
      DOI: 10.1111/bju.12910
  • Clinical performance of Prostate Health Index (PHI) for prediction of
           prostate cancer in obese men: data from a multicenter European prospective
           study, PROMEtheuS project
    • 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: n/a - n/a
      Abstract: Objectives To test [‐2]proPSA (p2PSA), p2PSA/fPSA (%p2PSA) and Prostate Health Index (PHI) accuracy in predicting prostate cancer (PCa) in obese men and to test whether PHI is more accurate than PSA in predicting PCa 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 PCa at prostate biopsy in obese men (BMI ≥ 30 kg/m2), compared to tPSA, fPSA and %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 Over 965 subjects, 383 (39.7%) were normal‐weight (BMI < 25 kg/m2), 440 (45.6%) were overweight (BMI 25‐29.9 kg/m2) and 142 (14.7%) were obese (BMI ≥ 30 kg/m2). Among obese patients, PCa was found in 65 subjects (45.8%), with a higher percentage of GS ≥7 diseases (67.7%). PSA, p2PSA, %p2PSA and PHI were significantly higher, and %fPSA significantly lower in patients with PCa (p
      PubDate: 2014-08-18T01:55:54.780163-05:
      DOI: 10.1111/bju.12907
  • Individual Patient Data from Registrational Trials of Silodosin in the
           Treatment of Non‐neurogenic Male Lower Urinary Tract Symptoms
           Associated with Benign Prostatic Enlargement: Subgroup Analyses of
           Efficacy and Safety Data
    • Authors: Giacomo Novara; Christopher R. Chapple, Francesco Montorsi
      Pages: n/a - n/a
      Abstract: Objective To evaluate efficacy and safety of silodosin in a pooled analysis of individual patient data from three registrational RCTs comparing silodosin and placebo in patients with lower urinary tract symptoms (LUTS). Patients and methods A pooled analysis of 1494 patients from three 12‐week, multicentre, double‐blind, placebo‐controlled phase III RCTs was performed. Efficacy and safety data were assessed across patients with different baseline characteristics. Statistical analyses were performed with SAS software v.9.3. Results Silodosin was significantly more effective than placebo in improving all IPSS‐related parameters, and Qmax (p
      PubDate: 2014-08-18T01:55:46.326916-05:
      DOI: 10.1111/bju.12906
  • Augmented‐reality‐based skills training for
           robot‐assisted urethrovesical anastomosis: a
           multi‐institutional randomised controlled trial
    • Authors: Ashirwad Chowriappa; Syed Johar Raza, Anees Fazili, Erinn Field, Chelsea Malito, Dinesh Samarasekera, Yi Shi, Kamran Ahmed, Gregory Wilding, Jihad Kaouk, Daniel D. Eun, Ahmed Ghazi, James O. Peabody, Thenkurussi Kesavadas, James L. Mohler, Khurshid A. Guru
      Pages: n/a - n/a
      Abstract: Objective To validate robot‐assisted surgery skills acquisition using an augmented reality (AR)‐based module for urethrovesical anastomosis (UVA). Methods Participants at three institutions were randomised to a Hands‐on Surgical Training (HoST) technology group or a control group. The HoST group was given procedure‐based training for UVA within the haptic‐enabled AR‐based HoST environment. The control group did not receive any training. After completing the task, the control group was offered to cross over to the HoST group (cross‐over group). A questionnaire administered after HoST determined the feasibility and acceptability of the technology. Performance of UVA using an inanimate model on the daVinci Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) was assessed using a UVA evaluation score and a Global Evaluative Assessment of Robotic Skills (GEARS) score. Participants completed the National Aeronautics and Space Administration Task Load Index (NASA TLX) questionnaire for cognitive assessment, as outcome measures. A Wilcoxon rank‐sum test was used to compare outcomes among the groups (HoST group vs control group and control group vs cross‐over group). Results A total of 52 individuals participated in the study. UVA evaluation scores showed significant differences in needle driving (3.0 vs 2.3; P = 0.042), needle positioning (3.0 vs 2.4; P = 0.033) and suture placement (3.4 vs 2.6; P = 0.014) in the HoST vs the control group. The HoST group obtained significantly higher scores (14.4 vs 11.9; P 0.012) on the GEARS. The NASA TLX indicated lower temporal demand and effort in the HoST group (5.9 vs 9.3; P = 0.001 and 5.8 vs 11.9; P = 0.035, respectively). In all, 70% of participants found that HoST was similar to the real surgical procedure, and 75% believed that HoST could improve confidence for carrying out the real intervention. Conclusion Training in UVA in an AR environment improves technical skill acquisition with minimal cognitive demand.
      PubDate: 2014-08-16T12:49:29.97563-05:0
      DOI: 10.1111/bju.12704
  • Massive renal size is not a contraindication to a laparoscopic approach
           for bilateral native nephrectomies in autosomal dominant polycystic kidney
           disease (ADPKD)
    • Authors: Eric S. Wisenbaugh; Mark D. Tyson, Erik P. Castle, Mitchell R. Humphreys, Paul E. Andrews
      Pages: n/a - n/a
      Abstract: Objective To determine if massive renal size should be a contraindication for attempting a laparoscopic approach to bilateral native nephrectomies in patients with autosomal dominant polycystic kidney disease (ADPKD). Patients and Methods We retrospectively reviewed all laparoscopic bilateral nephrectomies performed for ADPKD at our institution from 1 January 2000 to 31 December 2012. We stratified patients by kidney weight (with or without at least one kidney weighing >2500 g) and compared perioperative data, complications, and status of kidney allografts. Additionally, the subset of patients with at least one kidney weighing >3500 g was compared with the rest of the cohort. Results We identified 68 patients; mean (range) individual kidney weight was 1984 (197–5042) g. In all, 24 patients had at least one kidney weighing >2500 g, yet patients in this group were not significantly different from the rest of the cohort for complications, estimated blood loss, transfusion rate, or duration of hospitalisation. For those who underwent simultaneous renal allotransplantation, native kidney size was not associated with graft outcomes. Additionally, of the six patients with at least one kidney weighing >3500 g, only one required a blood transfusion, and the group had no intraoperative or postoperative Clavien grade ≥3 complications. None of the cohort required conversion to open surgery. Conclusion Massive size of polycystic kidneys is not a contraindication to attempting a laparoscopic approach to bilateral nephrectomies in an experienced, high‐volume centre.
      PubDate: 2014-08-16T12:41:42.786571-05:
      DOI: 10.1111/bju.12821
  • Metabolic syndrome and benign prostatic enlargement: a systematic review
           and meta‐analysis
    • Authors: Mauro Gacci; Giovanni Corona, Linda Vignozzi, Matteo Salvi, Sergio Serni, Cosimo De Nunzio, Andrea Tubaro, Matthias Oelke, Marco Carini, Mario Maggi
      Pages: n/a - n/a
      Abstract: Objective To summarise and meta‐analyse current literature on metabolic syndrome (MetS) and benign prostatic enlargement (BPE), focusing on all the components of MetS and their relationship with prostate volume, transitional zone volume, prostate‐specific antigen and urinary symptoms, as evidence suggests an association between MetS and lower urinary tract symptoms (LUTS) due to BPE. Methods An extensive PubMed and Scopus search was performed including the following keywords: ‘metabolic syndrome’, ‘diabetes’, ‘hypertension’, ‘obesity’ and ‘dyslipidaemia’ combined with ‘lower urinary tract symptoms’, ‘benign prostatic enlargement’, ‘benign prostatic hyperplasia’ and ‘prostate’. Results Of the retrieved articles, 82 were selected for detailed evaluation, and eight were included in this review. The eight studies enrolled 5403 patients, of which 1426 (26.4%) had MetS defined according to current classification. Patients with MetS had significantly higher total prostate volume when compared with those without MetS (+1.8 mL, 95% confidence interval [CI] 0.74–2.87; P < 0.001). Conversely, there were no differences between patients with or without MetS for International Prostate Symptom Score total or LUTS subdomain scores. Meta‐regression analysis showed that differences in total prostate volume were significantly higher in older (adjusted r = 0.09; P = 0.02), obese patients (adjusted r = 0.26; P < 0.005) and low serum high‐density lipoprotein cholesterol concentrations (adjusted r = −0.33; P < 0.001). Conclusions Our results underline the exacerbating role of MetS‐induced metabolic derangements in the development of BPE. Obese, dyslipidaemic, and aged men have a higher risk of having MetS as a determinant of their prostate enlargement.
      PubDate: 2014-08-16T12:26:19.776098-05:
      DOI: 10.1111/bju.12728
  • Role of multiparametric magnetic resonance imaging (MRI) in focal therapy
           for prostate cancer: a Delphi consensus project
    • Authors: Berrend G. Muller; Willemien Bos, Maurizio Brausi, Francois Cornud, Paolo Gontero, Alexander Kirkham, Peter A. Pinto, Thomas J. Polascik, Ardeshir R. Rastinehad, Theo M. Reijke, Jean J. Rosette, Osamu Ukimura, Arnauld Villers, Jochen Walz, Hessel Wijkstra, Michael Marberger
      Pages: n/a - n/a
      Abstract: Objective To define the role of multiparametric MRI (mpMRI) for treatment planning, guidance and follow‐up in focal therapy for prostate cancer based on a multidisciplinary Delphi consensus project. Materials and Methods An online consensus process based on a questionnaire was circulated according to the Delphi method. Discussion points were identified by literature research and were sent to the panel via an online questionnaire in three rounds. A face‐to‐face consensus meeting followed the three rounds of questions that were sent to a 48‐participant expert panel consisting of urologists, radiologists and engineers. Participants were presented with the results of the previous rounds. Conclusions formulated from the results of the questionnaire were discussed in the final face‐to‐face meeting. Results Consensus was reached in 41% of all key items. Patients selected for focal therapy should have biopsy‐proven prostate cancer. Biopsies should ideally be performed after mpMRI of the prostate. Standardization of imaging protocols is essential and mpMRIs should be read by an experienced radiologist. In the follow‐up after focal therapy, mpMRI should be performed after 6 months, followed by a yearly mpMRI. mpMRI findings should be confirmed by targeted biopsies before re‐treatment. No consensus was reached on whether mpMRI could replace transperineal template saturation biopsies to exclude significant lesions outside the target lesion. Conclusions Consensus was reached on a number of areas related to the conduct, interpretation and reporting of mpMRI for use in treatment planning, guidance and follow‐up of focal therapy for prostate cancer. Future studies, comparing mpMRI with transperineal saturation mapping biopsies, will confirm the importance of mpMRI for a variety of purposes in focal therapy for prostate cancer.
      PubDate: 2014-08-16T12:23:16.480748-05:
      DOI: 10.1111/bju.12548
  • Impact of comorbidity on health‐related quality of life after
           prostate cancer treatment: combined analysis of two prospective cohort
    • Authors: Bryce B. Reeve; Ronald C. Chen, Dominic T. Moore, Allison M. Deal, Deborah S. Usinger, Jessica C. Lyons, James A. Talcott
      Pages: n/a - n/a
      Abstract: Objective To improve and individualise estimates of treatment outcomes for men diagnosed with prostate cancer, we examined the impact of baseline comorbidity on health‐related quality of life (HRQL) outcomes in an analysis of two pooled, prospective cohort studies. Patients and Methods We studied 697 patients from three academic hospitals who received radical prostatectomy (RP), external beam radiation therapy (EBRT), or brachytherapy (BT). Measures of patient‐reported bowel, urinary, and sexual symptoms along with physical and mental health were prospectively collected before treatment and 3, 12, 24, and 36 months after treatment. We assessed baseline comorbidity by the validated Index of Co‐Existent Disease (ICED), abstracted from medical records. Regression mixed‐models were built for each treatment group and HRQL outcome controlling for baseline age, education, marital status, risk group and patient‐reported general health. Results About 71% of patients had one or more comorbid conditions at baseline. After adjusting for covariates, we found baseline comorbidity was independently associated with poorer sexual function after BT (P = 0.04) and RP (P = 0.03) but not EBRT (P = 0.35). Physical health was significantly worse for men receiving BT with more comorbidities (P = 0.02). Baseline comorbid conditions were not associated with urinary incontinence or bowel functioning. Conclusions Comorbidity at baseline is significantly associated with poorer sexual function after prostate BT or RP. This information may help patients and their physicians anticipate outcomes after surgical and radiation treatments.
      PubDate: 2014-08-16T12:23:02.846656-05:
      DOI: 10.1111/bju.12723
  • Vesico‐ureteric reflux (VUR) management and screening patterns: are
           paediatric urologists following the 2010 American Urological Association
           (AUA) guidelines?
    • Authors: Peter L. Sunaryo; Gina M. Cambareri, Dock G. Winston, Moneer K. Hanna, Jeffrey A. Stock
      Pages: n/a - n/a
      Abstract: Objective To evaluate the current practice patterns of vesico‐ureteric reflux (VUR) management and screening among paediatric urologists and their relationship with the current American Urological Association (AUA) guidelines in managing and treating VUR. Subjects and Methods A 17‐question survey was sent out to 476 paediatric urologists who are members of the Society for Pediatric Urology (SPU). In all, 133 respondents answered the survey and results were included for all questions. Results Paediatric urologists who were surveyed were consistent with the 2010 AUA guidelines in the initial evaluation of children with VUR, continuous antibiotic prophylaxis for the child aged < or >1 year, and follow‐up evaluation in children with VUR. Most paediatric urologists do not obtain a serum creatinine on initial screening of children with VUR. The new guidelines address screening of siblings of patients with VUR and most paediatric urologists were consistent with these recommendations. Almost one third of responders screened all neonates diagnosed with prenatal hydronephrosis regardless of clinical history or findings on imaging despite the recommendations of the new guidelines. Conclusion We conclude that based on our present sample, most paediatric urologists follow the 2010 AUA guidelines on VUR management.
      PubDate: 2014-08-16T12:22:46.893294-05:
      DOI: 10.1111/bju.12588
  • Testicular‐sparing surgery for bilateral or monorchide testicular
           tumours: a multicenter study of long‐term oncological and functional
    • Authors: Ludovic Ferretti; Paul Sargos, Marine Gross‐Goupil, Vincent Izard, Hervé Wallerand, Eric Huyghe, Jean‐Marc Rigot, Xavier Durand, Gerard Benoit, Jean‐Marie Ferriere, Stéphane Droupy
      Pages: n/a - n/a
      Abstract: Objective To review long‐term oncological and functional outcomes of testicular‐sparing surgery (TSS) in men presenting with bilateral or monorchide testicular tumours at one of five reference centres for testicular neoplasm and infertility. Patients and Methods We review 25 cases of bilateral synchrone and metachrone testicular tumours treated in five academic centres between 1984 and 2013. Clinical, biological, ultrasonography and pathological tumour findings, overall survival (OS) times, local or metastatic recurrence, pre‐ and postoperative hormonal profile, paternity and the need for androgen substitution were assessed. Results Eleven patients with a bilateral synchrone tumour and 14 patients with a testicular tumour on a solitary testicle underwent a tumorectomy. The mean (sem) patient age was 31.9 (1.04) years, total testosterone level was 4.5 (0.57) ng.mL and tumour size was 11.66 (1.49) mm. Tumour types were as follows: 11 seminoma, nine non‐seminomatous or mixed germ cell tumours, four Leydig tumours, and one hamartoma. Frozen‐section examination was performed in 14 patients, and matched the final pathological analysis in 11 patients. There was an OS rate of 100% and three patients (12%) presented with a local recurrence after a mean follow‐up of 42.7 months. Radical orchiectomy was performed for six patients. No patient with a preserved testicle required androgen therapy; the mean postoperative total testosterone level was 4.0 ng/mL. No patient remained fertile after radiation therapy. Conclusions TSS for bilateral testicular tumour is safe and effective in selected patients, and should be considered to avoid definitive androgen therapy. Adjuvant radiotherapy remains poorly described in the literature, leading to adjuvant treatment heterogeneity for testicular tumours.
      PubDate: 2014-08-16T12:14:40.811551-05:
      DOI: 10.1111/bju.12549
  • 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: n/a - n/a
      Abstract: Objective To 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
  • Oncological predictive value of the 2004 World Health Organisation grading
           classification in primary T1 non‐muscle‐invasive bladder
           cancer. A step forward or back?
    • Authors: Federico Pellucchi; Massimo Freschi, Marco Moschini, Lorenzo Rocchini, Carmen Maccagnano, Suardi Nazareno, Franco Bergamaschi, Francesco Montorsi, Renzo Colombo
      Pages: n/a - n/a
      Abstract: Objective To compare the clinical reliability of the 1973 and 2004 World Health Organisation (WHO) classification systems in pT1 bladder cancer. Patients and Methods We retrospectively evaluated 291 consecutive patients who had pT1 high grade bladder cancer between 2004 and 2011. All tumours were simultaneously evaluated by a single uro‐pathologist as high grade and G2 or G3. All patients underwent a second transurethral resection (TUR) and those confirmed with non‐muscle‐invasive bladder cancer at second TUR received bacille Calmette‐Guérin. Follow‐up included urine cytology and cystoscopy 3 months after second TUR and then every 6 months for 5 years. Univariate and multivariate analysis to determine recurrence‐free survival (RFS) and progression‐free survival (PFS) rates were performed using the Kaplan–Meier method with the log‐rank test. Results G2 tumours were found in 124 (46.6%) and G3 in 142 (53.4%) patients. The mean (median; range) follow‐up period was 31.1 (19; 1–93) months. The 5‐year RFS rate was 39.1% for the overall high grade population, and 49.1 and 31.8% for G2 and G3 subgroups, respectively. The 5‐year PFS was 82% for the overall high grade population and 89 and 73% for G2 and G3 subgroups, respectively. RFS (P < 0.002) and PFS (P < 0.001) rates were significantly different between the G2 and G3 subgroups. In multivariate analysis, only the grade assessed according to the 1973 WHO significantly correlated with both RFS (P = 0.003) and PFS (P < 0.001). Conclusion The results suggest that the 1973 WHO classification system has higher prognostic reliability for patients with T1 disease. If confirmed, these findings should be carefully taken into account when making treatment decisions for patients with T1 bladder cancer.
      PubDate: 2014-08-16T11:40:31.260509-05:
      DOI: 10.1111/bju.12666
  • Progression and treatment of incident lower urinary tract symptoms (LUTS)
           among men in the California Men's Health Study
    • Authors: Lauren P. Wallner; Jeff M. Slezak, Ronald K. Loo, Virginia P. Quinn, Stephen K. Van Den Eeden, Steven J. Jacobsen
      Pages: n/a - n/a
      Abstract: Objectives To characterise the progression and treatment of lower urinary tract symptoms (LUTS) among men aged 45–69 years in the California Men's Health Study. Patients and Methods A total of 39 222 men, aged 45–69 years, enrolled in the Southern California Kaiser Permanente Health Plan were surveyed in 2002–2003 and again in 2006–2007. Those men who completed both surveys who did not have a diagnosis of benign prostatic hyperplasia (BPH) and were not on medication for LUTS at baseline were included in the study (N = 19 505). Among the men with no or mild symptoms at baseline, the incidence of moderate/severe LUTS (American Urological Association Symptom Index [AUASI] score ≥8) and odds of progression to severe LUTS (AUASI score ≥20) was estimated during 4 years of follow‐up. Results Of the 9640 men who reported no/mild LUTS at baseline, 3993 (41%) reported moderate/severe symptoms at follow‐up and experienced a 4‐point change in AUASI score on average. Of these men, 351 (8.8%) had received a pharmacological treatment, eight (0.2%) had undergone a minimally invasive or surgical procedure and 3634 (91.0%) had no treatment recorded. Men who progressed to severe symptoms (AUASI score ≥20; n = 165) were more likely to be on medication for BPH (odds ratio [OR] 8.09, 95% confidence interval [CI] 5.77–11.35), have a BPH diagnosis (OR 4.74, 95% CI 3.40–6.61) or have seen a urologist (OR 2.49, 95% CI 1.81–3.43) when compared with men who did not progress to severe symptoms (AUASI score
      PubDate: 2014-08-16T11:39:12.989692-05:
      DOI: 10.1111/bju.12810
  • Risk factors of hospital readmission after radical cystectomy and urinary
           diversion: analysis of a large contemporary series
    • Authors: Ahmed M. Harraz; Yasser Osman, Samer El‐Halwagy, Mahmoud Laymon, Ahmed Mosbah, Hassan Abol‐Enein, Atalla A. Shaaban
      Pages: n/a - n/a
      Abstract: Objectives To determine the incidence, risk factors and causes of hospital readmission in a large series of patients who underwent radical cystectomy (RC) and urinary diversion. Patients and Methods We retrospectively analysed the data of 1000 patients who underwent RC and urinary diversion between January 2004 and September 2009 in our tertiary referral centre. Patients stayed in hospital for 21 and 11 days for orthotopic and ileal conduit diversions, respectively. The primary outcome was the development of a complication requiring hospital readmission at ≤3 months (early) and >3 months (late). Causes of hospital readmissions were categorised according to frequency of readmissions. Predictors were determined using univariate and multivariate logistic regression models. Results In all, 895 patients were analysed excluding 105 patients because of perioperative mortality and loss to follow‐up. Early and late readmissions occurred in 8.6% and 11% patients, respectively. The commonest causes of first readmission were upper urinary tract obstruction (UUO, 13%) and pyelonephritis (12.4%) followed by intestinal obstruction (11.9%) and metabolic acidosis (11.3%). The development of postoperative high‐grade complications (odds ratio [OR] 1.955; 95% confidence interval [CI] 1.254–3.046; P = 0.003) and orthotopic bladder substitution (OR 1.585; 95% CI 1.095–2.295; P = 0.015) were independent predictors for overall hospital readmission after RC. Postoperative high‐grade complications (OR 2.488; 95% CI 1.391–4.450; P = 0.002), orthotopic bladder substitution (OR 2.492; 95% CI 1.423–4.364; P = 0.001) and prolonged hospital stay (OR 1.964; 95% CI:1.166–3.308; P = 0.011) were independent predictors for early readmission while hypertension (OR 1.670; 95% CI 1.007–2.769; P = 0.047) was an independent predictor for late readmission. Conclusion Hospital readmissions are a significant problem after RC. In the present study, UUO, pyelonephritis, metabolic acidosis and intestinal obstruction were the main causes of readmission. Orthotopic bladder substitution and development of postoperative high‐grade complications were significant predictors for overall readmission.
      PubDate: 2014-08-16T11:38:59.268976-05:
      DOI: 10.1111/bju.12830
  • Bladder reconstruction using scaffold‐less autologous smooth muscle
           cell sheet engineering: early histological outcomes for autoaugmentation
    • Authors: Saman S. Talab; Abdol‐Mohammad Kajbafzadeh, Azadeh Elmi, Ali Tourchi, Shabnam Sabetkish, Nastaran Sabetkish, Maryam Monajemzadeh
      Pages: n/a - n/a
      Abstract: Objective To investigate the feasibility of a new approach for cystoplasty using autologous smooth muscle cell (SMC) sheet and scaffold‐less bladder tissue engineering with the main focus on histological outcomes in a rabbit model. Materials and Methods In all, 24 rabbits were randomly divided into two groups. In the experimental group, SMCs were obtained from the bladder muscular layer, labelled with PKH‐26, and seeded on temperature‐responsive culture dishes. Contiguous cell sheets were noninvasively harvested by reducing the temperature and triple‐layer cell‐dense tissues were constructed. After partial detrusorectomy, the engineered tissue was transplanted onto the urothelial diverticulum. The control group underwent partial detrusorectomy followed by peritoneal fat coverage. At 2, 4, and 12 weeks the rabbits were humanely killed and haematoxylin and eosin, Masson's trichrome, cluster of differentiation 34 (CD34), CD31, CD3, CD68, α‐smooth muscle actin (α‐SMA), picrosirius red, and pentachrome staining were used to evaluate bladder reconstruction. Results At 2 weeks after SMC‐sheet grafting, PKH‐26 labelled SMCs were evident in the muscular layer. At 4 weeks, 79.1% of the cells in the muscular layer were PKH‐positive cells. The portion of the muscular layer increased in the experimental group during the follow‐up and was similar to normal bladder tissue after 12 weeks. α‐SMA staining showed well organised muscle at 4 and 12 weeks. CD34+ endothelial progenitor cells and CD31+ microvessels increased continuously and peaked 4 and 12 weeks after grafting, respectively. Conclusion In the present study, we show that autologous SMC‐sheet grafting has the potential for reliable bladder reconstruction and is technically feasible with a favourable evolution over the 12 weeks following implantation. Our findings could pave the way toward future bladder tissue engineering using the SMC‐sheet technique.
      PubDate: 2014-08-16T11:18:33.744255-05:
      DOI: 10.1111/bju.12685
  • 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: n/a - n/a
      Abstract: Objective To 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
  • Indications for intervention during active surveillance of prostate
           cancer: a comparison of the Johns Hopkins and Prostate Cancer Research
           International Active Surveillance (PRIAS) protocols
    • Authors: Max Kates; Jeffrey J. Tosoian, Bruce J. Trock, Zhaoyong Feng, H. Ballentine Carter, Alan W. Partin
      Pages: n/a - n/a
      Abstract: Objective To analyse how patients enrolled in our biopsy based surveillance programme would fare under the Prostate Cancer Research International Active Surveillance (PRIAS) protocol, which uses PSA kinetics. Patients and Methods Since 1995, 1125 men with very‐low‐risk prostate cancer have enrolled in the AS programme at the Johns Hopkins Hospital (JHH), which is based on monitoring with annual biopsy. The PRIAS protocol uses a combination of periodic biopsies (in years 1, 4, and 7) and prostate‐specific antigen doubling time (PSADT) to trigger intervention. Patients enrolled in the JHH AS programme were retrospectively reviewed to evaluate how the use of the PRIAS protocol would alter the timing and use of curative intervention. Results Over a median of 2.1 years of follow up, 38% of men in the JHH AS programme had biopsy reclassification. Of those, 62% were detected at biopsy intervals corresponding to the PRIAS criteria, while 16% were detected between scheduled PRIAS biopsies, resulting in a median delay in detection of 1.9 years. Of the 202 men with >5 years of follow‐up, 11% in the JHH programme were found to have biopsy reclassification after it would have been identified in the PRIAS protocol, resulting in a median delay of 4.7 years to reclassification. In all, 12% of patients who would have undergone immediate intervention under PRIAS due to abnormal PSA kinetics would never have undergone reclassification on the JHH protocol and thus would not have undergone definitive intervention. Conclusions There are clear differences between PSA kinetics‐based AS programmes and biopsy based programmes. Further studies should address whether and how the differences in timing of intervention impact subsequent disease progression and prostate cancer mortality.
      PubDate: 2014-08-16T11:16:57.893064-05:
      DOI: 10.1111/bju.12828
  • The impact of urinary incontinence on health‐related quality of life
           (HRQoL) in a real‐world population of women aged 45–60 years:
           results from a survey in France, Germany, the UK and the USA
    • Authors: Paul Abrams; Andrew P. Smith, Nikki Cotterill
      Pages: n/a - n/a
      Abstract: Objective To develop a clear understanding of the relationship between severity of urinary incontinence (UI) and health‐related quality of life (HRQoL) and mental well‐being in a population of women of working age with the requisite demands of a busy, active life. Subjects and Methods A survey of women with UI, aged between 45 and 60 years, was conducted via the internet in the UK, France, Germany and USA between 1 and 30 September 2013. Validated outcome measures were used to assess symptoms and the impact of UI on activities of daily life, HRQoL, and mental well‐being: The International Consultation on Incontinence Modular Questionnaire Short Form; (ICIQ‐UI Short Form); the ICIQ‐Lower Urinary Tract Symptoms Quality of Life; (ICIQ‐LUTSqol); the Warwick‐Edinburgh Mental Well‐being Scale (WEMWBS). The relationships between UI, HRQoL and mental well‐being were analysed using analyses of variance and regression. Results The survey was completed by 1203 women with UI with an average age of 52.7 years. Based upon responses to the ICIQ‐UI Short Form about the amount of urine that leaks, respondents were categorised as having light (n = 1023, 87%), medium (n = 134, 11%), or severe UI (n = 20, 2%). The scores on the ICIQ‐UI Short Form increased with severity [mean (sd) scores: light UI 7.9 (3.4), medium UI 13.8 (2.9), and severe UI 18.3 (3.9)], as did the impact on HRQoL, assessed using the ICIQ‐LUTSqol [mean (sd) scores: light UI 30.6 (7.3), medium UI 41.0 (11.2), and severe UI 56.9 (17.6)]. Mental well‐being decreased with severity of UI, the mean (se) WEMWBS scores were: light UI 48.3 (10.1), medium UI 44.5 (9.5), and severe UI 39.9 (16.2). Conclusion In women with UI, aged 45–60 years, UI symptoms directly affect HRQoL, which subsequently impacts negatively on mental well‐being.
      PubDate: 2014-08-16T11:16:44.125414-05:
      DOI: 10.1111/bju.12852
  • Robot‐assisted retroperitoneal lymph node dissection: technique and
           initial case series of 18 patients
    • Authors: Scott M. Cheney; Paul E. Andrews, Bradley C. Leibovich, Erik P. Castle
      Pages: n/a - n/a
      Abstract: Objective To evaluate outcomes of the first 18 patients treated with robot‐assisted retroperitoneal lymph node dissection (RA‐RPLND) for non‐seminomatous germ cell tumours (NSGCT) and paratesticular rhabdomyosarcoma (RMS) at our institution. Patients and Methods Between March 2008 and May 2013, 17 patients underwent RA‐RPLND for NSGCT and one for paratesticular RMS. Data were collected retrospectively on patient demographics, preoperative tumour characteristics, and perioperative outcomes including open conversion rate, lymph node (LN) yield, rate of positive LNs, operative time, estimated blood loss (EBL), and length of stay (LOS). Perioperative outcomes were compared between patients receiving primary RA‐RPLND vs post‐chemotherapy RA‐RPLND. Medium‐term outcomes of tumour recurrence rate and maintenance of antegrade ejaculation were recorded. Results RA‐RPLND was completed robotically in 15 of 18 (83%) patients. LNs were positive in eight of 18 patients (44%). The mean LN yield was 22 LNs. For cases completed robotically, the mean operative time was 329 min, EBL was 103 mL, and LOS was 2.4 days. At a mean (range) follow‐up of 22 (1–58) months, there were no retroperitoneal recurrences and two of 17 (12%) patients with NSGCT had pulmonary recurrences. Antegrade ejaculation was maintained in 91% of patients with a nerve‐sparing approach. Patients receiving primary RA‐RPLND had shorter operative times compared with those post‐chemotherapy (311 vs 369 min, P = 0.03). There was no significant difference in LN yield (22 vs 18 LNs, P = 0.34), EBL (100 vs 313 mL, P = 0.13), or LOS (2.75 vs 2.2 days, P = 0.36). Conclusion This initial selected case series of RA‐RPLND shows that the procedure is safe, reproducible, and feasible for stage I–IIB NSGCT and RMS in the hands of experienced robotic surgeons. Larger studies are needed to confirm the diagnostic and therapeutic utility of this technique.
      PubDate: 2014-08-16T11:13:51.559788-05:
      DOI: 10.1111/bju.12804
  • Association of Androgen Deprivation Therapy with Excess
           Cardiac‐Specific Mortality in Men with Prostate Cancer
    • Authors: David R. Ziehr; Ming‐Hui Chen, Danjie Zhang, Michelle H. Braccioforte, Brian J. Moran, Brandon A. Mahal, Andrew S. Hyatt, Shehzad S. Basaria, Clair J. Beard, Joshua A. Beckman, Toni K. Choueiri, Anthony V. D'Amico, Karen E. Hoffman, Jim C. Hu, Neil E. Martin, Christopher J. Sweeney, Quoc‐Dien Trinh, Paul L Nguyen
      Abstract: Objectives To determine if androgen deprivation therapy (ADT) is associated with excess cardiac‐specific mortality (CSM) in men with prostate cancer and no cardiovascular comorbidity, coronary artery disease risk factors, or congestive heart failure (CHF) or past myocardial infarction (MI). Subjects/patients and methods Five thousand seventy‐seven men (median age, 69.5 years) with cT1c‐T3N0M0 prostate cancer were treated with brachytherapy with or without neoadjuvant ADT (median duration, four months) between 1997 and 2006. Fine and Gray's competing risks analysis evaluated the association of ADT with CSM, adjusting for age, year of brachytherapy, and ADT treatment propensity score among men in groups defined by cardiac comorbidity. Results After a median follow‐up of 4.8 years, no association was detected between ADT and CSM in men with no cardiac risk factors (1.08% at 5 years for ADT vs 1.27% at five years for no ADT, adjusted hazard ratio (AHR) 0.83; 95% confidence interval (CI), 0.39‐1.78; P=0.64; n=2653) or in men with diabetes mellitus, hypertension, or hypercholesterolemia (2.09% vs 1.97%, AHR, 1.33; 95% CI, 0.70‐2.53; P=0.39; n=2168). However, ADT was associated with significantly increased CSM in men with CHF or MI (AHR 3.28; 95% CI 1.01‐10.64; P=0.048; n=256). In this subgroup, the five‐year cumulative incidence of CSM was 7.01% (95% CI 2.82‐13.82%) for ADT vs 2.01% (95% CI 0.38‐6.45%) for no ADT. Conclusion ADT was associated with a five percent absolute excess risk of CSM at five years in men with CHF or prior MI, suggesting that administering ADT to 20 men in this potentially vulnerable subgroup could result in one cardiac death.
      PubDate: 2014-08-15T01:55:07.623913-05:
      DOI: 10.1111/bju.12905
  • Exploring associations between LUTS and GI problems in women: a study in
           women with urological and GI problems versus a control population
    • Authors: M. Wyndaele; B.Y. De Winter, P.A. Pelckmans, S. De Wachter, M. Van Outryve, J.J. Wyndaele
      Abstract: Objectives First, to study the prevalence of self‐reported LUTS in women consulting a Gastroenterology clinic with complaints of functional constipation (FC), fecal incontinence (FI) or both, compared to a female control population. Secondly, to study the influence of FC, FI, or both on self‐reported LUTS in women attending a Urology clinic. Patients and methods We present a retrospective study of data collected through a validated self‐administered bladder and bowel symptom questionnaire in a tertiary referral hospital from three different female populations: 104 controls, 159 gastroenterological patients and 410 urological patients. Based on the reported bowel symptoms, patients were classified as having FC, FI, a combination of both, or, no FC or FI. LUTS were compared between the control population and the gastroenterological patients, and between urological patients with and without concomitant gastroenterological complaints. Results were corrected for possible confounders through logistic regression analysis. Results The prevalence of LUTS in the control population was comparable to large population‐based studies. Nocturia was significantly more prevalent in gastroenterological patients with FI compared to the control population (OR 9.1). Female gastroenterological patients with FC more often reported straining to void (OR 10.3), intermittency (OR 5.5), need to immediately revoid (OR 3.7) and feeling of incomplete emptying (OR 10.5) compared to the control population. In urological patients, urgency (94%) and UUI (54% of UI) were reported more often by patients with FI than by patients without gastroenterological complaints (58% and 30% of UI respectively), whereas intermittency (OR 3.6), need to immediately revoid (OR 2.2) and feeling of incomplete emptying (OR 2.2) were reported more often by patients with FC than by patients without gastroenterological complaints. Conclusion As LUTS are reported significantly more often by female gastroenterological patients than by a control population, and as there is a difference in self‐reported LUTS between female urological patients with different concomitant gastroenterological complaints, we suggest that general practitioners, gastroenterologists and urologists should always include the assessment of symptoms of the other pelvic organ system in their patient evaluation. The clinical correlations between bowel and LUT symptoms may be explained by underlying neurological mechanisms.
      PubDate: 2014-08-15T01:55:00.74-05:00
      DOI: 10.1111/bju.12904
  • Candidate selection for quadrant‐based focal ablation through a
           combination of diffusion‐weighted magnetic resonance imaging and
           prostate biopsy
    • Authors: Yoh Matsuoka; Noboru Numao, Kazutaka Saito, Hiroshi Tanaka, Jiro Kumagai, Soichiro Yoshida, Junichiro Ishioka, Fumitaka Koga, Hitoshi Masuda, Satoru Kawakami, Yasuhisa Fujii, Kazunori Kihara
      Abstract: Objectives ● To identify prostatic quadrants that could be preserved without intervention, using diffusion‐weighted magnetic resonance imaging (DWI) and extended core biopsy, as a step toward implementation of quadrant‐based focal ablation with potential preservation of erectile and ejaculatory functions, based on comparisons with unilateral hemigland ablation. Patients and Methods ● We conducted a prebiopsy DWI study including 648 quadrants in 162 men who underwent 14‐core biopsy including anterior sampling and radical prostatectomy for localized cancer. ● Imaging and pathology were analyzed on a quadrant basis. Each quadrant was assessed through four‐core sampling. Predictive performance of DWI and biopsy regarding quadrant status was analyzed. Results ● On radical prostatectomy specimens, 170 anterior (52.5%) and 172 posterior quadrants (53.1%) harbored significant cancer (SC). ● Negative predictive values of DWI, biopsy, and their combination for SC were 79.7%, 70.6%, and 91.1%, respectively, in anterior quadrants, and 78.5%, 81.3%, and 91.7%, respectively, in posterior quadrants. ● DWI incrementally improved the negative predictive values of biopsy in anterior (p
      PubDate: 2014-08-14T04:08:45.348039-05:
      DOI: 10.1111/bju.12901
  • Enzalutamide in European and North American men participating in the
           AFFIRM trial
    • Authors: Axel S. Merseburger; Howard I. Scher, Joaquim Bellmunt, Kurt Miller, Peter F.A. Mulders, Arnulf Stenzl, Cora N. Sternberg, Karim Fizazi, Mohammad Hirmand, Billy Franks, Gabriel P. Haas, Johann de Bono, Ronald de Wit
      Abstract: Objective ● To explore any differences in efficacy and safety outcomes between European (EU) (n = 684) and North American (NA) (n = 395) patients in the AFFIRM trial (NCT00974311). Patients and Methods ● Phase III, double‐blind, placebo‐controlled, multinational AFFIRM trial in men with metastatic castration‐resistant prostate cancer (mCRPC) after docetaxel. ● Participants were randomly assigned in a 2:1 ratio to receive oral enzalutamide 160 mg/day or placebo. ● The primary end point was overall survival (OS) in a post hoc analysis. Results ● Enzalutamide significantly improved OS compared with placebo in both EU and NA patients. The median OS in EU patients was longer than NA patients in both treatment groups. However, the relative treatment effect, expressed as hazard ratio and 95% confidence interval, was similar in both regions: 0.64 (0.50, 0.82) for EU and 0.63 (0.47, 0.83) for NA. Significant improvements in other end points further confirmed the benefit of enzalutamide over placebo in patients from both regions. ● The tolerability profile of enzalutamide was comparable between EU and NA patients, with fatigue and nausea the most common adverse events. Four EU patients (4/461 enzalutamide‐treated, 0.87%) and one NA patient (1/263 enzalutamide‐treated, 0.38%) experienced seizures. ● The difference in median OS was related in part to the timing of development of CRPC and baseline demographics on study entry. Conclusion ● This post hoc exploratory analysis of the AFFIRM trial demonstrated a consistent OS benefit for enzalutamide in men with mCRPC who had previously progressed on docetaxel in both NA‐ and EU‐treated patients, although the median OS was higher in EU relative to NA patients. Efficacy benefits were consistent across end points, with a comparable safety profile in both regions.
      PubDate: 2014-08-14T04:08:05.911492-05:
      DOI: 10.1111/bju.12898
  • Hypoalbuminemia is Associated with Mortality in Patients Undergoing
           Cytoreductive Nephrectomy
    • Authors: Anthony T. Corcoran; Samuel D. Kaffenberger, Peter E. Clark, John Walton, Elizabeth Handorf, Zack Piotrowski, Jeffery J. Tomaszewski, Serge Ginzburg, Reza Mehrazin, Elizabeth Plimack, David Y.T. Chen, Marc C. Smaldone, Robert G. Uzzo, Todd M. Morgan, Alexander Kutikov
      Abstract: Objective ● To evaluate whether poor nutrition is associated with mortality in patients undergoing cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC). Patients and Methods ● A multi‐institutional review of prospective databases identified 246 patients meeting inclusion criteria who underwent CN for mRCC from 1993‐2012. ● Nutritional markers evaluated were: body mass index
      PubDate: 2014-08-14T04:07:54.615522-05:
      DOI: 10.1111/bju.12897
  • Real‐time in vivo periprostatic nerve tracking using multiphoton
           microscopy in a rat survival surgery model: a promising pre‐clinical
           study for enhanced nerve‐sparing surgery
    • Authors: Matthieu Durand; Manu Jain, Amit Aggarwal, Brian D. Robinson, Abhishek Srivastava, Rebecca Smith, Prasanna Sooriakumaran, Joyce Loeffler, Chris Pumill, Jean Amiel, Daniel Chevallier, Sushmita Mukherjee, Ashutosh K. Tewari
      Abstract: Objectives To assess the ability of MPM to visualize, differentiate and track periprostatic nerves in an in vivo rat model, mimicking real‐time imaging in humans during RP. To investigate the tissue toxicity and the reproducibility of in vivo MPM on prostatic glands in the rat after imaging and final histological correlation study. Patients and methods In vivo prostatic rat imaging was carried out using a custom‐built bench‐top MPM system generating real‐time 3D histologic images, after performing survival surgery consisting of mini‐laparotomies under xylazine/ketamine anesthesia exteriorizing the right prostatic lobe. The acquisition time and the depth of anesthesia were adjusted for collecting multiple images in order to track the periprostatic nerves in real‐time. The rats were then monitored for 15 days before undergoing a new set of imaging under similar settings. After sacrificing the rats, their prostates were submitted for routine histology and correlation studies. Results In vivo MPM images distinguished periprostatic nerves within the capsule and the prostatic glands from fresh unprocessed prostatic tissue without the use of exogenous contrast agents nor biopsy sample Real time nerve tracking outlining the prostate was feasible and acquisition was not disturbed by motion artifacts No serious adverse event was reported during rat monitoring; no tissue damage due to laser was seen on the imaged lobe compared to the contralateral lobe (control) allowing comparison of their corresponding histology. Conclusions For the first time, we have demonstrated that in vivo tracking of periprostatic nerves using MPM is feasible in rat models. Development of a multiphoton endoscope for intraoperative use in humans is currently in progress and must be assessed.
      PubDate: 2014-08-14T04:07:45.559747-05:
      DOI: 10.1111/bju.12903
  • Survival disparities between Māori and non‐Māori men with
           prostate cancer in New Zealand
    • Authors: Zuzana Obertová; Nina Scott, Charis Brown, Alistair Stewart, Ross Lawrenson
      Abstract: Objective To examine temporal trends and current survival differences between Māori and non‐Māori men with prostate cancer in New Zealand. Subjects/patients and methods A cohort of 37,529 men aged 40+ years diagnosed with prostate cancer between 1996 and 2010 was identified from the New Zealand Cancer Registry and followed until 25 May 2011. Cause of death was obtained from the Mortality Collection by data linkage. Survival for Māori compared with non‐Māori men was estimated using the Kaplan‐Meier method, and Cox proportional hazard regression models, adjusted for age, year of diagnosis, socioeconomic deprivation and rural/urban residence. Results The probability of surviving was significantly lower for Māori compared with non‐Māori men at one, five and 10 years post‐diagnosis. Māori men were more likely to die of any cause (adjusted hazard ratio (HR), 1.84 [95% CI, 1.72, 1.97]) and of prostate cancer (adjusted HR, 1.94 [95% CI, 1.76, 2.14]). The adjusted HR of prostate cancer death for Māori men diagnosed with regional extent was 2.62‐fold [95% CI; 1.60, 4.31]) compared with non‐Māori men. The survival gap between Māori and non‐Māori men has not changed throughout the study period. Conclusion Significantly poorer survival was observed for Māori men compared with non‐Māori, particularly when diagnosed with regional prostate cancer. Despite improvements in survival for all men diagnosed after 2000, the survival gap between Māori and non‐Māori men has not been reduced with time. Differences in prostate cancer detection and management, partly driven by higher socio‐economic deprivation in Māori men, were identified as the most likely contributors to ethnic survival disparities in New Zealand.
      PubDate: 2014-08-14T04:02:04.988083-05:
      DOI: 10.1111/bju.12900
  • Prostate cancer mortality outcomes and patterns of primary treatment for
           Aboriginal men in New South Wales, Australia
    • Authors: Jennifer C Rodger; Rajah Supramaniam, Alison J Gibberd, David P Smith, Bruce K Armstrong, Anthony Dillon, Dianne L O'Connell
      Abstract: Objective To compare prostate cancer mortality for Aboriginal and non‐Aboriginal men and to describe prostate cancer treatments received by Aboriginal men. Subjects and methods We analysed cancer registry records for all men diagnosed with prostate cancer in New South Wales (NSW) in 2001‐2007 linked to hospital inpatient episodes and deaths. More detailed information on androgen deprivation therapy and radiotherapy was obtained from medical records for 87 NSW Aboriginal men diagnosed in 2000‐2011. The main outcomes were primary treatment for, and death from, prostate cancer. Analysis included Cox proportional hazards regression and logistic regression. Results There were 259 Aboriginal men among 35214 prostate cancer cases diagnosed in 2001‐2007. Age and spread of disease at diagnosis were similar for Aboriginal and non‐Aboriginal men. Prostate cancer mortality 5 years after diagnosis was higher for Aboriginal men (17.5%, 95% Confidence Interval (CI):12.4‐23.3) than non‐Aboriginal men (11.4%, 95% CI:11.0‐11.8). Aboriginal men were 49% more likely to die of prostate cancer (Hazard Ratio 1.49, 95% CI:1.07‐1.99) after adjusting for differences in demographic factors, stage at diagnosis, health access and comorbidities. Aboriginal men were less likely to have a prostatectomy for localised or regional cancer than non‐Aboriginal men (adjusted Odds Ratio 0.60 95% CI:0.40‐0.91). Of 87 Aboriginal men with full staging and treatment information 60% were diagnosed with localised disease. Of these 38% had a prostatectomy (+/‐ radiotherapy), 29% had radiotherapy only and 33% had neither. Conclusion More research is required to explain differences in treatment and mortality for Aboriginal men with prostate cancer compared to non‐Aboriginal men. In the meantime, ongoing monitoring and efforts are needed to ensure Aboriginal men have equitable access to best care.
      PubDate: 2014-08-14T04:01:56.567746-05:
      DOI: 10.1111/bju.12899
  • Health‐related quality of life from a prospective randomised
           clinical trial of robot‐assisted laparoscopic vs open radical
    • Authors: Jamie C. Messer; Sanoj Punnen, John Fitzgerald, Robert Svatek, Dipen J. Parekh
      Abstract: Objective To compare health‐related quality‐of‐life (HRQoL) outcomes for robot‐assisted laparoscopic radical cystectomy (RARC) with those of traditional open radical cystectomy (ORC) in a prospective randomised fashion. Patients and Methods This was a prospective randomised clinical trial evaluating the HRQoL for ORC vs RARC in consecutive patients from July 2009 to June 2011. We administered the Functional Assessment of Cancer Therapy–Vanderbilt Cystectomy Index questionnaire, validated to assess HRQoL, preoperatively and then at 3, 6, 9 and 12 months postoperatively. Scores for each domain and total scores were compared in terms of deviation from preoperative values for both the RARC and the ORC cohorts. Multivariate linear regression was used to assess the association between the type of radical cystectomy and HRQoL. Results At the time of the study, 47 patients had met the inclusion criteria, with 40 patients being randomised for analysis. The cohorts consisted of 20 patients undergoing ORC and 20 undergoing RARC, who were balanced with respect to baseline demographic and clinical features. Univariate analysis showed a return to baseline scores at 3 months postoperatively in all measured domains with no statistically significant difference among the various domains between the RARC and the ORC cohorts. Multivariate analysis showed no difference in HRQoL between the two approaches in any of the various domains, with the exception of a slightly higher physical well‐being score in the RARC group at 6 months. Conclusions There were no significant differences in the HRQoL outcomes between ORC and RARC, with a return of quality of life scores to baseline scores 3 months after radical cystectomy in both cohorts.
      PubDate: 2014-08-13T09:43:12.395242-05:
      DOI: 10.1111/bju.12818
  • 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
      PubDate: 2014-08-13T09:41:33.083937-05:
      DOI: 10.1111/bju.12836
  • Baseline characteristics predict risk of progression and response to
           combined medical therapy for benign prostatic hyperplasia (BPH)
    • Authors: Michael A. Kozminski; John T. Wei, Jason Nelson, David M. Kent
      Abstract: Objective To better risk stratify patients, using baseline characteristics, to help optimise decision‐making for men with moderate‐to‐severe lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) through a secondary analysis of the Medical Therapy of Prostatic Symptoms (MTOPS) trial. Patients and Methods After review of the literature, we identified potential baseline risk factors for BPH progression. Using bivariate tests in a secondary analysis of MTOPS data, we determined which variables retained prognostic significance. We then used these factors in Cox proportional hazard modelling to: i) more comprehensively risk stratify the study population based on pre‐treatment parameters and ii) to determine which risk strata stood to benefit most from medical intervention. Results In all, 3047 men were followed in MTOPS for a mean of 4.5 years. We found varying risks of progression across quartiles. Baseline BPH Impact Index score, post‐void residual urine volume, serum prostate‐specific antigen (PSA) level, age, American Urological Association Symptom Index score, and maximum urinary flow rate were found to significantly correlate with overall BPH progression in multivariable analysis. Conclusions Using baseline factors permits estimation of individual patient risk for clinical progression and the benefits of medical therapy. A novel clinical decision tool based on these analyses will allow clinicians to weigh patient‐specific benefits against possible risks of adverse effects for a given patient.
      PubDate: 2014-08-13T09:41:17.979521-05:
      DOI: 10.1111/bju.12802
  • Early unclamping technique during robot‐assisted laparoscopic
           partial nephrectomy can minimise warm ischaemia without increasing
    • Authors: Benoit Peyronnet; Hervé Baumert, Romain Mathieu, Alexandra Masson‐Lecomte, Yohann Grassano, Mathieu Roumiguié, Walid Massoud, Vincent Abd El Fattah, Franck Bruyère, Stéphane Droupy, Alexandre Taille, Nicolas Doumerc, Jean‐Christophe Bernhard, Christophe Vaessen, Morgan Rouprêt, Karim Bensalah
      Abstract: Objective To compare perioperative outcomes of early unclamping (EUC) vs standard unclamping (SUC) during robot‐assisted partial nephrectomy (RAPN), as early unclamping of the renal pedicle has been reported to decrease warm ischaemia time (WIT) during laparoscopic PN. Patients and Methods A retrospective multi‐institutional study was conducted at eight French academic centres between 2009 and 2013. Patients who underwent RAPN for a renal mass were included in the study. Patients without vascular clamping or for whom the decision to perform a radical nephrectomy was taken before unclamping were excluded. Perioperative outcomes were compared using the chi‐squared and Fisher's exact tests for discrete variables and the Mann–Whitney test for continuous variables. Predictors of WIT and estimated blood loss (EBL) were assessed using multiple linear regression analysis. Results In all, there were 430 patients: 222 in the EUC group and 208 in the SUC group. Tumours were larger (35.8 vs 32.3 mm, P = 0.02) and more complex (R.E.N.A.L. nephrometry score 6.9 vs 6.1, P < 0.001) in the EUC group but surgeons were more experienced (>50 procedures 12.2% vs 1.4%, P < 0.001). The mean WIT was shorter (16.7 vs 22.3 min, P < 0.001) and EBL was higher (369.5 vs 240 mL, P = 0.001) in the EUC group with no significant difference in complications or transfusion rates. The results remained the same when analysing subgroups of complex renal tumours (R.E.N.A.L. nephrometry score ≥7) or RAPN performed by less experienced surgeons (
      PubDate: 2014-08-13T09:41:01.133506-05:
      DOI: 10.1111/bju.12766
  • Lymphatic drainage in renal cell carcinoma: back to the basics
    • Authors: Riaz J. Karmali; Hiroo Suami, Christopher G. Wood, Jose A. Karam
      Abstract: Lymphatic drainage in renal cell carcinoma (RCC) is unpredictable, however, basic patterns can be observed in cadaveric and sentinel lymph node mapping studies in patients with RCC. The existence of peripheral lymphovenous communications at the level of the renal vein has been shown in mammals but remains unknown in humans. The sentinel lymph node biopsy technique can be safely applied to map lymphatic drainage patterns in patients with RCC. Further standardisation of sentinel node biopsy techniques is required to improve the clinical significance of mapping studies. Understanding lymphatic drainage in RCC may lead to an evidence‐based consensus on the surgical management of retroperitoneal lymph nodes.
      PubDate: 2014-08-13T09:36:00.030566-05:
      DOI: 10.1111/bju.12814
  • Propensity‐score matched analysis comparing robot‐assisted
           with laparoscopic partial nephrectomy
    • Authors: Zhenjie Wu; Mingmin Li, Shangqing Song, Huamao Ye, Qing Yang, Bing Liu, Chen Cai, Bo Yang, Liang Xiao, Qi Chen, Chen Lü, Xu Gao, Chuanliang Xu, Xiaofeng Gao, Jianguo Hou, Linhui Wang, Yinghao Sun
      Abstract: Objectives To compare the peri‐operative and early renal functional outcomes of robot‐assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) for kidney tumours. Materials and Methods A total of 237 patients fulfilling the selection criteria were included, of whom 146 and 91 patients were treated with LPN and RAPN, respectively. To adjust for potential baseline confounders, propensity‐score matching was performed. A favourable outcome was defined as a warm ischaemia time (WIT) of ≤20 min, negative surgical margins, no surgical conversion, no Clavien ≥3 complications and no postoperative chronic kidney disease (CKD) upstaging. Descriptive statistics and multivariable logistic regression analyses were performed before and after propensity‐score matching. Results Within the propensity‐score‐matched cohort, the RAPN group was associated with significantly lower estimated blood loss (EBL; 156 vs 198 mL, mean difference [MD] = −42; P = 0.025), a shorter WIT (22.8 vs 31 min, MD = −8.2; P < 0.001) and a higher proportion of malignant lesions (88.4 vs 67.5%; odds ratio [OR]: 2.6; 95% confidence interval [CI]: 1.2–5.67; P = 0.023). With regard to early renal functional outcomes, the mean last estimated glomerular filtration rate was 95.8 and 89.4 mL/min per 1.73 m2 (MD = 6.4; P = 0.01), with a mean ± sd percentage change of −4.8 ± 17.9 and −12.2 ± 16.6 (MD = 7.4; P = 0.018) in the RAPN and LPN groups, respectively. The intra‐operative complication rate was significantly lower in the RAPN group (1.3 vs 11.7%; OR 0.1, 95% CI 0.01–0.81; P = 0.018). On multivariable analysis, surgical approach (RAPN vs LPN, OR 5.457, 95% CI 2.075–14.346; P = 0.001), Charlson Comorbidity Index (OR 0.223; 95% CI 0.062–0.811; P = 0.023), diameter‐axial‐polar score (OR 0.488, 95% CI 0.329–0.723; P < 0.001) and preoperative CKD stage (OR 3.189, 95% CI 1.204–8.446; P = 0.020) were found to be independent predictors of obtaining a favourable outcome. Conclusions After adjusting for potential treatment selection biases, RAPN was found to be superior to LPN for peri‐operative outcomes (EBL, WIT and intra‐operative complications) and early renal functional preservation.
      PubDate: 2014-08-13T09:17:27.862438-05:
      DOI: 10.1111/bju.12774
  • 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
      Abstract: Objectives To 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
  • External validation of the Briganti nomogram to estimate the probability
           of specimen‐confined disease in patients with high‐risk
           prostate cancer
    • Authors: Mathieu Roumiguié; Jean‐Baptiste Beauval, Thomas Filleron, Thibaut Benoit, Pascal Rischmann, Alexandre Taille, Laurent Salomon, Michel Soulié, Bernard Malavaud, Guillaume Ploussard
      Abstract: Objective To establish an external validation of the updated nomogram from Briganti et al., which provides estimates of the probability of specimen‐confined disease using the variables age, prostate‐specific antigen (PSA), clinical stage and biopsy Gleason score in preoperatively defined high‐risk prostate cancer (PCa). Patients and Methods The study included 523 patients with high‐risk PCa, as defined by d'Amico classification, undergoing radical prostatectomy (RP) and bilateral lymph node dissection in one of two academic centres between 1990 and 2013. Specimen‐confined disease was defined as pT2–pT3a node‐negative PCa with negative surgical margins. The receiver–operator characteristic (ROC) curve was obtained to quantify the overall accuracy (area under the curve [AUC]) of the model in predicting specimen‐confined disease. A calibration curve was then constructed to illustrate the relationship between the risk estimates obtained by the model (x‐axis) and the observed proportion of specimen‐confined disease (y‐axis). The Kaplan–Meier method was used to assess biochemical recurrence (BCR)‐free survival. Results Patients' median age and PSA level were 64 years and 21 ng/mL, respectively. The definition of high‐risk PCa was based on PSA level only in 38.3%, a biopsy Gleason score >7 in 34.5%, a clinical stage >T2b in 6.9%, or a combination of these two or three factors in 20.3% of patients. Positive surgical margins were observed in 43.6%, with a rate of 14.8% in pT2 cancers and lymph node metastasis in 12.1% of patients. pT stage was pT0 in 0.9%, pT2 in 28.9%, pT3a in 37.5% and pT3b–4 in 32.7% of patients. Overall, 44.4% of patients (N = 232) had specimen‐confined disease. PSA and cT stage were independently predictive of specimen‐confined disease. The median (range) 2‐, 5‐, and 8‐year BCR‐free survival rates were significantly higher in specimen‐confined disease as compared with non‐specimen‐confined disease: 80.87 (73.67–86.29) vs 37.55 (30.64–44.44)%, 63.53 (52.37–72.74) vs 26.93 (19.97–34.36)% and 55.08 (41.49–66.74) vs 19.52 (12.50–27.70)%, respectively (P < 0.001). The ROC curve analysis showed relevant accuracy of the model (AUC 0.6470, 95% CI 0.60–0.69) although the calibration plot suggested that, for risks ranging from 0.3 to 0.5, the odds of extracapsular extension were underestimated. Conclusions This external validation of the Briganti nomogram shows relevant accuracy, although the relative imprecision for intermediate risk may limit its clinical relevance. Our follow‐up findings confirm the large proportion of specimen‐confined PCa with good oncological outcomes in this heterogeneous subgroup of patients with high‐risk PCa.
      PubDate: 2014-08-13T08:44:24.400723-05:
      DOI: 10.1111/bju.12763
  • Is radical nephrectomy a legitimate therapeutic option in patients with
           renal masses amenable to nephron‐sparing surgery'
    • Authors: Jeffrey J. Tomaszewski; Marc C. Smaldone, Robert G. Uzzo, Alexander Kutikov
      Abstract: The decision to perform a radical nephrectomy (RN) or a partial nephrectomy (PN), not unlike most decisions in clinical practice, ultimately hinges on the balance of risk. Do the higher risks of a more complex surgery (PN) justify the theoretical benefits of kidney tissue preservation' Data suggest that for patients with an anatomically complex renal mass and a normal contralateral kidney, for whom additional surgical intensity may be risky, such as the elderly and comorbid, RN presents a robust treatment option. Nevertheless, PN, especially for small and anatomically simple renal masses in young patients without comorbidities should remain the surgical reference standard, as preservation of renal tissue can serve as an ‘insurance policy’ not only against future renal functional decline, but also against the possibility of tumour development in the contralateral kidney. In the present review, we outline the ongoing debate between the role of RN and PN in treatment of the enhancing renal mass.
      PubDate: 2014-08-13T08:39:14.002305-05:
      DOI: 10.1111/bju.12696
  • Combined injection of three different lineages of
           early‐differentiating human amniotic fluid‐derived cells
           restores urethral sphincter function in urinary incontinence
    • Authors: So Young Chun; Joon Beom Kwon, Seon Yeong Chae, Jong Kil Lee, Jae‐sung Bae, Bum Soo Kim, Hyun Tae Kim, Eun Sang Yoo, Jeong Ok Lim, James J Yoo, Wun‐Jae Kim, Bup Wan Kim, Tae Gyun Kwon
      Abstract: Objective To investigate whether a triple combination of early‐differentiated cells derived from human amniotic fluid stem cells (hAFSCs) would show synergistic effects in urethral sphincter regeneration. Materials and Methods We early‐differentiated hAFSCs into muscle, neuron and endothelial progenitor cells and then injected them into the urethral sphincter region of pudendal neurectomized ICR mice, as single‐cell, double‐cell or triple‐cell combinations. Urodynamic studies and histological, immunohistochemical and molecular analyses were performed. Results Urodynamic study showed significantly improved leak point pressure in the triple‐cell‐combination group compared with the single‐cell‐ or double‐cell‐combination groups. These functional results were confirmed by histological and immunohistochemical analyses, as evidenced by the formation of new striated muscle fibres and neuromuscular junctions at the cell injection site. Molecular analysis showed higher target marker expression in the retrieved urethral tissue of the triple‐cell‐combination group. The injection of early‐differentiated hAFSCs suppressed in vivo host CD8 lymphocyte aggregations and did not form teratoma. The nanoparticle‐labelled early‐differentiated hAFSCs could be tracked in vivo with optical imaging for up to 14 days after injection. Conclusion Our novel concept of triple‐combined early‐differentiated cell therapy for the damaged sphincter may provide a viable option for incontinence treatment.
      PubDate: 2014-08-13T08:37:46.861095-05:
      DOI: 10.1111/bju.12815
  • Outcomes of men with an elevated prostate‐specific antigen (PSA)
           level as their sole preoperative intermediate‐ or high‐risk
    • Authors: Farzana A. Faisal; Debasish Sundi, Phillip M. Pierorazio, Mark W. Ball, Elizabeth B. Humphreys, Misop Han, Jonathan I. Epstein, Alan W. Partin, H. Ballentine Carter, Trinity J. Bivalacqua, Edward M. Schaeffer, Ashley E. Ross
      Abstract: Objective To investigate the post‐prostatectomy and long‐term outcomes of men presenting with an elevated pretreatment prostate‐specific antigen (PSA) level (>10 ng/mL), but otherwise low‐risk features (biopsy Gleason score ≤6 and clinical stage ≤T2a). Patients and Methods PSA‐incongruent intermediate‐risk (PII) cases were defined as those patients with preoperative PSA >10 and ≤20 ng/mL but otherwise low‐risk features, and PSA‐incongruent high‐risk (PIH) cases were defined as men with PSA >20 ng/mL but otherwise low‐risk features. Our institutional radical prostatectomy database (1992–2012) was queried and the results were stratified into D’Amico low‐, intermediate‐ and high risk, PSA‐incongruent intermediate‐risk and PSA‐incongruent high‐risk cases. Prostate cancer (PCa) features and outcomes were evaluated using appropriate comparative tests. Multivariable analyses were adjusted for age, race and year of surgery. Results Of the total cohort of 17 608 men, 1132 (6.4%) had PII‐risk disease and 183 (1.0%) had PIH‐risk disease. Compared with the low‐risk group, the odds of upgrading at radical prostatectomy (RP) were 2.20 (95% CI 1.93–2.52; P < 0.001) for the PII group and 3.58 (95% CI 2.64–4.85; P < 0.001) for the PIH group, the odds of extraprostatic disease at RP were 2.35 (95% CI 2.05–2.68; P < 0.001) for the PII group and 6.68 (95% CI 4.89–9.15; P < 0.001) for the PIH group, and the odds of positive surgical margins were 1.97 (95% CI 1.67–2.33; P < 0.001) for the PII group and 3.54 (95% CI 2.50–4.95, P < 0.001) for the PIH group. Compared with low‐risk disease, PII‐risk disease was associated with a 2.85‐, 2.99‐ and 3.32‐fold greater risk of biochemical recurrence (BCR), metastasis and PCa‐specific mortality, respectively, and PIH‐risk disease was associated with a 5.32‐, 6.14‐ and 7.07‐fold greater risk of BCR, metastasis and PCa‐specific mortality, respectively (P ≤ 0.001 for all comparisons). For the PII group, the higher risks of positive surgical margins, upgrading, upstaging and BCR were dependent on PSA density (PSAD): men in the PII group who had a PSAD 10 and ≤20 ng/mL with a PSAD ≥0.15 ng/mL/g, but otherwise low‐risk PCa, are at greater risk of adverse pathological and oncological outcomes and may be inappropriate candidates for active surveillance. These men are at greater risk of having anterior tumours that are undersampled at biopsy, so if treatment is deferred, ancillary testing such as anterior zone sampling or magnetic resonance imaging should be strongly encouraged. Men with elevated PSA levels >10 and ≤20 ng/mL but low PSAD have outcomes similar to those in the low‐risk group, and consideration of surveillance is appropriate in these cases.
      PubDate: 2014-08-13T08:32:08.058701-05:
      DOI: 10.1111/bju.12771
  • Development and internal validation of a nomogram for predicting
           stone‐free status after flexible ureteroscopy for renal stones
    • Authors: Hiroki Ito; Kentaro Sakamaki, Takashi Kawahara, Hideyuki Terao, Kengo Yasuda, Shinnosuke Kuroda, Masahiro Yao, Yoshinobu Kubota, Junichi Matsuzaki
      Abstract: Objective To develop and internally validate a preoperative nomogram for predicting stone‐free status (SF) after flexible ureteroscopy (fURS) for renal stones, as there is a need to predict the outcome of fURS for the treatment of renal stone disease. Patients and Methods We retrospectively analysed 310 fURS procedures for renal stone removal performed between December 2009 and April 2013. Final outcome of fURS was determined by computed tomography 3 months after the last fURS session. Assessed preoperative factors included stone volume and number, age, sex, presence of hydronephrosis and lower pole calculi, and ureteric stent placement. Multivariate logistic regression analysis with backward selection was used to model the relationship between preoperative factors and SF after fURS. Bootstrapping was used to internally validate the nomogram. Results Five independent predictors of SF after fURS were identified: stone volume (P < 0.001), presence of lower pole calculi (P = 0.001), operator with experience of >50 fURS (P = 0.026), stone number (P = 0.075), and presence of hydronephrosis (P = 0.047). We developed a nomogram to predict SF after fURS using these five preoperative characteristics. Total nomogram score (maximum 25) was derived from summing individual scores of each predictive variable; a high total score was predictive of successful fURS outcome, whereas a low total score was predictive of unsuccessful outcome. The area under the receiver operating characteristics for nomogram predictions was 0.87. Conclusion The nomogram can be used to reliably predict SF based on patient characteristics after fURS treatment of renal stone disease.
      PubDate: 2014-08-13T08:29:40.746532-05:
      DOI: 10.1111/bju.12775
  • Evolution of shockwave lithotripsy (SWL) technique: a 25‐year single
           centre experience of >5000 patients
    • Authors: Jitendra Jagtap; Shashikant Mishra, Amit Bhattu, Arvind Ganpule, Ravindra Sabnis, Mahesh Desai
      Abstract: Objective To assess the impact of various treatment optimisation strategies in shockwave lithotripsy (SWL) used at a single centre over the last 25 years. Patients and Methods In all, 5017 patients treated between 1989 and 2013 were reviewed and divided into groups A, B, C and D for the treatment periods of 1989–1994 (1561 patients), 1995–2000 (1741), 2001–2006 (1039) and 2007–2013 (676), respectively. The Sonolith 3000 (A and B) and Dornier compact delta lithotripters (C and D) were used. Refinements included frequent re‐localisation, limiting maximum shocks and booster therapy in group B and Hounsfield unit estimation, power ramping and improved coupling in group D. Parameters reviewed were annual SWL utilisation, stone and treatment data, retreatment, auxiliary procedures, complications and stone‐free rate (SFR). Results The SFR with Dornier compact delta was significantly higher than that of the Sonolith 3000 (P < 0.001). The SFR improved significantly from 77.58%, 81.28%, 82.58% to 88.02% in groups A, B, C, and D, respectively (P < 0.001). There was a concomitant decrease in repeat SWL (re‐treatment rate: A, 48.7%; B, 33.4%; C, 15.8%; and D, 10.1%; P < 0.001) and complication rates (A, 8%; B, 6.4%; C, 4.9%; and D, 1.6%; P < 0.001). This led to a rise in the efficiency quotient (EQ) in groups A–D from 50.41, 58.94, 68.78 to 77.06 (P < 0.001).The auxiliary procedure rates were similar in all groups (P = 0.62). Conclusion In conclusion, improvement in the EQ together with a concomitant decrease in complication rate can be achieved with optimum patient selection and use of various treatment optimising strategies.
      PubDate: 2014-08-11T06:13:56.586457-05:
      DOI: 10.1111/bju.12808
  • Real‐time transrectal ultrasonography‐guided hands‐free
           technique for focal cryoablation of the prostate
    • Authors: Andre Luis Castro Abreu; Duke Bahn, Sameer Chopra, Scott Leslie, Toru Matsugasumi, Inderbir S. Gill, Osamu Ukimura
      Pages: n/a - n/a
      Abstract: Objectives To describe, step‐by‐step, our hands‐free technique for focal cryoablation of prostate cancer. Materials and Methods After detailed discussion of its limitations and benefits, consent was obtained to perform focal cryoablation in patients with biopsy‐proven unilateral low‐ to intermediate‐risk prostate cancer. The procedure was performed transperineally, using a hands‐free technique (without an external grid template) under real‐time bi‐plane transrectal ultrasonography (TRUS) guidance, using an argon/helium‐gas‐based third generation cryoablation system. Follow‐up consisted of validated questionnaires, physical examination, PSA measures, multiparametric TRUS and/or magnetic resonance imaging (MRI) and mandatory biopsy. Results The important steps for achieving safety, satisfactory oncological and functional outcomes included: patient selection, including TRUS/MRI fusion target biopsy; thermocouple and cryoprobe placement with a hands‐free technique, allowing delivery in unrestricted angulations according to the prostatic contour, the course of the neurovascular bundle and the rectal wall angle; and hands‐free bi‐plane TRUS probe manipulation to facilitate real‐time monitoring of anatomical landmarks at the ideal angle of the image plane. To achieve a lethal temperature in the known cancer area, while preserving the urinary sphincter, neurovascular bundle, urethra and rectal wall, continuous intraoperative control of the thermocouple temperatures was necessary, as were real‐time TRUS monitoring of ice‐ball size, control of the energy delivered and the use of a warming urethral catheter. Conclusion We have described step‐by‐step the focal cryoablation of prostate cancer using a hands‐free technique. This technique facilitates the effective delivery of cryoprobes and the intra‐operative real‐time quick manipulation of the TRUS probe.
      PubDate: 2014-08-11T06:09:31.661608-05:
      DOI: 10.1111/bju.12795
  • Nanotechnology applications in urology: a review
    • Authors: Michael Maddox; James Liu, Sree Harsha Mandava, Cameron Callaghan, Vijay John, Benjamin R. Lee
      Pages: n/a - n/a
      Abstract: The objectives of this review are to discuss the current literature and summarise some of the promising areas with which nanotechnology may improve urological care. A Medline literature search was performed to elucidate all relevant studies of nanotechnology with specific attention to its application in urology. Urological applications of nanotechnology include its use in medical imaging, gene therapy, drug delivery, and photothermal ablation of tumours. In vitro and animal studies have shown initial encouraging results. Further study of nanotechnology for urological applications is warranted to bridge the gap between preclinical studies and translation into clinical practice, but nanomedicine has shown significant potential to improve urological patient care.
      PubDate: 2014-08-11T06:06:36.566175-05:
      DOI: 10.1111/bju.12782
  • γEpithelial Na+ Channel and the Acid‐Sensing Ion Channel 1
           expression in the urothelium of patients with neurogenic detrusor
    • Authors: C. Traini; G. Del Popolo, M. Lazzeri, K. Mazzaferro, F. Nelli, L. Calosi, M.G. Vannucchi
      Abstract: Objective To investigate the expression of two types of cation channels such as the γEpithelial Na+ Channel (γENaC) and the Acid‐Sensing Ion Channel1 (ASIC1) in the urothelium of controls and in patients affected by neurogenic detrusor overactivity (NDO). In parallel, the urodynamic parameters were collected and correlated to the immunohistochemical (IHC) results. Subjects and Methods Four controls and 12 patients with a clinical diagnosis of NDO and suprasacral spinal cord lesion underwent to urodynamic measurements and cystoscopy. Cold cup biopsies were frozen and processed for immunohistochemistry and western blots. Spearman's correlation coefficient between morphological and urodynamic data was applied. One‐way ANOVA followed by Newman–Keuls multiple comparison post‐hoc test was applied for western blot results. Results In the controls, γENaC and ASIC1 were expressed in the urothelium with differences in their cell distribution and intensity. In NDO patients, both markers showed consistent changes either in cell distribution and labeling intensity compared to controls. A significant correlation between the higher intensity of the γENaC expression in urothelium of NDO patients and the lower values of bladder compliance was detected. Conclusion The present findings show important changes in the expression of γENaC and ASIC1 in NDO human urothelium. Of note, while the changes in γENaC might impair the mechanosensory function of urothelium, the increase of the ASIC1 might represent an attempt to compensate excess in local sensitivity.
      PubDate: 2014-08-11T06:02:42.495484-05:
      DOI: 10.1111/bju.12896
  • Cardiopulmonary Reserve as Determined by Cardiopulmonary Exercise Testing
           Correlates with Length of Stay and Predicts Complications following
           Radical Cystectomy
    • Authors: Stephen Tolchard; Johanna Angell, Mark Pyke, Simon Lewis, Nicholas Dodds, Alia Darweish, Paul White, David Gillatt
      Abstract: Objective To investigate whether poor pre‐operative cardiopulmonary reserve and comorbid state dictate high risk status and can predict complications in patients undergoing radical cystectomy. Subjects and Methods 105 consecutive patients with transitional cell carcinoma (stage T1‐T3) undergoing robotic (n=38) or open (n=67) radical cystectomy in a single UK centre underwent pre‐operative cardiopulmonary exercise testing (CPET). Outcome measures and statistical analysis Prospective primary outcome variables were all cause complications and post‐operative 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 Fishers exact test. Any relationships were confirmed using the Mantel‐Haenszel Common Odds Ratio Estimate, Kaplan‐Meier analysis and the Chi‐squared test. Results AT was negatively (r = ‐·206, p = ·035), and VE/VCO2 positively (r = ·324, p = ·001) correlated with complications and LOS. Logistic regression analysis identified low AT (50% of patients presenting for radical cystectomy had significant heart failure, whereas pre‐operatively only very few (2%) had this diagnosis. Analysis using the Mann Whitney test showed that VE/VCO2≥33 was the most significant determinant of LOS (p = ·004). Kaplan‐Meier analysis showed that patients in this group had an additional median stay of 4 days (p = ·008). Finally, patients with an ASA grade of 3 and those on long‐term β‐blocker therapy were found to be at particular risk of MI and death following radical cystectomy with Odds ratios of 4.0 (p = ·042, 95% CI [1·05 – 15·24]) and 6.3 (p = ·008, [1·60 – 24·84]). Conclusion Patients with poor cardiopulmonary reserve and hypertension are at higher risk of post‐operative complications and have increased LOS following radical cystectomy. Heart failure is known to be a significant determinant of peri‐operative death and is significantly under diagnosed in this patient group.
      PubDate: 2014-08-11T06:02:34.259856-05:
      DOI: 10.1111/bju.12895
  • 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: Objectives 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 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. 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 of presentation of disease, number of stone episodes and interventions were compared between patients in the two groups using Mann‐Whitney U test. Results 41 patients had type A cystinuria including one patient with a variant of unknown significance. 23 patients had type B cystinuria, including 6 patients with variants of unknown significance. One patient had 3 sequence variants in SLC7A9 however 2 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 reported in literature. In patients with type A cystinuria, the presence of a missense mutation correlated to lower levels of urinary lysine (611.9mM/MC SE22.65 vs 752.3mM/MC SE46.39, p=0.0171), arginine (194.8mM/MC SE24.83 vs 397.7mM/MC SE15.32, p=0.0008) and ornithine (109.2mM/MC SE7.403 vs 146.6mM/MC SE12.7, p=0.0211). There was no difference in the levels of urinary cystine (182.1mM/MC SE8.89 vs 207.2mM/MC SE19.23, p=0.2343). Conclusions We have characterised the genetic diversity of cystinuria in a UK population including 23 pathogenic mutations not previously described in literature. Patients with at least one missense mutation in SLC3A1 had significantly lower levels of lysine, arginine, ornithine but not cystine than patients with all other combinations of mutations.
      PubDate: 2014-08-11T06:02:24.342261-05:
      DOI: 10.1111/bju.12894
  • Oncologic outcomes after partial versus radical nephrectomy in renal cell
           carcinomas smaller than 7 cm with presumed renal sinus fat invasion on
           preoperative imaging
    • Authors: Kyo Chul Koo; Jong Chan Kim, Kang Su Cho, Young Deuk Choi, Sung Joon Hong, Seung Choul Yang, Won Sik Ham
      Abstract: Objectives To compare oncological outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for renal tumors ≤7 cm which preoperative imaging reveals potential renal sinus fat invasion (cT3a), as RN is preferred for these tumors due to concerns regarding high tumor stage. Materials and Methods Among 1,137 nephrectomies performed for renal tumors ≤7 cm from January 2005 to August 2012, 401 solitary cT3a renal cell carcinomas (RCCs) without metastases were analyzed. Classification as cT3a included only renal sinus fat invasion, as there were no tumors with suspected perinephric fat invasion. Multivariate models were used to evaluate predictors of recurrence‐free survival (RFS) and cancer‐specific survival (CSS). Results There were 34 RCCs (8.5%) with unexpected perinephric fat invasion, but only 77 RCCs (19.2%) were staged as pT3a. During the median follow‐up of 43.0 months, recurrence occurred in seven (6.7%) PN cases and 25 (8.4%) RN cases. Six recurred PN cases had positive surgical margins (PSMs). The two cohorts showed equal oncologic outcomes with respect to 5‐year RFS and CSS. Multivariate analyses revealed PSM, pathologic T stage, sarcomatoid dedifferentiation, and type of surgery as significant predictors of recurrence. Older age, pathologic T stage, and sarcomatoid dedifferentiation were significant predictors of cancer‐specific mortality. Conclusions Renal tumors ≤7 cm with presumed renal sinus fat invasion were mostly pT1. PN conferred equivalent oncologic outcomes to RN. If clear surgical margins can be obtained, PN should be considered for these tumors, as patients may benefit from renal function preservation.
      PubDate: 2014-08-07T07:05:28.499173-05:
      DOI: 10.1111/bju.12893
  • Defining the Learning Curve for multi‐parametric MRI of the prostate
           using MRI‐TRUS fusion guided transperineal prostate biopsies as a
           validation tool
    • Authors: Gabriele Gaziev; Karan Wadhwa, Tristan Barrett, Brendan C. Koo, Ferdia A. Gallagher, Eva Serrao, Julia Frey, Jonas Seidenader, Lina Carmona, Anne Warren, Vincent Gnanapragasam, Andrew Doble, Christof Kastner
      Abstract: Objectives To determine the accuracy of multiparametric Magnetic Resonance Imaging (mpMRI) during the learning curve of radiologists using MRI targeted, transrectal ultrasound guided transperineal fusion biopsy (MTTP) for validation. Material And Methods Prospective data on 340 men who underwent mpMRI (T2 weighted and DW‐MRI) followed by MTTP prostate biopsy, was collected according to Ginsburg and STARD standards. MRI were reported by two experienced radiologists and scored on a Likert scale. Biopsies were performed by consultant urologists blinded to the MRI result and men had both targeted and systematic sector biopsies which were reviewed by a dedicated uropathologist. The cohorts were divided into groups representing five consecutive time intervals in the study. Sensitivity and specificity of positive MRI reports, Prostate cancer (CaP) detection by positive MRI, distribution of significant Gleason score and negative MRI with false negative for CaP were calculated. Data were sequentially analyzed and the learning curve was determined by comparing the first and last group. Results We detected a positive mpMRI in 64 patients from group A (91%) and 52 patients from group E (74%). CaP detection rate on mpMRI increased from 42% (27/64) in group A to 81% (42/52) in group E (p value
      PubDate: 2014-08-07T07:05:26.40246-05:0
      DOI: 10.1111/bju.12892
  • An evaluation of the ‘weekend effect’ in patients admitted
           with metastatic prostate cancer
    • Authors: Marianne Schmid; Khurshid R. Ghani, Toni K. Choueiri, Akshay Sood, Victor Kapoor, Firas Abdollah, Felix K. Chun, Jeffrey J. Leow, Kola Olugbade, Jesse D. Sammon, Mani Menon, Adam S. Kibel, Margit Fisch, Paul L. Nguyen, Quoc‐Dien Trinh
      Abstract: Objectives To investigate whether mortality is increased for patients with metastatic prostate cancer (mCaP) admitted over the weekend. Patients and methods Using the Nationwide Inpatient Sample (NIS) between 1998‐2009, admitted patients with a diagnosis of prostate cancer and concomitant metastases were identified. Rates of in‐hospital mortality, complications, utilization of imaging and procedures were assessed. Adjusted logistic regression models examined associations of mortality and complications. Results A weighted sample of 534,011 patients with mCaP was identified, including 81.7% weekday and 18.3% weekend admissions. Of these, 8.6% died following a weekday vs. 10.9% after a weekend admission (p
      PubDate: 2014-08-07T07:05:24.857614-05:
      DOI: 10.1111/bju.12891
  • Perioperative Outcomes of Cytoreductive Nephrectomy in the UK in 2012
    • Authors: Jackson BL; Fowler S, Williams ST,
      Abstract: Objectives To define the perioperative morbidity and 30‐day mortality of cytoreductive nephrectomy (CN) using the BAUS nephrectomy dataset for 2012, the first year of public reporting of individual surgeon outcomes in the United Kingdom. Patients & Methods All nephrectomies recorded in the database in 2012 were analysed, and cytoreductive cases identified. Outcome measures were: blood loss greater than 1000mls, transfusion requirement, intra‐ and post‐operative complications assessed by Clavien‐Dindo score, and 30‐day mortality (including failure‐to‐rescue rate). Univariate and multivariate logistic regression analysis was used to assess predictors of adverse outcomes. Results 279 cases were undertaken by 141 surgeons in 90 centres. WHO Performance Status was 0 or 1 in 72.4% (n = 202). Open nephrectomy was performed in 59% (n = 163), with the remainder laparoscopic. Conversion rate for laparoscopy was 14% (n=16). 40 patients underwent pre‐operative tyrosine‐kinase inhibitor treatment. No significant differences in outcome were observed for this group. 30‐day mortality was 1.79%. Intraoperative complications occurred in 11.9%, post‐operative complications in 20.8%. Complications of Clavien‐Dindo grade III or above occurred in 8%. Blood loss of greater than one litre occurred in 15.4% of cases and 24.1% of patients required a perioperative transfusion. Tumour size >10cm was an independent risk factor for blood loss >1 litre (p=0.021) and intraoperative complications (p=0.021). The number of metastatic sites was an independent predictor of blood loss >1 litre (p=0.001) and transfusion requirement (p=0.026). Performance status of two or more was also independently associated with intraoperative complication risk (p=0.021). Conclusions CN in contemporary UK practice appears to have excellent perioperative outcomes overall. Risk factors for adverse perioperative outcomes include tumour size over 10cm, number of metastatic sites and PS ≥ 2. The balance of risk and benefit for CN should be carefully considered for patients with poor performance status or extensive metastases.
      PubDate: 2014-08-07T07:05:22.897188-05:
      DOI: 10.1111/bju.12890
  • Number of positive pre‐operative biopsy cores is a predictor of
           positive surgical margins in small prostates after robot‐assisted
           radical prostatectomy
    • Authors: Patrick H. Tuliao; Kyo Chul Koo, Christos Komninos, Chien Hsiang Chang, Young Deuk Choi, Byung Ha Chung, Sung Joon Hong, Koon Ho Rha
      Abstract: Objective To determine the impact of prostate size on positive surgical margin (PSM) rates after RARP and the pre‐operative factors associated with PSM. Materials And Methods A total of 1,229 men underwent RARP by a single surgeon, from 2005 to August of 2013. Excluded were patients who had trans‐urethral resection of the prostate, neo‐adjuvant therapy, clinically‐advanced cancer, and the first 200 performed cases, to reduce the effect of learning curve. Included were 815 patients who were then divided into three groups: 45 g (group3). Multivariate analysis determined predictors of PSM and BCR. Results Console time and blood loss increased with increasing prostate size. There were more high‐grade tumors in group one (group1 vs. group2 and group3, 33.9% vs. 25.1 and 25.6%, p=0.003 and p=0.005). PSM were increased in 20 ng/dl, Gleason score >7, T3 tumor, and >3 positive biopsy cores. In group one, pre‐operative stage T3 (OR=3.94, p=0.020) and >3 positive biopsy core (OR=2.52, p=0.043) were predictive of PSM while a PSA >20ng/dl predicted the occurrence of BCR (OR=5.34, p=0.021). No pre‐operative factors predicted PSM or BCR for groups two and three. Conclusion A pre‐operative biopsy with >3 positive cores in men with small prostates predicts PSM after RARP. In small prostates with PSM, a PSA >20 ng/dl is a predictor of BCR. These factors should guide the choice of therapy and indicate the need for closer post‐operative follow‐up.
      PubDate: 2014-08-07T07:05:21.294877-05:
      DOI: 10.1111/bju.12888
  • Minimum five‐year follow‐up of 1,138 consecutive laparoscopic
           radical prostatectomies
    • Authors: Ricardo Soares; Antonina Di Benedetto, Zach Dovey, Simon Bott, Roy G. McGregor, Christopher G. Eden
      Abstract: Objectives To investigate the long‐term outcomes of laparoscopic radical prostatectomy (LRP). Methods A total of 1,138 patients underwent LRP during a 163 month period from 2000‐2008 of which 51.5%, 30.3% and 18.2% were in d'Amico's low‐, intermediate‐ and high‐risk groups [d'Amico, 1998], respectively. All intermediate‐ and high‐risk patients were staged by pre‐operative MRI or CT and isotope bone scanning and had a pelvic lymph node dissection (PLND), which was extended after April 2008. Median patient age (with range) = 62 (40‐78) yr; BMI = 26 (19‐44) kg/m2; PSA = 7.0 (1‐50) ng/ml and Gleason = 6 (6‐10). NVB preservation was done in 55.3% (bilateral = 45.5%; unilateral = 9.8%) of patients. Results Median gland weight = 52 (14‐214) g; operating time = 177 (78‐600) minutes; PLND in 299 (26.3%) of which 54 (18.0%) were extended; blood loss = 200 (10‐1300) ml; post‐op. Hospital stay = 3 (2‐14) nights; catheterization time = 14 (1‐35) days; complication rate = 5.2%; node count = 12 (4‐26); lymph node positivity = 0.8%; node involvement = 2 (1‐2); margin positivity = 13.9%; up‐grading = 29.3%; down‐grading = 5.3%; up‐staging from T1/2 to T3 = 11.4%; down‐staging from T3 to T2 = 37.1%. One case (0.09%) was converted to open surgery and 6 patients were transfused (0.5%). At a mean 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
      PubDate: 2014-08-07T07:05:19.53146-05:0
      DOI: 10.1111/bju.12887
  • Lack of association of joint hypermobility with urinary incontinence
           subtypes and pelvic organ prolapse
    • Abstract: Objective To 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.
  • Ureteric stents vs percutaneous nephrostomy for initial urinary drainage
           in children with obstructive anuria and acute renal failure due to
           ureteric calculi: a prospective, randomised study
    • Abstract: Objectives To compare percutaneous nephrostomy (PCN) tube vs JJ ureteric stenting as the initial urinary drainage method in children with obstructive calcular anuria (OCA) and post‐renal acute renal failure (ARF) due to bilateral ureteric calculi, to identify the selection criteria for the initial urinary drainage method that will improve urinary drainage, decrease complications and facilitate the subsequent definitive clearance of stones, as this comparison is lacking in the literature. Patients and Methods A series of 90 children aged ≤12 years presenting with OCA and ARF due to bilateral ureteric calculi were included from March 2011 to September 2013 at Cairo University Pediatric Hospital in this randomised comparative study. Patients with grade 0–1 hydronephrosis, fever or pyonephrosis were excluded. No patient had any contraindication for either method of drainage. Stable patients (or patients stabilised by dialysis) were randomised (non‐blinded, block randomisation, sealed envelope method) into PCN‐tube or bilateral JJ‐stent groups (45 patients for each group). Initial urinary drainage was performed under general anaesthesia and fluoroscopic guidance. We used 4.8–6 F JJ stents or 6–8 F PCN tubes. The primary outcomes were the safety and efficacy of both groups for the recovery of renal functions. Both groups were compared for operative and imaging times, complications, and the period required for a return to normal serum creatinine levels. The secondary outcomes included the number of subsequent interventions needed for clearance of stones. Additional analysis was done for factors affecting outcome within each group. Results All presented patients completed the study with intention‐to‐treat analysis. There was no significant difference between the PCN‐tube and JJ‐stent groups for the operative and imaging times, period for return to a normal creatinine level and failure of insertion. There were significantly more complications in the PCN‐tube group. The stone size (>2 cm) was the only factor affecting the rates of mucosal complications, operative time and failure of insertion in the JJ‐stent group. The degree of hydronephrosis significantly affected the operative time for PCN‐tube insertion. Grade 2 hydronephrosis was associated with all cases of insertion failure in the PCN‐tube group. The total number of subsequent interventions needed to clear stones was significantly higher in the PCN‐tube group, especially in patients with bilateral stones destined for chemolytic dissolution (alkalinisation) or extracorporeal shockwave lithotripsy (ESWL). Conclusion We recommend the use of JJ stents for initial urinary drainage for stones that will be subsequently treated with chemolytic dissolution or ESWL, as this will lower the total number of subsequent interventions needed to clear the stones. This is also true for stones destined for ureteroscopy (URS), as JJ‐stent insertion will facilitate subsequent URS due to previous ureteric stenting. Mild hydronephrosis will prolong the operative time for PCN‐tube insertion and may increase the incidence of insertion failure. We recommend the use of PCN tube if the stone size is >2 cm, as there was a greater risk of possible iatrogenic ureteric injury during stenting with these larger ureteric stones in addition to prolongation of operative time with an increased incidence of failure.
  • Diagnostic accuracy of magnetic resonance imaging (MRI) prostate imaging
           reporting and data system (PI‐RADS) scoring in a transperineal
           prostate biopsy setting
    • Abstract: Objectives To determine the sensitivity and specificity of multiparametric magnetic resonance imaging (mpMRI) for significant prostate cancer with transperineal sector biopsy (TPSB) as the reference standard. Patients and Methods The study included consecutive patients who presented for TPSB between July 2012 and November 2013 after mpMRI (T2‐ and diffusion‐weighted images, 1.5 Tesla scanner, 8‐channel body coil). A specialist uro‐radiologist, blinded to clinical details, assigned qualitative prostate imaging reporting and data system (PI‐RADS) scores on a Likert‐type scale, denoting the likelihood of significant prostate cancer as follows: 1, highly unlikely; 3, equivocal; and 5, highly likely. TPSBs sampled 24–40 cores (depending on prostate size) per patient. Significant prostate cancer was defined as the presence of Gleason pattern 4 or cancer core length ≥6 mm. Results A total of 201 patients were included in the analysis. Indications were: a previous negative transrectal biopsy with continued suspicion of prostate cancer (n = 103); primary biopsy (n = 83); and active surveillance (n = 15). Patients' mean (±sd) age, prostate‐specific antigen and prostate volumes were 65 (±7) years, 12.8 (±12.4) ng/mL and 62 (±36) mL, respectively. Overall, biopsies were benign, clinically insignificant and clinically significant in 124 (62%), 20 (10%) and 57 (28%) patients, respectively. Two of 88 men with a PI‐RADS score of 1 or 2 had significant prostate cancer, giving a sensitivity of 97% (95% confidence interval [CI] 87–99) and a specificity of 60% (95% CI 51–68) at this threshold. Receiver–operator curve analysis gave an area under the curve of 0.89 (95% CI 0.82–0.92). The negative predictive value of a PI‐RADS score of ≤2 for clinically significant prostate cancer was 97.7% Conclusion We found that PI‐RADS scoring performs well as a predictor for biopsy outcome and could be used in the decision‐making process for prostate biopsy.
  • Role of emergency ureteroscopy in the management of ureteric stones:
           analysis of 394 cases
    • Abstract: Objective To analyse the outcomes of emergency ureteroscopy (URS) cases performed in Auckland City Hospital. Methods We conducted a retrospective review of all emergency URS procedures performed at Auckland City Hospital between 1 January 2010 and 31 December 2011. Data on patients, stones and procedures were collected and analysed. Emergency URS failure was defined as fragments >3 mm or the need for a repeat procedure. Results A total of 499 URS procedures were identified. Of these 394 (79%) were emergency procedures. The mean (sd; range) patient age was 48 (16; 13–88) years. In all, 83% of emergency URS cases had an American Society of Anesthesiologists (ASA) score of 1 or 2, 25% of stones were >9 mm, with a mean (sd) size of 8 (4) mm, and 285 procedures (72%) were successful. These patients were younger (47 vs 51 years), were more likely to have an ASA score of 1 (103 patients in the successful treatment group vs 26 in the failed treatment group), had smaller stones (7 vs 9 mm) and were more likely to have distal stones (P < 0.05). A total of 20 complications (5%) were recorded including six false passages and three mucosal injuries, one of which required radiological intervention, and 50 patients (13%) re‐presented, for pain (76%), bleeding (10%) or infection (14%). Conclusion We showed that emergency URS is a feasible approach for the routine management of acute ureteric colic with a low complications rate. A subgroup of younger, healthier patients may benefit the most from the procedure.
  • Long‐term follow‐up of a multicentre randomised controlled
           trial comparing tension‐free vaginal tape, xenograft and autologous
           fascial slings for the treatment of stress urinary incontinence in women
    • Abstract: Objective To compare the long‐term outcomes of a tension‐free vaginal tape (TVT; Gynecare™, Somerville, NJ, USA), autologous fascial sling (AFS) and xenograft sling (porcine dermis, Pelvicol™; Bard, Murray Hill, NJ, USA) in the management of female stress urinary incontinence (SUI). Patients and Methods A multicentre randomised controlled trial carried out in four UK centres from 2001 to 2006 involving 201 women requiring primary surgery for SUI. The women were randomly assigned to receive TVT, AFS or Pelvicol. The primary outcome was surgical success defined as ‘women reporting being completely ‘dry’ or ‘improved’ at the time of follow‐up’. The secondary outcomes included ‘completely dry’ rates, changes in the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) and EuroQoL EQ‐5D questionnaire scores. Results In all, 162 (80.6%) women were available for follow‐up with a median (range) duration of 10 (6.6–12.6) years. ‘Success’ rates for TVT, AFS and Pelvicol were 73%, 75.4% and 58%, respectively. Comparing the 1‐ and 10‐year ‘success’ rates, there was deterioration from 93% to 73% (P < 0.05) in the TVT arm and 90% to 75.4% (P < 0.05) in the AFS arm; ‘dry’ rates were 31.7%, 50.8% and 15.7%, respectively. Overall, the ‘dry’ rates favoured AFS when compared with Pelvicol (P < 0.001) and TVT (P = 0.036). The re‐operation rate for persistent SUI was 3.2% (two patients) in the TVT arm, 13.1% (five) in the Pelvicol arm, while none of the patients in the AFS arm required further intervention. Conclusions Our study indicates there is not enough evidence to suggest a difference in long‐term success rates between AFS and TVT. However, there is some evidence that ‘dry’ rates for AFS may be more durable than TVT.
  • Contemporary practice and technique‐related outcomes for radical
           prostatectomy in the UK: a report of national outcomes
    • Abstract: Objective To determine current radical prostatectomy (RP) practice in the UK and compare surgical outcomes between techniques. Patients and Methods All RPs performed between 1 January 2011 and 31 December 2011 in the UK with data entered into the British Association of Urological Surgeons (BAUS) database, were identified for analysis. Overall surgical outcomes were assessed and subgroup analyses of these outcomes, based on operative technique [open RP (ORP), laparoscopic RP (LRP) and robot‐assisted laparoscopic RP (RALP)], were made. Continuous variables were compared using the Mann–Whitney U‐test and categorical variables using the Pearson chi‐squared test. Univariate and multivariate binary regression analyses were performed to assess the effect of patient, surgeon and technique‐related variables on surgical outcomes. Results During the study period 2163 RPs were performed by 115 consultants with a median (range) of 11 (1–154) cases/consultant. Most RPs were performed laparoscopically (ORP 25.8%, LRP 54.6%, RALP 19.6%) and those performing minimally invasive techniques are more likely to have a higher annual case volume with 50 cases/year. Most patients were classified as having intermediate‐ or high‐risk disease preoperatively (1596 patients, 82.5%) and this increased to 97.2% (1649) on postoperative risk stratification. The overall intraoperative complication rate was 14.2% and was significantly greater for LRP (17.8%) vs ORP (8.2%) and RALP (12.4%), (P < 0.001). In all, 71% of patients had an estimated blood loss (EBL) of 500, > 1000 and >2000 mL EBL compared with the other techniques (P < 0.001). The postoperative complication rate was 10.7% overall, with a significantly greater postoperative complication rate in the LRP group (LRP 14.6%, ORP 8.8% and RALP 10.3% respectively, P = 0.007). Positive surgical margin (PSM) rates were 17.5% for pT2 disease and 42.3% for pT3 disease. The PSM rate was significantly lower in the RALP patients compared with the ORP patients for those with pT2 disease (P = 0.025), while there was no difference between ORP and LRP (ORP 21.7%, LRP 18.1% and RALP 13.0%). There was no significant difference in the PSM rate in pT3 disease between surgical techniques. Conclusion Most RPs in the UK are performed using minimally invasive techniques, which offer reduced blood loss and transfusion rates compared with ORP. The operation time, complication rate, PSM rates, and association with higher volume practice support RALP as the minimally invasive technique of choice, which could have implications for regions without access to such services. The disparity in outcomes between this national study and high‐volume single centres, most probably reflects the low median national case volume, and combined with the positive effect of high case volume on multivariate analysis of surgical outcomes and PSM rates, strengthens the argument for centralisation of services.
  • Incidence of needle‐tract seeding following prostate biopsy for
           suspected cancer: a review of the literature
    • Abstract: With the widespread clinical use of prostate‐specific antigen (PSA), biopsy of the prostate has become one of the most commonly performed urological procedures. In general it is well tolerated, although there is some morbidity and risk of infection. In recent years, there have been increasing concerns that prostate biopsy may lead to tumour seeding along the needle tract. The aim of the present paper was to review the evidence on the prevalence of tumour seeding after prostate biopsy and to define the risk of this event in the context of current clinical practice. A PubMed literature search was conducted in January 2014 according to the Preferred Reporting Items for Systematic Reviews and Meta‐analysis (PRISMA) statement. Literature was examined with emphasis on the incidence of seeding, clinical presentation and on risk factors including type of needle used, transrectal vs transperineal approach, as well as tumour grade and stage. In all, 26 publications were identified reporting needle‐tract seeding after prostate biopsy. In all, 42 patients with needle‐tract seeding were identified. In most cases, seeding was reported after transperineal biopsy of the prostate, while nine cases occurred after transrectal biopsy. Based on the reviewed series the incidence of seeding appears to be
  • Evaluation of functional outcomes after laparoscopic partial nephrectomy
           using renal scintigraphy: clamped vs clampless technique
    • Abstract: Objectives To 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.
  • Patients with prostate cancer continue to have excess mortality up to 15
           years after diagnosis
    • Abstract: Objective To estimate the population‐based conditional 5‐year relative survival rates for patients with prostate cancer (PCa). Patients and Methods All 98 672 patients, aged 45–89 years, diagnosed in the Netherlands with PCa (clinical T stage 1–4) in the period 1989–2008 were selected from the Netherlands Cancer Registry and followed up until 2010. The conditional 5‐year relative survival rate was estimated for every subsequent year of survival up to 15 years after diagnosis. Results The conditional 5‐year relative survival rate decreased with survival time from diagnosis. Excess mortality (conditional 5‐year relative survival rate
  • Positive surgical margins: rate, contributing factors and impact on
           further treatment: findings from the Prostate Cancer Registry
    • Abstract: Objective To describe the characteristics of patients with and without positive surgical margins (PSMs) and to analyse the impact of PSMs on secondary cancer treatment after radical prostatectomy (RP), with short‐term follow‐up. Patients and Methods We analysed data from 2385 consecutive patients treated using RP, who were notified to the Prostate Cancer Registry by 37 hospitals in Victoria, Australia between August 2008 and February 2012. Independent and multivariate models were constructed to predict the likelihood of PSMs. Independent and multivariate predictors of secondary treatment after RP in the initial 12 months after diagnosis were also assessed. Results Data on PSM status were collected for 2219/2385 (93%) patients. In total 592/2175 (27.2%) RPs resulted in PSMs; 102/534 (19.1%) in the low‐risk group, 317/1218 (26.0%) in the intermediate‐risk group, 153/387 (39.5%) in the high‐risk group, and 9/11 (81.8%) in the very‐high‐risk disease group of patients. Patients having surgery in a hospital where
  • Postoperative statin use and risk of biochemical recurrence following
           radical prostatectomy: results from the Shared Equal Access Regional
           Cancer Hospital (SEARCH) database
    • Abstract: Objective To investigate the effect of statin use after radical prostatectomy (RP) on biochemical recurrence (BCR) in patients with prostate cancer who never received statins before RP. Patients and Methods We conducted a retrospective analysis of 1146 RP patients within the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Multivariable Cox proportional hazards analyses were used to examine differences in risk of BCR between post‐RP statin users vs nonusers. To account for varying start dates and duration of statin use during follow‐up, post‐RP statin use was treated as a time‐dependent variable. In a secondary analysis, models were stratified by race to examine the association of post‐RP statin use with BCR among black and non‐black men. Results After adjusting for clinical and pathological characteristics, post‐RP statin use was significantly associated with 36% reduced risk of BCR (hazard ratio [HR] 0.64, 95% confidence interval [CI] 0.47–0.87; P = 0.004). Post‐RP statin use remained associated with reduced risk of BCR after adjusting for preoperative serum cholesterol levels. In secondary analysis, after stratification by race, this protective association was significant in non‐black (HR 0.49, 95% CI 0.32–0.75; P = 0.001) but not black men (HR 0.82, 95% CI 0.53–1.28; P = 0.384). Conclusion In this retrospective cohort of men undergoing RP, post‐RP statin use was significantly associated with reduced risk of BCR. Whether the association between post‐RP statin use and BCR differs by race requires further study. Given these findings, coupled with other studies suggesting that statins may reduce risk of advanced prostate cancer, randomised controlled trials are warranted to formally test the hypothesis that statins slow prostate cancer progression.
  • Positive vascular wall margins have minimal impact on cancer outcomes in
           patients with non‐metastatic renal cell carcinoma (RCC) with tumour
    • Abstract: Objective To evaluate the impact of microscopically positive vascular margins on recurrence and cancer‐specific survival (CSS) in patients with renal cell carcinoma (RCC) with venous thrombus Patients and Methods We reviewed the records from the period 1993 to 2009 of consecutive patients treated surgically for RCC with venous tumour thrombus at the University of Texas MD Anderson Cancer Center. Patients with metastatic disease, positive soft tissue margins or gross residual disease at time of thrombectomy were excluded. The primary outcome measures were local or systemic disease recurrence, and CSS. Univariate and multivariate analysis were used to evaluate whether microscopically positive vascular margins were associated with RCC recurrence or CSS after nephrectomy with thrombectomy. Results A total of 256 patients with RCC were identified with a median (interquartile range) follow‐up of 36.7 (18.4–63.5) months. Microscopic tumour was present at the margin of resection in 47 patients (18.4%). The median recurrence‐free interval was significantly shorter in patients with positive vascular margins: 22.1 vs 70.2 months (P = 0.009). The rate of local recurrence was higher in patients with positive vein margins: 12.8 vs 4.3% (P < 0.01). Local recurrence without concomitant systemic recurrence was identified in only two of 256 (0.8%) patients. Patients with positive vascular margins had significantly worse CSS times compared with patients with negative vascular margins: 37.7 vs 93.0 months (P = 0.004). In multivariable analysis, positive vascular margins were found to be independently predictive of local recurrence but not of systemic recurrence or CSS. Conclusions Complete surgical excision should always be attempted because positive vascular wall margins increase local recurrence rates. Invasion of RCC into the vein wall at the resection margin is associated with aggressive tumour biology, and the majority of patients with positive vascular wall margins experience systemic recurrence.
  • Lessons learned from Asian Urology
  • Statins and biochemical recurrence after radical prostatectomy – who
  • ‘Discontent is the first necessity of progress’, Thomas A.
  • Evolution of extracorporeal shockwave lithotripsy (ESWL)
  • Where next in ketamine uropathy' Dedicated management centres'
  • Prostate artery embolization (PAE) for benign prostatic hyperplasia (BPH)
  • Current status of magnetic resonance imaging (MRI) and ultrasonography
           fusion software platforms for guidance of prostate biopsies
    • Abstract: Prostate MRI is currently the best diagnostic imaging method for detecting PCa. Magnetic resonance imaging (MRI)/ultrasonography (US) fusion allows the sensitivity and specificity of MRI to be combined with the real‐time capabilities of transrectal ultrasonography (TRUS). Multiple approaches and techniques exist for MRI/US fusion and include direct ‘in bore’ MRI biopsies, cognitive fusion, and MRI/US fusion via software‐based image coregistration platforms.
  • Corrigendum
  • One‐stop clinic for ketamine‐associated uropathy: report on
           service delivery model, patients' characteristics and non‐invasive
           investigations at baseline by a cross‐sectional study in a
           prospective cohort of 318 teenagers and young adults
    • Abstract: Objective To describe a service delivery model and report the baseline characteristics of patients investigated by a non‐invasive approach for ketamine‐associated uropathy. Patients and Methods This was a cross‐sectional study in a prospective cohort of patients who attended their first visit and underwent non‐invasive investigations at a dedicated centre to treat ketamine‐associated uropathy in Hong Kong from December 2011 to July 2013. Data on demographics, illicit ketamine use, symptoms scores and voiding function parameters at baseline were prospectively collected. Differences between active abusers and ex‐abusers, and risk factors for the most symptomatic group were investigated by univariate and multivariate analysis. Results In all, 318 patients completed the non‐invasive assessment at their first visit and were eligible for inclusion. In all, 174 were female and the mean (sd) age of the entire cohort was 24.4 (3.1) years. Patients had used ketamine for a mean (sd) period of 81 (36) months. The mean (sd) ketamine use per week was 18.5 (15.8) g. In all, 214 patients were active abusers while 104 were ex‐abusers but had persistent lower urinary tract symptoms. The mean (sd) voided volume, bladder capacity, and bladder emptying efficiency were 111.5 (110) mL, 152.5 (126) mL and 73.3 (26.9)%, respectively. The ex‐abusers had a lower symptom score (19.3 vs 24.1; P < 0.001), a larger voided volume (126 vs 85 mL; P < 0.001), and a larger bladder capacity (204.8 vs 126.7 mL; P < 0.001) compared with active abusers. Multivariate analysis found female gender was associated with a higher symptom score (odds ratio [OR] 2.39; 95% confidence interval [CI] 1.35–4.23; P = 0.003) and a smaller voided volume (OR 1.9; 95% CI 1.1–3.3; P = 0.02). Ketamine taken (g/week) was another risk factor for a higher symptom score (OR 1.03; 95% CI 1.01–1.05; P = 0.002). Status of ex‐abuser was the only protective factor associated with fewer symptoms, larger voided volume and bladder capacity. Conclusions An effective service model for recruiting patients with ketamine‐associated uropathy is possible. With such a service model as a platform, further prospective studies are warranted to investigate the appropriate choice of treatment for this new clinical entity.
  • Postoperative nomogram to predict cancer‐specific survival after
           radical nephroureterectomy in patients with localised and/or locally
           advanced upper tract urothelial carcinoma without metastasis
    • Abstract: Objective To propose and validate a nomogram to predict cancer‐specific survival (CSS) after radical nephroureterectomy (RNU) in patients with pT1–3/N0–x upper tract urothelial carcinoma (UTUC). Patients and Methods The international and the French national collaborative groups on UTUC pooled data from 3387 patients treated with RNU. Only 2233 chemotherapy naïve pT1–3/N0–x patients were included in the present study. The population was randomly split into the development cohort (1563) and the external validation cohort (670). To build the nomogram, logistic regressions were used for univariable and multivariable analyses. Different models were generated. The most accurate model was assessed using Harrell's concordance index and decision curve analysis (DCA). Internal validation was then performed by bootstrapping. Finally, the nomogram was calibrated and externally validated in the external dataset. Results Of the 1563 patients in the nomogram development cohort, 309 (19.7%) died during follow‐up from UTUC. The actuarial CSS probability at 5 years was 75.7% (95% confidence interval [CI] 73.2–78.6%). DCA revealed that the use of the best model was associated with benefit gains relative to prediction of CSS. The optimised nomogram included only six variables associated with CSS in multivariable analysis: age (P < 0.001), pT stage (P < 0.001), grade (P < 0.02), location (P < 0.001), architecture (P < 0.001) and lymphovascular invasion (P < 0.001). The accuracy of the nomogram was 0.81 (95% CI, 0.78–0.85). Limitations included the retrospective study design and the lack of a central pathological review. Conclusion An accurate postoperative nomogram was developed to predict CSS after RNU only in locally and/or locally advanced UTUC without metastasis, where the decision for adjuvant treatment is controversial but crucial for the oncological outcome.
  • Muscle‐invasive bladder cancer: evaluating treatment and survival in
           the National Cancer Data Base
    • Abstract: Objective To evaluate the association between patterns of care and patient survival for the treatment of muscle‐invasive bladder cancer (MIBC) using a large, national database. Patients and Methods We identified a cohort of 36 469 patients with MIBC (stage II) from 1998 to 2010 from the National Cancer Data Base. Patients were stratified into four treatment groups: radical cystectomy, chemo‐radiation, other therapy, or no treatment. Overall survival (OS) among the groups was evaluated using Kaplan–Meier analysis and the log rank test. A multivariable Cox proportional hazards model was fit to evaluate the association between treatment groups and OS. Results In all, 27% of patients received radical cystectomy, 10% chemo‐radiation, 61% other therapy and 2% no treatment. Unadjusted Kaplan–Meier analysis showed significant differences by treatment group, with cystectomy having the greatest median OS (48 months) followed by chemo‐radiation (28 months), other therapy (20 months), and no treatment (5 months). When controlling for multiple covariates, the OS for cystectomy was similar to that for chemo‐radiation (hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.98, 1.12), but superior to other therapy (HR 1.42; 95% CI 1.35, 1.48), and no treatment (HR 2.40; 95% CI 2.12, 2.72). The OS time for chemo‐radiation was superior to other therapy and no treatment. Conclusions Radical cystectomy and chemo‐radiation are significantly underused despite a substantial survival benefit compared with other therapies or no treatment. Future studies are needed to optimise care delivery and improve outcomes for patients with MIBC.
  • Low‐dose oral desmopressin for treatment of nocturia and nocturnal
           enuresis in patients after radical cystectomy and orthotopic urinary
    • Abstract: Objectives To assess the effect of oral desmopressin on nocturia and nocturnal enuresis in patients after orthotopic neobladder reconstruction. Patients and Methods Of 55 patients who underwent radical cystectomy and orthotopic neobladder reconstruction at our medical centre in the period 2004–2011, 34 patients were deemed eligible for the present study. Inclusion criteria were estimated glomerular filtration rate >50 mL/min/1.73 m2, normal baseline sodium serum level, intact daytime urinary continence, and any degree of nocturia or nocturnal enuresis. Patients were treated daily with oral desmopressin 0.1 mg at bedtime for 30 days and completed the Nocturia, Nocturnal Enuresis and Sleep Interruption Questionnaire at trial enrolment and closure. Sodium serum levels were monitored throughout. Results Three patients withdrew from the trial because of headaches or anxiety. The mean (sd) number of nocturnal voids decreased from 2.5 (1.4)/night at baseline to 1.5 (1.3)/night at trial closure (P = 0.015). The number of patients with one or no episodes of nocturnal enuresis per week increased from six to 12 (19 to 39%; P = 0.065). Thirteen patients (42%) reported an increase of a minimum 1–2 h of sleep until the first nocturnal void; all of them asked to continue the drug. No significant adverse events or changes in sodium level were observed. Conclusions Bedtime treatment with low‐dose oral desmopressin appears to decrease episodes of nocturia and nocturnal enuresis effectively and safely in ∼50% of the patients with neobladder, allowing longer undisrupted sleep time and improved quality of life. Further investigation is warranted to determine if higher doses would result in a more meaningful clinical response.
  • The emerging use of Twitter by urological journals
    • Abstract: Objective To assess the emerging use of Twitter by urological journals. Methods A search of the Journal of Citation Reports 2012 was performed to identify urological journals. These journals were then searched on Each journal website was accessed for links to social media (SoMe). The number of ‘tweets’, followers and age of profile was determined. To evaluate the content, over a 6‐month period (November 2013 to April 2014), all tweets were scrutinised on the journals Twitter profiles. To assess SoMe influence, the Klout score of each journal was also calculated. Results In all, 33 urological journals were identified. Eight (24.2%) had Twitter profiles. The mean (range) number of tweets and followers was 557 (19–1809) and 1845 (82–3692), respectively. The mean (range) age of the twitter profiles was 952 (314–1758) days with an average 0.88 tweets/day. A Twitter profile was associated with a higher mean impact factor of the journal (mean [sd] 3.588 [3.05] vs 1.78 [0.99], P = 0.013). Over a 6‐month period, November 2013 to April 2014, the median (range) number of tweets per profile was 82 (2–415) and the median (range) number of articles linked to tweets was 73 (0–336). Of these 710 articles, 152 were Level 1 evidence‐based articles, 101 Level 2, 278 Level 3 and 179 Level 4. The median (range) Klout score was 47 (19–58). The Klout scores of major journals did not exactly mirror their impact factors. Conclusion SoMe is increasingly becoming an adjunct to traditional teaching methods, due to its convenient and user‐friendly platform. Recently, many of the leading urological journals have used Twitter to highlight significant articles of interest to readers.
  • Ejaculatory dysfunction after treatment for lower urinary tract symptoms:
           retrograde ejaculation or retrograde thinking'
  • Robotic management of genitourinary injuries from obstetric and
    • Abstract: Objective To evaluate the utility of robotic repair of injuries to the ureter or bladder from obstetrical and gynaecological (OBGYN) surgery Patients and Methods A retrospective review of all patients from four different high‐volume institutions between 2002 and 2013 that had a robot‐assisted (RA) repair by a urologist after an OBGYN genitourinary injury. Results Of the 43 OBGYN operations, 34 were hysterectomies: 10 open, 10 RA, nine vaginally, and five pure laparoscopic. Nine patients had alternative OBGYN operations: three caesarean sections, three oophorectomies (one open, two laparoscopic), one RA colpopexy, one open pelvic cervical cerclage with mesh and one RA removal of an invasive endometrioma. In all, 49 genitourinary (GU) injuries were sustained: ureteric ligation (26), ureterovaginal fistula (10), ureterocutaneous fistula (one), vesicovaginal fistula (VVF; 10) and cystotomy alone (two). In all, 10 patients (23.3%) underwent immediate urological repair at the time of their OBGYN RA surgery. The mean (range) time between OBGYN injury and definitive delayed repair was 23.5 (1–297) months. Four patients had undergone prior failed repair: two open VVF repairs and two balloon ureteric dilatations with stent placement. In all, 22 ureteric re‐implants (11 with ipsilateral psoas hitch) and 15 uretero‐ureterostomies were performed. Stents were placed in all ureteric cases for a mean (range) of 32 (1–63) days. In all, 10 VVF repairs and two primary cystotomy closures were performed. Drains were placed in 28 cases (57.1%) for a mean (range) of 4.1 (1–26) days. No case required open conversion. Two patients (4.1%) developed ureteric obstruction after RA repair requiring dilatation and stenting. The mean (range) follow‐up of the entire cohort was 16.6 (1–63) months. Conclusions RA repair of GU injuries during OBGYN surgery is associated with good outcomes, appears safe and feasible, and can be used successfully immediately after injury recognition or as a salvage procedure after prior attempted repair. RA techniques may improve convalescence in a patient population where quick recovery is paramount.
  • Hypogonadal symptoms in young men are associated with a serum total
           testosterone threshold of 400ng/dL
    • Abstract: Objective To investigate the association between hypogonadal symptoms and total serum testosterone levels in young men (
  • Long‐term efficacy of polydimethylsiloxane (Macroplastique®)
           injection for Mitrofanoff leakage after continent urinary diversion
    • Abstract: Objective To assess the long‐term efficacy of polydimethylsiloxane (Macroplastique®) injection (MPI) in the treatment of Mitrofanoff leakage secondary to valve incompetence. Patients and Methods Between 1995 and 2012, the records of 24 consecutive patients who underwent MPI for Mitrofanoff urinary leakage after continent cutaneous urinary diversion (CCUD) surgery were examined. All patients had a valve deemed of sufficient length (>2 cm) to attempt Macroplastique coaptation. Treatment outcomes were divided into three categories based on physician assessment: success (dry), partial success (>50% reduction in incontinence pads) and failure. Success rates were assessed according to the type of reservoir and conduit channel. Results The mean (range) follow‐up was 30 (6–96) months. One patient had initial difficulty catheterising, and subsequently required major revision surgery. In all, 12 patients (50%) failed the treatment and subsequently underwent operative revision to the channel. Three patients (12.5%) achieved complete success; one patient had an appendix channel through native bladder and the remaining two had Monti channels through colon. Nine patients (37.5%) had partial success; success rates were higher with appendix channels (four of six) and colonic reservoirs (six of seven) when compared with Monti channels (eight of 18, 44%) and ileal reservoirs (zero of two). Five of the nine patients with partial success eventually required further surgical revision for deteriorating continence at a mean (range) of 41 (14–96) months, whilst the other four have maintained sufficient continence with MPI alone. Conclusion Macroplastique bulking cured only 12.5% patients, but leakage was substantially improved in a further 37.5% allowing major surgery to be avoided or postponed in one half of the cohort. Appendix Mitrofanoffs do better than the Monti Mitrofanoff, with channels through colonic segments generally doing better than those through ileal bladders. MPI should be considered as a less invasive alternative to avoid or delay major reconstructive surgery.
  • Obesity is associated with higher risk of prostate cancer detection in a
           biopsy population in Korea
    • Abstract: Objective To evaluate the impact of obesity on prostate cancer detection, as measured by the body mass index (BMI) in a Korean biopsy population. Patients and Methods We retrospectively reviewed the records of 1213 men who underwent transrectal ultrasonography‐guided prostate biopsy at our institution. Biopsy outcomes were analysed with respect to various variables, including patient age, prostate‐specific antigen (PSA), prostate volume, digital rectal examination (DRE) findings and obesity, defined as BMI ≥25 kg/m2, an Asian BMI category. Results Among 1213 men, 408 (33.6%) were obese and 344 (28.4%) had a positive biopsy. Obese men were younger (65.5 vs 67.1 years, P = 0.003), had a larger prostate (49.2 vs 42.9 mL, P < 0.001) and were less likely to have any abnormality on DRE (8.1 vs 15.9% P < 0.001) than non‐obese men. In the multivariate analysis, obesity was significantly associated with a higher risk of prostate cancer detection in men undergoing biopsy (odds ratio [OR] = 1.446, P = 0.024). In addition, obesity was significantly associated with a higher rate of biopsy‐detected high grade (Gleason score ≥4 + 3) disease, and this association remained after multivariate adjustment (OR = 1.498, P = 0.039). Conclusions Obese men were younger, had a larger prostate, and had less tendency to have an abnormality on DRE than non‐obese men. Obesity was associated with a higher risk of prostate cancer detection as an independent factor, including high grade prostate cancer in a Korean biopsy population.
  • A novel prognostic model for patients with sarcomatoid renal cell
    • Abstract: Objective To demonstrate sarcomatoid differentiation is an independent prognostic feature for patients with grade 4 renal cell carcinoma (RCC) with or without distant metastases. To identify independent predictors of survival, evaluate the correlation between the amount of sarcomatoid differentiation and cancer‐specific survival (CSS), and to design a multivariate prognostic model for patients with sarcomatoid RCC. Patients and Methods We used the Mayo Clinic Nephrectomy Registry to identify 204 post‐nephrectomy patients with sarcomatoid‐variant RCC, as well as 207 patients with unilateral grade 4 RCC without sarcomatoid features for comparison. All slides were reviewed by one pathologist. CSS was estimated using the Kaplan–Meier method. The associations of clinical and pathological features with death from RCC were evaluated using Cox proportional hazards regression models. Results For all patients with grade 4 RCC, the presence of sarcomatoid differentiation was associated with a 58% increased risk of death from RCC (P < 0.001). For patients with grade 4 non‐metastatic (M0) RCC, the presence of sarcomatoid differentiation was associated with an 82% increased risk of death from RCC (P < 0.001). For patients with sarcomatoid RCC, the 2009 primary tumour classifications, presence of regional lymph nodes and distant metastases, coagulative tumour necrosis, and the amount of sarcomatoid differentiation were each significantly associated with death from RCC in a multivariate setting. After adjusting for other prognostic variables, each 10% increase in the amount of sarcomatoid differentiation was associated with a 6% increased risk of death from RCC (P = 0.028). Patients whose tumours contained ≥30% (median amount) sarcomatoid differentiation were 52% more likely to die from RCC compared with patients whose tumours contained
  • Early adopters or laggards' Attitudes toward and use of social media
           among urologists
    • Abstract: Objective To understand the attitudes and practices of urologists regarding social media use. Social media services have become ubiquitous, but their role in the context of medical practice is underappreciated. Subjects and Methods A survey was sent to all active members of the Canadian Urological Association by e‐mail and surface mail. Likert scales were used to assess engagement in social media, as well as attitudes toward physician responsibilities, privacy concerns and patient interaction online. Results Of 504 surveys delivered, 229 were completed (45.4%). Urologists reported frequent or daily personal and professional social media use in 26% and 8% of cases, respectively. There were no differences between paper (n = 103) or online (n = 126; P > 0.05) submissions. Among frequent social media users, YouTube™ (86%), Facebook™ (76%), and Twitter™ (41%) were most commonly used; 12% post content or links frequently to these sites. The most common perceived roles of social media in health care were for inter‐professional communication (67%) or as a simple information repository (59%); online patient interaction was endorsed by 14% of urologists. Fewer than 19% had read published guidelines for online patient interaction, and ≤64% were unaware of their existence. In all, 94.6% agreed that physicians need to exercise caution personal social media posting, although 57% felt that medical regulatory bodies should ‘stay out of [their] personal social media activities’, especially those in practice 20 years (P = 0.02). Conclusion Practicing urologists engage infrequently in social media activities, and are almost universal in avoiding social media for professional use. Most feel that social media is best kept to exchanges between colleagues. Emerging data suggest an increasing involvement is likely in the continuing professional development space.
  • Cigarette smoking during external beam radiation therapy for prostate
           cancer is associated with an increased risk of prostate
           cancer‐specific mortality and treatment‐related toxicity
    • Abstract: Purpose To evaluate whether a history of smoking or smoking during therapy after external beam radiotherapy (EBRT) for clinically localized prostate cancer is associated with increased treatment‐related toxicity or disease progression. Methods Of 2,358 patients receiving EBRT for prostate cancer 1988‐2005, 2,156 had chart‐recorded smoking histories. Patients were classified as never smokers, current smokers, former smokers, and current smoking unknown. Variables considered included quantity of tobacco use in pack‐years, duration of smoking, and, for former smokers, how long before initiation of RT the patient quit smoking, when available. Median EBRT dose was 8100 Gy and median follow‐up was 95 months. Toxicity was graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events. Results Current smoking significantly increased the risks of both prostate‐specific antigen relapse (hazard ratio [HR] = 1.4, P = 0.02) and distant metastases (HR = 2.37, P
  • The scientific basis for the use of biomaterials in stress urinary
           incontinence (SUI) and pelvic organ prolapse (POP)
    • Abstract: Objectives To review the scientific and clinical literature to assess the basis for the use of biomaterials in stress urinary incontinence (SUI) and pelvic organ prolapse (POP). Pelvic floor diseases (PFDS), such as SUI and POP, are common and vexing disorders. While synthetic mesh‐based repairs have long been considered an option for PFD treatment, and their efficacy established in randomised clinical trials, safety of its use has recently been called into question. Materials and Methods Using the PubMed, MEDLINE and Medical Subject Headings (MeSH) databases, we performed a critical review of English‐language publications that contained the following keywords: ‘pelvic organ prolapse’, ‘stress urinary incontinence’, ‘mesh’, ‘biomaterial’, ‘collagen’, ‘elastin’ and ‘extracellular matrix’. After reviewing for relevance for mesh use in the pelvis by two independent reviewers with a third available in the case of disagreement, a total of 60 articles were included in the present review. Results We found that many of the potential causes of PFDs are due to altered metabolism of patient extracellular matrix (specifically collagen, elastin, and their respective enzymes) and as such, repairs using native tissue may suffer from the same abnormalities leading to a subsequent lack of repair integrity. However, mesh use is not without its unique risks. Several publications have suggested that biomaterials may undergo alteration after implantation, but these findings have not been demonstrated in the normal milieu. Conclusion While the decision for the use of synthetic mesh is scientifically sound, its benefits and risks must be discussed with the patient in an informed decision‐making process.
  • A new one‐layer epididymovasostomy technique
    • Abstract: Objectives To 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.
  • Safety and diagnostic accuracy of percutaneous biopsy in upper tract
           urothelial carcinoma
    • Abstract: Objective To 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.
  • Metabolic syndrome‐like components and prostate cancer risk: results
           from the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study
    • Abstract: Objective To evaluate the relationship between number of metabolic syndrome (MetS)‐like components and prostate cancer diagnosis in a group of men where nearly all biopsies were taken independent of prostate‐specific antigen (PSA) level, thus minimising any confounding from how the various MetS‐like components may influence PSA levels. Subjects/Patients and Methods We analysed data from 6426 men in the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study with at least one on‐study biopsy. REDUCE compared dutasteride vs placebo on prostate cancer risk among men with an elevated PSA level and negative pre‐study biopsy and included two on‐study biopsies regardless of PSA level at 2 and 4 years. Available data for MetS‐like components included data on diabetes, hypertension, hypercholesterolaemia, and body mass index. The association between number of these MetS‐like components and prostate cancer risk and low‐grade (Gleason sum 7) vs no prostate cancer was evaluated using logistic regression. Results In all, 2171 men (34%) had one MetS‐like component, 724 (11%) had two, and 163 (3%) had three or four. Men with more MetS‐like components had lower PSA levels (P = 0.029). One vs no MetS‐like components was protective for overall prostate cancer (P = 0.041) and low‐grade prostate cancer (P = 0.010). Two (P = 0.69) or three to four (P = 0.15) MetS‐like components were not significantly related to prostate cancer. While one MetS‐like component was unrelated to high‐grade prostate cancer (P = 0.97), two (P = 0.059) or three to four MetS‐like components (P = 0.02) were associated with increased high‐grade prostate cancer risk, although only the latter was significant. Conclusion When biopsies are largely PSA level independent, men with an initial elevated PSA level and a previous negative biopsy, and multiple MetS‐like components were at an increased risk of high‐grade prostate cancer, suggesting the link between MetS‐like components and high‐grade prostate cancer is unrelated to a lowered PSA level.
  • Testosterone therapy and cancer risk
    • Abstract: Objective To determine if testosterone therapy (TT) status modifies a man's risk of cancer. Patients and Methods The Urology clinic hormone database was queried for all men with a serum testosterone level and charts examined to determine TT status. Patient records were linked to the Texas Cancer Registry to determine the incidence of cancer. Men accrued time at risk from the date of initiating TT or the first office visit for men not on TT. Standardised incidence rates and time to event analysis were performed. Results In all, 247 men were on TT and 211 did not use testosterone. In all, 47 men developed cancer, 27 (12.8%) were not on TT and 20 (8.1%) on TT. There was no significant difference in the risk of cancer incidence based on TT (hazard ratio [HR] 1.0, 95% confidence interval [CI] 0.57–1.9; P = 1.8). There was no difference in prostate cancer risk based on TT status (HR 1.2, 95% CI 0.54–2.50). Conclusion There was no change in cancer risk overall, or prostate cancer risk specifically, for men aged >40 years using long‐term TT.
  • Adverse Effects of Androgen Deprivation Therapy in Prostate Cancer and
           Their Management
    • Abstract: Objective To provide an up‐to‐date summary of current literature on the management of adverse effects of androgen deprivation therapy (ADT). Subjects All men suffering from prostate cancer who are treated with androgen deprivation therapy. Methods All relevant medical literature from 2005 to 2014 and older relevant papers were reviewed to formulate this article. Recent health advisory statements from the Australian government, societies and advocacy groups have been incorporated to the document. Results There are numerous adverse effects of ADT that require pro‐active prevention and treatment. Ranging from cardiovascular disease, diabetes and osteoporosis to depression, cognitive decline and sexual dysfunction, the range of adverse effects is wide. Baseline assessment, monitoring, prevention and consultation from a multidisciplinary team are important in minimizing the harm from ADT. Conclusions This review provides series of practical recommendations to assist with managing adverse effects of ADT.
  • A Prognostic Model for Survival after Palliative Urinary Diversion for
           Malignant Ureteral Obstruction: A Prospective Study of 208 Patients
    • Abstract: Objective To identify factors associated with survival after palliative urinary diversion for patients with malignant ureteral obstruction (MUO) and create a risk‐stratification model for treatment decisions. Methods We prospectively collected clinical and laboratory data for patients who underwent palliative UD by ureteral stenting or percutaneous nephrostomy (PCN) between January 1, 2009 and November 1, 2011 in 2 tertiary‐care university hospitals, with a minimum 6‐month follow‐up. Inclusion criteria were age >18 years and MUO confirmed by CT, ultrasonography or MRI. Outcome measurements and statistical analysis Factors related to poor prognosis were identified by Cox univariable and multivariable regression analyses, and a risk stratification model was created by Kaplan‐Meier survival estimates at 1, 6 and 12 months and log‐rank tests. Results Median survival was 144 days (range 0–1,084 days) for the 208 patients included after UD (n=58 uretral stenting, n=150 PCN); 164 patients died, 44 (21.2%) during hospitalization. Overall survival did not differ by UD type (p=0.216). The number of events related to malignancy (≥4) and Eastern Cooperative Oncology Group (ECOG) index (≥2) were associated with short survival on multivariable analysis. These 2 risk factors were used to divide patients into 3 groups by survival type: favorable (no factors), intermediate (1 factor) and unfavorable (2 factors). The median survival at 1, 6, and 12 months was 94.4%, 57.3% and 44.9% in the favorable group; 78.0%, 36.3%, and 15.5% in the intermediate group; and 46.4%, 14.3%, and 7.1% in the unfavorable group (p
  • Endophytic Tumours Do Not Constitute a Barrier to Robotic Partial
  • Penile cancer: organ‐sparing techniques
    • Abstract: To compare the oncological safety of treating patients with penile cancer with conservative techniques developed to preserve function, cosmesis and psychological well‐being with more radical ablative strategies. We conducted an extensive review of the literature of penile‐preserving and ablative techniques and report on the oncological as well as functional outcomes. There were no randomised studies comparing penile‐preserving and ablative techniques. Most studies consisted of retrospective cohorts. The quality of evidence was level 3 at best. Cancer‐specific survival is similar in penile‐preserving and ablative approaches for low‐stage disease. Penile preservation is better for functional and cosmetic outcomes and should be offered as a primary treatment method in men with low‐stage penile cancer.
  • Venous thromboembolism (VTE) prophylaxis and urological pelvic cancer
           surgery: a UK national audit
    • Abstract: Objectives To evaluate the use of post‐discharge venous thromboembolism (VTE) prophylaxis in UK pelvic cancer centres consistent with national guidelines. Methods Data was collected from healthcare professionals from 64 UK pelvic cancer centres. Results After radical cystectomy (RC), all cancer centres routinely use low‐molecular‐weight heparin (LMWH) in the perioperative period. After RC 67% of cancer centres use post‐discharge LMWH routinely. After radical prostatectomy (RP), 98% of units use perioperative LMWH VTE prophylaxis routinely. After RP, 61% of hospitals always use post‐discharge LMWH. In all, 27% of all UK cancer centres reported deaths or serious VTE complications from urological pelvic cancer surgery in the last 2 years. Conclusions The National Institute for Health and Care Excellence (NICE) issued explicit guidance of VTE prophylaxis after pelvic and abdominal cancer surgery. Conversion of national guidance into local policy is ≈60% for UK pelvic cancer centres. A lack of good quality evidence is cited as a reason for not adhering to NICE guidance.
  • Burden of male lower urinary tract symptoms (LUTS) suggestive of benign
           prostatic hyperplasia (BPH) – focus on the UK
    • 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.
  • Primary invasive carcinoma associated with penoscrotal extramammary
           Paget's disease: a clinicopathological analysis of 56 cases
    • Abstract: Objectives To investigate the clinicopathological features, therapeutic strategies, and prognostic factors of patients with penoscrotal invasive extramammary Paget's disease (EMPD). Patients and Methods We retrospectively collected clinical, pathological, and follow‐up data of 56 men with invasive penoscrotal EMPD. Histopathological features of the primary skin lesion including tumour size, surgical margin status, depth of invasion and lymphovascular invasion were examined. Results The median age was 67 years and median longest diameter of lesion was 5 cm. All patients were treated with wide surgical excision and 22 patients with clinically positive regional lymph nodes underwent therapeutic regional lymph node dissection. At the end of the study, 44.6% of patients developed distant metastasis and 39.3% of patients had died from disease. Univariate analysis showed that patients with one of the following poor prognostic factors: depth of invasion of lower dermis or deeper, presence of lymphovascular invasion and regional lymph node metastasis at diagnosis, had significantly shorter cancer‐specific survival time. Multivariate analysis found that depth of invasion was the only independent prognostic factor. Conclusion The prognosis of invasive EMPD is significantly associated with depth of invasion, lymphovascular invasion and regional lymph node status. More aggressive therapy and more rigorous follow‐up should be recommended for patients with these poor prognostic factors.
  • NICE Guidelines on Prostate Cancer Active Surveillance: Is UK Practice
           Leading the World'
  • Multiparametric magnetic resonance imaging (MRI) and subsequent
           MRI/ultrasonography fusion‐guided biopsy increase the detection of
           anteriorly located prostate cancers
    • Abstract: Objective To describe the detection rate of anteriorly located prostate cancer (PCa) with the addition of magnetic resonance imaging (MRI)/ultrasonography (US) fusion‐guided biopsy (FGB) to the standard transrectal ultrasonography (TRUS)‐guided biopsy. Patients and Methods All patients, regardless of their biopsy history, who were referred for clinical suspicion of PCa (i.e elevated prostate‐specific antigen (PSA) level and abnormal digital rectal examination) underwent 3T multiparametric‐MRI (mpMRI) screening; and those with suspicious lesions in the anterior region of the prostate were identified. Patients then received a FGB of all suspicious lesions in addition to a systematic 12‐core extended sextant TRUS‐guided biopsy. We conducted a lesion‐based analysis comparing cancer detection rates of anterior targets using FGB vs systematic cores taken from the same anatomic sextant within the prostate. Lengths of cancer in the most involved core were also compared between the two biopsy techniques used. Patients with only anterior targets were analysed separately. Results Of 499 patients undergoing FGB, 162 had a total of 241 anterior lesions. The mean age, PSA level and prostate volume in this group were 62 years, 12.7 ng/dL, and 57 mL, respectively. In total, PCa was diagnosed in 121 anterior lesions (50.2%) identified on mpMRI. Sixty‐two (25.7%) of these anterior lesions were documented as positive for cancer on systematic 12‐core TRUS‐guided biopsy cores, while 97 (40.2%) were positive on the targeted FGB cores (P = 0.001). In lesions that were positive on both FGB and TRUS biopsy, the most involved core was 112% longer on FGB (3.7 vs 1.6 mm, P ≤ 0.01). Forty‐two patients had only anterior lesions on mpMRI; of these, 24 (57.1%) were found to have cancer on the FGB + TRUS biopsy platform. Six patients were positive on FGB only and 13 were positive on both biopsy techniques; however, 7/13 patients were upgraded to a higher Gleason score after FGB. All five patients positive on TRUS biopsy only were candidates for active surveillance. Conclusion The results showed that FGB detects significantly more anteriorly located PCa than does TRUS‐guided biopsy alone and it may serve as an effective tool for the subset of patients with such tumours.
  • Complications after artificial urinary sphincter implantation in patients
           with or without prior radiotherapy
    • Abstract: Objective To compare complications after implantation of an artificial urinary sphincter (AUS) in patients with or without prior radiotherapy (RT). Patients and Methods Between January 2000 and December 2011, 160 patients underwent AMS 800 AUS implantation in our institution. We excluded neurological and traumatic causes, implantation on ileal conduit diversion, penoscrotal urethral cuff position and those lost to follow‐up. In all, 122 patients were included in the study, 61 with prior RT and 61 without prior RT. All patients underwent the same surgical technique by two different surgeons. All AUS were implanted with a bulbar urethral cuff position. The mean (range) follow‐up was 37.25 (1–126) months. Results In the patients without prior RT and those with prior RT, revision rates were 32.8% vs 29.5%, respectively (P = 0.59). The median time to first revision was 11.7 months. Early complications were similar in the two groups (4.9% vs 6.5%, P = 1). Erosion rates were not significantly different (4.9% vs 13.1%, P = 0.13). However, infection and explantation were more prevalent in patients with prior RT [two (3.2%) vs 10 (16.3%), P = 0.018 and three (4.9%) vs 12 (19.6%), P = 0.016, respectively]. Finally, continence rates were not significantly different [75.4% (without prior RT) vs 63.9% (with prior RT), P = 0.23]. Conclusion AUS is the ‘gold standard’ treatment of male urinary incontinence after re‐education failure in patients with or without prior RT. Our experience showed similar functional outcomes in both groups but a higher rate of major complications in the group with prior RT.
  • Hypothermic Machine Perfusion Improves Doppler Ultrasound Resistive
           Indices and Long‐term Allograft Function Following Renal
           Transplantation: A Single Center Analysis
    • Abstract: Objectives To evaluate whether hypothermic machine perfusion (HMP) of transplanted kidneys may improve long‐term renal allograft function compared to static cold storage (CS). Methods We evaluated whether graft doppler ultrasound resistive indices improved with HMP compared to CS preservation and examined whether these improvements were predictive of long term graft function. 30 kidney transplants (15 pairs) were examined. One of the kidney pair was placed on CS and transplanted first (CS group, n = 15). The other kidney of each pair was placed on HMP and transplanted after the CS group (HMP group, n=15). Doppler ultrasound was done on days 1 and 7 after transplantation and resistive indices were evaluated. Estimated glomerular filtration rate (eGFR) was monitored for 24 months after transplantation. Results Despite longer cold‐ischemic times, kidneys maintained with HMP had lower resistive indices (p = 0.005) with correspondingly higher eGFR throughout follow‐up. Subgroup analysis showed that the HMP induced improvement in post‐operative eGFR is largest in kidneys obtained from donors after cardiac death (DCD), even at 2 years after transplantation (p=0.008). Conclusions HMP of transplant kidneys appears to improve vascular resistance after transplantation and positively impacts long‐term allograft function compared to CS in the DCD recipient population.
  • International multicenter psychometric evaluation of patient reported
           outcome data for the treatment of Peyronie's disease
    • Abstract: Objective To compare patient reported outcomes of the the Nesbit procedure, plaque incision and grafting, and the insertion of a malleable penile implant following surgical correction of the penile curvature. Materials and Methods A retrospective review was performed regarding men who underwent surgical correction of PD between January 2010 and December 2012 at six international centres. Treatment‐related patient reported outcomes and satisfaction were evaluated with a non‐validated questionnaire. Results The average response rate to the questionnaire was 70,9%, resulting in a study cohort of 206 patients. The Nesbit procedure, plaque incision with grafting, or implantation of a malleable penile prosthesis was performed in 50, 48, and 108 individuals, respectively. Overall, 79.1% reported a subjective loss of penile length due to PD (range 2.1‐3.2 cm), preoperatively. Those patients treated with a malleable penile implant reported the greatest subjective penile length loss, due to PD. A subjective loss of penile length of >2.5 cm resulted in reduced preoperative sex ability. Postoperatively, 78.0%, 29.2% and 24.1% patients in the Nesbit, grafting, and implant groups reported a postoperative, subjective loss of penile length (range, 0.4‐1.2cm), with 86.3%, 78.6%, and 82.1% of the patients in each group, respectively, being bothered by loss of length. Conclusions Penile length loss due to PD affects the majority of patients. Further penile length loss due to the surgical correction leads to bother among the affected patients, irrespective of the magnitude of the loss. The Nesbit procedure was associated with the highest losses in penile length. In patients with PD and severe erectile dysfunction, a concomitant lengthening procedure may be offered to patients to help overcome the psychological burden caused by the loss of penile length.
  • DGKK Variants and hypospadias in Han Chinese: association and
    • Abstract: Objective To investigate whether diacylglycerol kinase kappa (DGKK) is a susceptibility gene for hypospadias in the Han Chinese population, as has been suggested by previous publications. Patients and Methods A case‐control study involving 466 patients with hypospadias and 402 healthy subjects was conducted to assess the relationship between DGKK single nucleotide polymorphisms (SNPs) and hypospadias risk in the Han Chinese population. The 466 hypospadias cases were further divided into mild, moderate and severe subgroups for analysis. Results Six SNPs (rs1934179, rs4143304, rs9969978, rs1934188, rs4826632 and rs4599945) were marginally associated with mild and moderate hypospadias (ORs>1, 0.050.1). After correcting for multiple testing, it was determined that neither individual SNPs nor individual haplotypes were associated with hypospadias. To evaluate this relationship in multiple populations, we performed a meta‐analysis on six SNPs, using combined data from our results and those of previous studies of different races (including 1966 cases and 2492 controls). Six SNPs (rs1934179, rs4143304, rs9969978, rs1934188, rs7063116 and rs1934190) were significantly associated with mild/moderate hypospadias (ORs>1, p1, p
  • Risk of Acute Myocardial Infarction after Androgen Deprivation Therapy for
           Prostate Cancer in the Chinese Population
    • Abstract: Objective ‐ To investigate the risk of acute myocardial infarction (AMI) after androgen deprivation therapy (ADT) for prostate cancer in the Chinese population. Methods ‐ All Chinese prostate cancer patients who were treated primarily with radical prostatectomy or radiotherapy, with or without further ADT at our hospital from 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, hyperlipidemia, history of stroke, ischemic heart disease, ECOG performance status and duration of ADT were reviewed. ‐ The risk of AMI after ADT was first analyzed with Kaplan‐Meier method, followed by Cox regression analyses including the potential risk factors mentioned. Results ‐ A total of 452 patients were included, consisting of 200 patients in the non‐ADT group and 252 patients in the ADT group. ‐ The mean 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 was no significant difference in their pre‐existing medical conditions and ECOG performance status. ‐ The ADT group was associated with an increased risk of AMI when compared to the non‐ADT group (P = 0.004) upon Kaplan‐Meier analysis. ‐ Upon multivariate Cox regression analysis, hyperlipidemia, poor ECOG performance status 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 the Chinese population. ‐ Hyperlipidemia and poor ECOG performance status were also significant risk factors for developing AMI. ‐ The risk of AMI should be considered while deciding on ADT, especially in patients with history of hyperlipidemia and relatively poor ECOG performance status. Prostate cancer, androgen deprivation therapy, myocardial infarction, Asian population
  • ATP release from freshly isolated guinea‐pig bladder urothelial
           cells: a quantification and study of the mechanisms involved
    • Abstract: Objectives To quantify the amount of ATP released from freshly isolated bladder urothelial cells, study its control by intracellular and extracellular calcium and identify the pathways responsible for its release. Materials and methods Urothelial cells were isolated from male guinea‐pig urinary bladders and stimulated to release ATP by imposition of drag forces by repeated pippetting. ATP was measured using a luciferin‐luciferase assay and the effects of modifying internal and external calcium concentration and blockers of potential release pathways studied. Results Freshly isolated guinea‐pig urothelial cells released ATP at a mean rate of 1.9±0.1‐2 cell membrane, corresponding to about 700 pmoles/g of tissue, and about half (49±6 %, n=9) of available cell ATP. This release was reduced to 0.46±0.08‐2 (160 pmoles/g) with 1.8 mM external calcium, and was increased approximately 2‐fold by increasing intracellular calcium. The release from umbrella cells was not significantly different from a mixed intermediate and basal cell population, suggesting that all three groups of cells release a similar amount of ATP per unit area. ATP release was reduced by about 50% by agents which block pannexin and connexin hemichannels. It is suggested that the remainder may involve vesicular release. Conclusions A significant fraction of cellular ATP is released from isolated urothelial cells by imposing drag forces that cause minimal loss of cell viability. This release involves multiple release pathways, including hemichannels and vesicular release.
  • Pelvic Recurrence Following Radical Cystectomy: A Call to Arms
  • Transurethral Intraprostatic Injection of Botulinum Toxin Type A for the
           Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Results of
           a Prospective Pilot Double‐Blind and Randomized
           Placebo‐Controlled study
    • Abstract: Objective To evaluate the effect of botulinumneurotoxin type‐A (BoNT‐A) on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) refractory to medical therapy. Materials and Methods From November 2011 to January 2013, 60 men aged ≥18 years with CP/CPPS, NIH‐CPSI symptom scale score≥10 and pain subscale score≥8, and refractory to 4 to 6 weeks medical therapy underwent transurethral intraprostatic injection of BoNT‐A or normal saline (NS) in a prospective pilot double‐blind randomized study. NIH‐CPSI total and subscale scores, AUA‐SS, VAS and (QoL) scores and frequencies of diurnal and nocturnal urination were evaluated and compared at baseline and 1,3 and 6 months after injection and also were compared between two groups. Results 60 consecutive patients were randomized as BoNT‐A or placebo group. In BoNT‐A group at 1, 3 and 6‐month evaluation compared to baseline values, NIH‐CPSI total and subscale scores, AUA‐SS, VAS and QoL scores along with frequencies of diurnal and nocturnal urinations had significantly improved (p
  • Clinical utility of 18F‐fluorocholine PET‐CT in biochemical
           relapse of prostate cancer after radical treatment. Results of a
           multicentre study
    • Abstract: Objective This study evaluated the usefulness of 18F‐fluorocholine PET/CT in restaging patients with a history of prostate adenocarcinoma who faced biochemical relapse after early radical treatment, and correlated the technique's disease detection rate with a set of variables and clinical and pathological parameters. Material and methods This was a retrospective multicentre study which included 374 patients referred for choline PET/CT who had biochemical relapse. In the end, 233 patients who met the following inclusion criteria were analysed: diagnosis of prostate cancer; early radical treatment; biochemical relapse; main clinical and pathological variables; and clinical, pathological and imaging data needed to validate the results. Criteria used to validate the PET/CT: findings from other imaging techniques, clinical follow‐up, treatment response and histological analysis. Different statistical tests were used depending on the distribution of the data to correlate the results of the choline PET/CT with qualitative (T, N, early prostatectomy vs. other treatments, hormone therapy concomitant to choline PET/CT) and quantitative (age, Gleason score, PSA levels at diagnosis, PSA nadir, PSA on the day of the choline PET/CT or trigger PSA and PSADT) variables. We analysed whether there were independent predictive factors associated with the positive PET/CT result. All statistical tests were considered two‐sided and significant values where p
  • A Systematic Review of Experience of 180W XPS GreenLight Laser
           Vaporization of the Prostate in 1640 men
    • Abstract: Aim To systematically review the literature regarding clinical outcomes of 180W XPS GreenLight laser (GL) vaporization for the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). Methods Recent publications in the field of 180 Watt GreenLight Laser (GL) vaporization for the treatment of LUTS due to BPH were identified by a literature search. It was searched for peer reviewed original articles in English language. Search items were: 180W lithium triborate laser or 180W greenlight laser or 180 watt lithium triborate laser or 180 watt greenlight laser or XPS greenlight laser. 30 papers published between 2012 and 2014 matched this search. Out of this collective 10 papers were identified dealing with consecutive cohorts of patients treated with the 180W XPS GreenLight® laser. Results Ten papers included a total experience of 1640 patients. The only RCT in this field compares 180W XPS with transurethral resection of the Prostate (TURP). Functional outcomes and prostate volume reduction following GL vaporization were similar to TURP. Catheterization time and hospital stay were shorter in patients undergoing 180W XPS GL‐vaporization (41 and 66 hours vs 60 and 97 hours respectively). Four papers compared the 180W XPS system to former GL devices demonstrating increased operation time efficiency and comparable postoperative voiding results and adverse events. One paper defined the learning curve to achieve an expert level according to the speed of the procedure and the effectiveness of volume reduction was met after 120 procedures. Conclusion The 180W XPS GreenLight laser offers shorter operation times than the former devices. In the one randomised controlled trial comparison with TURP, volume reduction and functional results were comparable to those of TURP. Longer term studies are required.
  • Targeted local therapy in oligometastatic prostate cancer: a promising
           potential opportunity after failed primary treatment
  • Radical Cystectomy with Super‐extended Lymphadenectomy: Impact of
           Separate Versus en Bloc Lymph Node Submission on Analysis and Outcomes
    • Abstract: Objective ● At USC, the submission of lymphadenectomy specimens changed from en bloc to 13 separate anatomically defined packets in May 2002. ● We update our previous analysis of the clinical and pathological impact of this change in methodology, and determine whether lymph node (LN) packeting resulted in any change in oncologic outcomes. Patients and Methods ● 846 patients who underwent radical cystectomy (RC) with super‐extended LN dissection (LND) for cTxN0M0 bladder cancer between 01/1996 and 12/2007 were identified, ● Specimens of 376 patients were sent en bloc (group 1), and specimens of 470 patients were sent in 13 separate anatomical packets (group 2). Results ● Pathologic tumor stage distribution and proportion of LN‐positive patients (group 1: 82 (22%) vs. group 2: 99 (21%); p=0.80) were similar: the median number of total LNs identified increased significantly (group 1: 32 (range: 10‐97), group 2: 65 (range: 10‐179); p
  • Renal cell cancer histologic subtype distribution differs by race and sex
    • Abstract: Objectives To examine racial differences in the distribution of histologic subtypes of renal cell carcinoma (RCC) and associations with established RCC risk factors by subtype. Materials and methods Tumors from 1,532 consecutive RCC patients who underwent nephrectomy at Vanderbilt University Medical Center (1998‐2012) were classified as clear cell, papillary, chromophobe, and other subtypes. In pairwise comparisons, we used multivariate logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for the associations between race, sex, age, ESRD and body mass index at diagnosis (BMI, kg/m2) according to histologic subtype. Results The RCC subtype distribution was significantly different among blacks compared with whites (p
  • Prognostic Factors Influencing Survival from Regionally Advanced Squamous
           Cell Carcinoma of the Penis After Preoperative Chemotherapy
    • Abstract: Objective To describe both clinical and pathologic response rates, survival, and predictors of survival when utilizing contemporary peri‐operative chemotherapy and surgical resection for patients with regionally advanced squamous cell carcinoma of the penis. Materials & Methods Retrospective review of all patients diagnosed with squamous cell carcinoma of the penis and regional lymph node metastases that were treated with chemotherapy with the intent to undergo lymphadenectomy. Clinical and pathologic responses were reported. Recurrence‐free and overall survival was estimated using Kaplan‐Meier analysis. Cox proportional hazards regression was used to assess factors for survival. Results Sixty‐one patients were identified, of which 54 (90%) received chemotherapy with paclitaxel/ifosfamide/cisplatin. Thirty‐nine patients (65%) exhibited either a partial (PR) or complete response (CR) to chemotherapy. Five‐year survival varied significantly (p=0.045‐0.001) among patients achieving a CR/PR (50%), stable disease (25%), and progression (7.7%). Ten patients (16.4%) were rendered pN0 with combined therapy. Twenty patients (33%) were alive and disease free at a median follow‐up of 67 months, while 32 (52%) died of disease. Long‐term survival was associated with response to chemotherapy and favorable pathologic findings post resection. Conclusion Contemporary chemotherapy resulted in clinically significant responses among patients with regionally advanced penile cancer. Approximately 50% of such patients with an objective response to chemotherapy who undergo consolidative lymphadenectomy will remain alive at 5 years.
  • Long‐Term Analysis of Oncologic Outcomes After Laparoscopic Radical
           Cystectomy in Europe: Results from a Multicentric Study of
           Eau‐Section of Uro‐Technology
    • Abstract: Objective To report long‐term outcomes of laparoscopic radical cystectomy (LRC) in a multi‐centric European cohort, and explore feasibility and safety of the procedure. Patients and Methods This study was coordinated by EAU‐section of Uro‐technology (ESUT) with nine centers enrolling 503 patients undergoing LRC for bladder cancer prospectively between 2000 and 2013. Data were retrospectively analyzed. Descriptive statistics were used to explore peri‐ and post‐operative characteristics of the cohort. Kaplan‐Meier curves were constructed to evaluate recurrence free survival (RFS), cancer specific survival (CSS) and overall survival (OS). Outcomes were also stratified according to tumour stage, node involvement and surgical margin status. Results Minor complications (Clavien I‐II) occurred in 39% and major (IIIa‐IVb) in 17%. 10 (2%) post‐operative deaths were recorded. Median lymph node retrieval was 14 (IQR 9‐17) and positive surgical margins were detected in 29 (5.8%) patients. Median follow‐up was 50 months (mean 60, IQR 19‐90), during which 134 (27%) recurrences were detected. Actuarial RFS, CSS and OS rates were 66%, 75% and 62% at 5years and 62%, 55%, 38% at 10 years. Significant differences in RFS, CSS and OS were found according to tumour stage, node involvement and margin status (log‐rank p
  • Safety and clinical outcomes of patients treated with abiraterone acetate
           after docetaxel: results of the Italian Named Patient Programme
    • Abstract: Objective To assess the safety and efficacy of abiraterone acetate (AA) in patients with metastatic castration‐resistant prostate cancer (mCRPC) treated in a compassionate named patient programme (NPP). Patients and Methods We retrospectively reviewed the clinical records of patients with mCRPC treated with AA at the standard daily oral dose of 1000 mg plus prednisone 10 mg/day in 19 Italian hospitals. Results We assessed 265 patients with mCRPC treated with AA. The most frequent (>1%) grade 3–4 toxicities were anaemia (4.2%), fatigue (4.2%), and bone pain (1.5%). The median progression‐free survival was 7 months; median overall survival was 17 months after starting AA, and 35 months after the first docetaxel administration. Our study reproduced the clinical outcomes reported in the AA pivotal trial, including those relating to special populations such as the elderly, patients with a poor performance status, symptomatic patients, and patients with visceral metastases. Conclusions Our data show the safety and activity of AA when administered outside clinical trials, and confirm the findings of the post‐docetaxel pivotal trial in the patients as a whole population and in special populations of specific interest.
  • Short‐term pretreatment with a dual 5α‐reductase
           inhibitor before bipolar transurethral resection of the prostate
           (B‐TURP): evaluation of prostate vascularity and decreased surgical
           blood loss in large prostate
    • Abstract: Introduction dual 5α‐reductase inhibitor (5‐ARI), dutasteride, blocks the convertion of testosterone into its active form dihydrotestosterone (DHT), and reduces prostate volume, PSA, while increasing urinary flow rate. Bipolar transurethral resection of the prostate (B‐TURP) represents an improvement of the traditional TURP with almost the same efficacy and outcomes while the incidence of side‐effects is lower. Assuming that dutasteride has an action on prostatic vascularisation and assuming B‐TURP as a standard procedure for patients affected by BPH, we hypothesized that a short‐term pretreatment with dutasteride (0.5 mg daily for 8 weeks) can reduce intraoperative bleeding. Materials & Methods A total of 259 patients have been enrolled and randomized in Group A receiving placebo and Group B receiving dutasteride. In particular we evaluated blood parameters (haemoglobin and hematocrit) and prostate vascularity with vascular endothelial growth factor (VEGF) and microvascular density (MVD) using CD34. Statistical analysis was carried out using two‐sided tests, with p values < 0.05 denoting statistical significance. Continuous variables are reported as mean ± standard deviation and compared between groups using Student's t test. Analysis of Covariance was applied to assess the significance of variation in hemoglobin and hematocrit levels. Results total testosterone, DHT, PSA and prostate volume were evaluated and with the exception of DHT and PSA there was no statistically significant difference between the two groups. When comparing changes in hemoglobin and haematocrit between the Group A and Group B, before and after the B‐TURP, there is a statistically significant difference only when in the case of a large prostate ≥ 50 mL (ΔHb 3.86 vs. 2.05 and ΔHt 4.98 vs. 2.64 respectively). Evaluating MVD and VEGF index in prostates < 50 mL there is no significant difference while in large prostate the difference become statistically significant. Conclusions dutasteride is able to reduce operative and peri‐operative bleeding in patients submitted to B‐TURP only if a large prostate (≥ 50 mL) is being treated. Our findings are confirmed by hemoglobin and hematocrit values reported before and after the surgery and by the count of VEGF and CD34.
  • Changing trends in the aetiology and management of male urethral stricture
           disease in China: an observational descriptive study from 13 centres
    • Abstract: Objective To determine whether there were any changes in the aetiology and management of urethral strictures in China. Patients and Methods The data from 4764 male patients with urethral stricture disease who underwent treatment at 13 medical centres in China between 2005 and 2010 were retrospectively collected. The databases were analysed for the possible causes, site and treatment techniques for the urethral stricture, as well as for changes in the urethral stricture aetiology and management. Results The most common cause of urethral strictures was trauma, which occurred in 2466 patients (51.76%). The second most common cause was iatrogenic injures, which occurred in 1643 patients (34.49%). The most common techniques to treat urethral strictures were endourological surgery (1740, 36.52%), anastomotic urethroplasty (1498, 31.44%) and substitution urethroplasty (1039, 21.81%). A comparison between the first three years and the last three years showed that the constituent ratio of endourological surgery decreased from 54% to 32.75%, whereas the constituent ratios of anastomotic urethroplasty and substitution urethroplasty increased from 26.73% and 19.18% to 39.93% and 27.32%, respectively (P<0.05). Conclusions During recent years, there has been an increase in the incidence of urethral strictures caused by trauma and iatrogenic injury. Endourological urethral surgery rates decreased significantly, and open urethroplasty rates increased significantly during the latter three years analysed.
  • Three‐dimensional navigation system integrating
           position‐tracking technology with movable tablet display for
           percutaneous targeting
    • Abstract: Objectives To assess the feasibility of a novel percutaneous navigation system (Translucent™ Medical) that integrates position‐tracking technology with a movable tablet display. Materials and Methods Total 18 fiducial markers (CIVCO Medical), which served as the target centers for the virtual tumors (target‐fiducials), were implanted in the prostate and kidney of fresh cadaver, followed by a pre‐operative CT for 3D models reconstruction of the surgical regions, which were registered on the body intra‐operatively. The position of movable tablet's display can be selected to obtain the best recognition of the interior anatomy. The system navigated puncture needle (with position‐tracking‐sensor attached) with a color‐coded, predictive puncture‐line. When the operator punctured the target‐fiducial, another fiducial, serving as the center of the ablative treatment (treatment‐fiducial), was placed. A post‐operative CT was acquired to assess the digitized distance (as 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) facilitated the surgeon to recognize the 3D anatomy of the internal organs with overlaid puncture line of puncture needle with position‐tracking‐sensor attached. The mean (virtual) distance from the needle tip to the target, (calculated with 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
  • Survival outcomes after radical and partial nephrectomy for clinical T2
           renal tumours categorised by R.E.N.A.L. nephrometry score
    • Abstract: Objective We evaluated survival outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for clinical T2 renal masses (cT2RM) controlling for R.E.N.A.L. nephrometry score. Patients and Methods A two‐centre study comprised of 202 patients with cT2RM who underwent RN (122) or PN (80) between July 2002 and June 2012 (median follow‐up 41.5 months). Kaplan−Meier analysis compared overall survival (OS), cancer‐specific survival (CSS) and progression‐free survival (PFS) among the entire cohort and within categories of R.E.N.A.L. nephrometry score of ≥10 and
  • Preoperative predictors of renal function decline after radical
           nephroureterectomy for upper tract urothelial carcinoma
    • Abstract: Objectives To model renal function after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). To identify predictors of renal function decline after surgery, thereby allowing the identification of patients likely to be ineligible for cisplatin‐based chemotherapy in the adjuvant setting. Patients and Methods We retrospectively identified 374 patients treated with RNU for UTUC at three centres between 1995 and 2010. Estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration equation before RNU and at early (1–5 months after RNU) and late (>5 months) time points after RNU. Only patients deemed eligible for cisplatin‐based chemotherapy before RNU (preoperative glomerular filtration rate [GFR] ≥60 mL/min/1.73 m2) were included. Multivariable analysis identified the preoperative predictors of eGFR after RNU at early postoperative and late postoperative time points. Results A total of 163 patients had an eligible early post‐RNU eGFR measurement and 172 had an eligible late eGFR measurement. The median eGFR declined by 32% and did not show a significant trend toward recovery over time (P = 0.4). On multivariable analysis preoperative eGFR and patient age were significantly associated with early and late postoperative eGFR, while Charlson comorbidity index score was significantly associated with late postoperative eGFR alone. Conclusions In patients with normal preoperative eGFR (≥60 mL/min/1.73 m2), renal function decreases by one‐third after RNU and does not show evidence of recovery over time. Elderly patients and those with pre‐RNU eGFR closer to 60 mL/min/1.73 m2 (lower eGFR in the present cohort) are more likely to be ineligible for adjuvant cisplatin‐based chemotherapy regimens because of renal function loss after RNU.
  • Effects of bariatric surgery on untreated Lower Urinary Tract Symptoms: a
           prospective multicentre cohort study
    • Abstract: OBJECTIVE To evaluate the effects of bariatric surgery on Lower Urinary Tract Symptoms in a prospective cohort study. MATERIALS AND METHODS Patients undergoing bariatric surgery were recruited into the study. Assessment was done using International Prostate Symptoms Score (IPSS) in men and Bristol Female Lower Urinary Tract Symptoms Score Questionnaire (BFLUTS) in women. Serum glucose, insulin and PSA levels were recorded, insulin resistance was quantified using Homeostasis Model Assessment method (HOMA‐IR). Patients were assessed prior to; 6‐8 weeks post; and 1 year post surgery. Weight loss, change in BMI, total symptoms score as well as individual symptoms were tested for statistical significance with correction for multiple testing using Bonferroni method. Linear regression analysis was performed with total symptoms score change at one year as the outcome variable and BMI, age, total symptoms score before surgery, HOMA‐IR, glucose level before surgery, insulin level before surgery, change in insulin level after surgery, weight loss and BMI loss as predictor variables. RESULTS 86 patients were recruited, 82% completed at least one follow up after surgery. There was significant weight loss and reduction of BMI after surgery (p
  • A rare 8q24 single nucleotide polymorphism (SNP) predisposes North
           American men to prostate cancer and possibly more aggressive disease
    • Abstract: Objective To assess the frequency of a novel prostate cancer‐associated single nucleotide polymorphism (SNP), rs188140481, in a North American population and to evaluate the clinical significance of this variant including annotated prostatectomy pathology. Patients/Subjects and Methods We examined the frequency of the minor allele at rs188140481 in 4299 North American men including 1979 men with prostate cancer and 2320 healthy volunteers. We compared the clinicopathological features of prostate cancer between carriers and non‐carriers of the SNP. Results The rs188140481[A] SNP was present in 1.6% of the cohort; it was significantly more likely to be carried by men with prostate cancer than healthy controls (odds ratio 3.14; 95% confidence interval [CI] 1.85–5.35). After adjusting for age and PSA levels, carriers were found to be 6.73‐fold (95% CI 1.69–26.76) more likely to develop prostate cancer than non‐carriers. Age at diagnosis, frequency of a positive family history of prostate cancer, and biochemical recurrence rates were similar between SNP carriers and non‐carriers. Patients with the SNP had a proportionately higher frequency of stage ≥T2c disease (29.5% vs 20.1%; P = 0.13), Gleason ≥8 tumours (13.3% vs 6.5%; P = 0.10), and extracapsular extension (28.9% vs 18.8%; P = 0.12) compared with non‐carriers. Conclusions rs188140481[A] is a rare SNP that confers greater risk of prostate cancer compared with SNPs identified by genome‐wide association studies. Because of its low frequency, larger studies are needed to validate the prognostic significance of this locus, and associations with adverse pathology.
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