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J. of Microscopy     Hybrid Journal   (Followers: 3, SJR: 0.765, h-index: 76)
J. of Midwifery & Women's Health     Hybrid Journal   (Followers: 29, SJR: 0.503, h-index: 36)
J. of Molecular Recognition     Hybrid Journal   (Followers: 2, SJR: 1.012, h-index: 60)
J. of Money, Credit and Banking     Hybrid Journal   (Followers: 37, SJR: 2.128, h-index: 61)
J. of Morphology     Hybrid Journal   (Followers: 3, SJR: 0.767, h-index: 49)
J. of Multi-Criteria Decision Analysis     Hybrid Journal   (Followers: 2)
J. of Multicultural Counseling and Development     Hybrid Journal   (Followers: 3, SJR: 0.267, h-index: 25)
J. of Neurochemistry     Hybrid Journal   (Followers: 1, SJR: 2.075, h-index: 172)
J. of Neuroendocrinology     Hybrid Journal   (Followers: 6, SJR: 1.417, h-index: 83)
J. of Neuroimaging     Hybrid Journal   (Followers: 2, SJR: 0.761, h-index: 43)
J. of Neuroscience Research     Hybrid Journal   (Followers: 8, SJR: 1.423, h-index: 120)
J. of Nursing and Healthcare of Chronic Illne Ss: An Intl. Interdisciplinary J.     Hybrid Journal   (Followers: 3)
J. of Nursing Management     Hybrid Journal   (Followers: 20, SJR: 1.185, h-index: 38)
J. of Nursing Scholarship     Hybrid Journal   (Followers: 4, SJR: 1.258, h-index: 49)
J. of Obstetric, Gynecologic, & Neonatal Nursing     Hybrid Journal   (Followers: 20, SJR: 0.647, h-index: 42)
J. of Obstetrics and Gynaecology Research     Hybrid Journal   (Followers: 15, SJR: 0.498, h-index: 32)
J. of Oral Pathology & Medicine     Hybrid Journal   (Followers: 3, SJR: 0.775, h-index: 58)
J. of Oral Rehabilitation     Hybrid Journal   (Followers: 4, SJR: 1.033, h-index: 57)
J. of Organizational Behavior     Hybrid Journal   (Followers: 34, SJR: 3.102, h-index: 95)
J. of Orthopaedic Research     Hybrid Journal   (Followers: 17, SJR: 1.505, h-index: 106)
J. of Paediatrics and Child Health     Hybrid Journal   (Followers: 16, SJR: 0.594, h-index: 51)
J. of Pathology     Hybrid Journal   (Followers: 9, SJR: 4.402, h-index: 131)
J. of Pathology : Clinical Research     Open Access  
J. of Peptide Science     Hybrid Journal   (Followers: 18, SJR: 0.641, h-index: 47)
J. of Periodontal Research     Hybrid Journal   (SJR: 0.781, h-index: 58)
J. of Personality     Hybrid Journal   (Followers: 12, SJR: 2.266, h-index: 83)
J. of Petroleum Geology     Hybrid Journal   (Followers: 7, SJR: 0.524, h-index: 24)
J. of Pharmaceutical Sciences     Hybrid Journal   (Followers: 172, SJR: 1.284, h-index: 113)
J. of Philosophy of Education     Hybrid Journal   (Followers: 11, SJR: 0.687, h-index: 20)
J. of Phycology     Hybrid Journal   (Followers: 6, SJR: 1.148, h-index: 84)
J. of Physical Organic Chemistry     Hybrid Journal   (Followers: 9, SJR: 0.64, h-index: 48)
J. of Phytopathology     Hybrid Journal   (Followers: 4, SJR: 0.503, h-index: 37)
J. of Pineal Research     Hybrid Journal   (Followers: 1, SJR: 2.189, h-index: 81)
J. of Plant Nutrition and Soil Science     Hybrid Journal   (Followers: 5, SJR: 0.846, h-index: 49)
J. of Policy Analysis and Management     Hybrid Journal   (Followers: 12, SJR: 1.531, h-index: 47)
J. of Policy and Practice In Intellectual Disabilities     Hybrid Journal   (Followers: 16, SJR: 0.62, h-index: 10)
J. of Political Philosophy     Hybrid Journal   (Followers: 33, SJR: 1.21, h-index: 31)
J. of Polymer Science Part A: Polymer Chemistry     Hybrid Journal   (Followers: 170, SJR: 1.211, h-index: 109)
J. of Polymer Science Part B: Polymer Physics     Hybrid Journal   (Followers: 24, SJR: 1.222, h-index: 96)
J. of Polymer Science Part C : Polymer Letters     Hybrid Journal   (Followers: 5)
J. of Popular Music Studies     Hybrid Journal   (Followers: 8, SJR: 0.199, h-index: 3)
J. of Product Innovation Management     Hybrid Journal   (Followers: 17, SJR: 2.115, h-index: 82)
J. of Prosthodontics     Hybrid Journal   (SJR: 0.44, h-index: 31)
J. of Psychiatric and Mental Health Nursing     Hybrid Journal   (Followers: 60, SJR: 0.529, h-index: 39)
J. of Psychological Issues in Organizational Culture     Hybrid Journal   (Followers: 5)
J. of Public Affairs     Hybrid Journal   (Followers: 2, SJR: 0.434, h-index: 7)
J. of Public Economic Theory     Hybrid Journal   (Followers: 3, SJR: 1.028, h-index: 21)
J. of Public Health Dentistry     Hybrid Journal   (Followers: 1, SJR: 0.757, h-index: 41)
J. of Quaternary Science     Hybrid Journal   (Followers: 22, SJR: 1.763, h-index: 65)
J. of Raman Spectroscopy     Hybrid Journal   (Followers: 11, SJR: 1.105, h-index: 69)
J. of Regional Science     Hybrid Journal   (Followers: 10, SJR: 2.642, h-index: 42)
J. of Religious Ethics     Hybrid Journal   (Followers: 6, SJR: 0.2, h-index: 10)
J. of Religious History     Hybrid Journal   (Followers: 19, SJR: 0.179, h-index: 7)
J. of Renal Care     Hybrid Journal   (Followers: 4, SJR: 0.468, h-index: 13)
J. of Research In Reading     Hybrid Journal   (Followers: 11, SJR: 0.789, h-index: 23)
J. of Research in Science Teaching     Hybrid Journal   (Followers: 14, SJR: 4.717, h-index: 70)
J. of Research in Special Educational Needs     Hybrid Journal   (Followers: 3, SJR: 0.525, h-index: 10)
J. of Research on Adolescence     Hybrid Journal   (Followers: 5, SJR: 1.851, h-index: 55)
J. of Risk & Insurance     Hybrid Journal   (Followers: 20, SJR: 0.925, h-index: 36)
J. of School Health     Hybrid Journal   (Followers: 7, SJR: 1.099, h-index: 52)
J. of Sensory Studies     Hybrid Journal   (Followers: 3, SJR: 1.136, h-index: 30)
J. of Separation Science     Hybrid Journal   (Followers: 10, SJR: 1.148, h-index: 71)
J. of Sexual Medicine     Hybrid Journal   (Followers: 6, SJR: 1.403, h-index: 65)
J. of Sleep Research     Hybrid Journal   (Followers: 12, SJR: 1.259, h-index: 73)
J. of Small Animal Practice     Hybrid Journal   (Followers: 12, SJR: 0.71, h-index: 44)
J. of Small Business Management     Hybrid Journal   (Followers: 10, SJR: 1.117, h-index: 51)
J. of Social Issues     Hybrid Journal   (Followers: 19, SJR: 0.965, h-index: 72)
J. of Social Philosophy     Hybrid Journal   (Followers: 18, SJR: 0.156, h-index: 15)
J. of Sociolinguistics     Hybrid Journal   (Followers: 19, SJR: 1.11, h-index: 21)
J. of Software : Evolution and Process     Hybrid Journal   (Followers: 4, SJR: 0.209, h-index: 4)
J. of Supreme Court History     Hybrid Journal   (Followers: 10)
J. of Surgical Oncology     Hybrid Journal   (Followers: 3, SJR: 1.263, h-index: 75)
J. of Synthetic Lubrication     Hybrid Journal  
J. of Systematics Evolution     Open Access   (Followers: 4, SJR: 0.647, h-index: 22)
J. of Texture Studies     Hybrid Journal   (Followers: 2, SJR: 0.773, h-index: 33)
J. of the American Association of Nurse Practitioners     Partially Free   (Followers: 3, SJR: 0.46, h-index: 27)
J. of the American Ceramic Society     Hybrid Journal   (Followers: 26, SJR: 1.247, h-index: 129)
J. of the American Geriatrics Society     Hybrid Journal   (Followers: 32, SJR: 2.112, h-index: 151)
J. of the American Water Resources Association     Hybrid Journal   (Followers: 20, SJR: 1.072, h-index: 61)
J. of the Association for Information Science and Technology     Hybrid Journal   (Followers: 129)
J. of the CardioMetabolic Syndrome     Hybrid Journal   (Followers: 1)
J. of the European Academy of Dermatology and Venereology     Hybrid Journal   (Followers: 12, SJR: 1.422, h-index: 58)
J. of the Experimental Analysis of Behavior     Hybrid Journal   (Followers: 4, SJR: 0.907, h-index: 36)
J. of the History of the Behavioral Sciences     Hybrid Journal   (Followers: 3, SJR: 0.316, h-index: 15)
J. of the Institute of Brewing     Free   (Followers: 1, SJR: 0.562, h-index: 28)
J. of the Peripheral Nervous System     Hybrid Journal   (Followers: 3, SJR: 1.335, h-index: 45)
J. of the Royal Anthropological Institute     Hybrid Journal   (Followers: 32, SJR: 0.741, h-index: 31)
J. of the Royal Statistical Society Series A (Statistics in Society)     Hybrid Journal   (Followers: 13, SJR: 1.59, h-index: 49)
J. of the Royal Statistical Society Series B (Statistical Methodology)     Hybrid Journal   (Followers: 25, SJR: 7.863, h-index: 82)
J. of the Royal Statistical Society Series C (Applied Statistics)     Hybrid Journal   (Followers: 17, SJR: 1.435, h-index: 51)
J. of the Science of Food and Agriculture     Hybrid Journal   (Followers: 21, SJR: 0.846, h-index: 88)
J. of the Society for Information Display     Hybrid Journal   (Followers: 1, SJR: 0.451, h-index: 32)
J. of the Society for the Anthropology of Europe     Hybrid Journal   (Followers: 8)
J. of the World Aquaculture Society     Hybrid Journal   (Followers: 13, SJR: 0.477, h-index: 38)
J. of Thrombosis and Haemostasis     Hybrid Journal   (Followers: 46, SJR: 2.56, h-index: 108)
J. of Time Series Analysis     Hybrid Journal   (Followers: 8, SJR: 1.361, h-index: 34)
J. of Tissue Engineering and Regenerative Medicine     Hybrid Journal   (Followers: 5, SJR: 1.074, h-index: 35)
J. of Traumatic Stress     Hybrid Journal   (Followers: 13, SJR: 1.63, h-index: 82)
J. of Travel Medicine     Hybrid Journal   (SJR: 0.738, h-index: 40)
J. of Urban Affairs     Hybrid Journal   (Followers: 21, SJR: 1.306, h-index: 32)

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Journal Cover   BJU International
  [SJR: 1.812]   [H-I: 104]   [83 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  [1597 journals]
  • Nephron‐sparing surgery across a nation – outcomes from the
           British Association of Urological Surgeons 2012 national partial
           nephrectomy audit
    • Authors: Archie Fernando; Sarah Fowler, Tim O'Brien,
      Abstract: Objective To determine the scope and outcomes of nephron‐sparing surgery (NSS) across the UK and in so doing set a realistic benchmark and identify fresh contemporary challenges in NSS . Patients and methods In 2012 reporting of outcomes of all types of nephrectomy became mandatory in the UK. 148 surgeons in 86 centres prospectively entered data on 6042 nephrectomies undertaken in 2012. This study is a retrospective analysis of the NSS procedures in the dataset. Results 1044 NSS procedures. Median surgical volume 4 per consultant (1‐39) and 8 per centre (1‐59). 36 surgeons and 10 centres reported on only 1 NSS. Indications: elective ≤4.5cm 59%; elective >4.5cms 10%; relative 7%; imperative 12%; and VHL 1%; unknown 11%. Median tumour size 3.4cm (0.8‐30). Technique: Minimally invasive surgery (MIS) 42%, open 58%. Conversions 4%. Histology: Malignant 80%; benign 18%; unknown 2%. Risk factors for benign histology: age
      PubDate: 2015-11-18T05:17:37.156372-05:
      DOI: 10.1111/bju.13353
  • Trends of the risk of second primary cancer among bladder cancer
           survivors: a population‐based cohort of 10,047 patients
    • Abstract: Objectives To determine whether the risk of second primary cancer (SPC) among patients with bladder cancer (BCa) has changed over past years. Materials and methods Data from ten French population‐based cancer registries were used to establish a cohort of 10,047 patients diagnosed with a first invasive (T1 or greater) BCa between 1989 and 2004 and followed up until 2007. A SPC was defined as the first primary cancer occurring at least two months after a BCa diagnosis. Standardized incidence ratios (SIRs) of metachronous SPC were calculated. Multivariate Poisson regression models were used to assess the direct effect of the year of BCa diagnosis on the risk of SPC. Results The risk of new malignancy among BCa survivors was 60% higher than the general population (SIR=1.60, 95% CI 1.51–1.68). Male patients presented a high risk of SPC of the lung (SIR=3.12), head and neck (SIR=2.19) and prostate (SIR=1.54). In multivariate analyses adjusted on gender, age at diagnosis and follow‐up, a significant increase of the risk of second cancer of the lung was observed over calendar year of BCa diagnosis (p for linear trend .010), with a SIR increasing by 3.7% for each year (95% CI 0.9%‐6.6%). However, no particular trend was observed regarding the risk of second cancer of the head and neck (p=.596) or the prostate (p=.518). Conclusions As the risk of SPC of the lung increased between 1989 and 2004, this study contributes more evidence to support promotion of tobacco‐cessation interventions among BCa patients. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-17T10:35:02.659784-05:
      DOI: 10.1111/bju.13351
  • Clinical significance of preoperative C‐reactive protein and
           squamous cell carcinoma antigen levels in penile squamous cell carcinoma
    • Abstract: Objective The association between pre‐treatment levels of C‐reactive protein (CRP) and squamous cell carcinoma antigen (SCC‐Ag) has not been clarified. Therefore, we evaluated the relevance of CRP and SCC‐Ag levels in relation to clinicopathologic factors and prognosis in penile cancer. Patients and Methods A total of 124 Chinese penile squamous cell cancer patients treated between November 2007 and October 2014 were analyzed retrospectively. Receiver operating characteristic curves were used to identify the combination of markers with the best sensitivity and specificity for prognosis prediction. Statistical data analysis was performed using a nonparametric method, and survival analysis was performed using the log rank test and Cox proportional hazard model. Results Levels of CRP ≥4.5 mg/L and SCC‐Ag ≥1.4 ng/ml were both significantly associated with lymph node metastasis laterality (χ2 trend test, P=0.041), extranodal extension (χ2 trend test, P
      PubDate: 2015-11-17T07:36:53.684623-05:
      DOI: 10.1111/bju.13379
  • Multiphoton microscopy for rapid histopathological evaluation of kidney
    • Authors: Manu Jain; Brian D. Robinson, Amit Aggarwal, Maria M. Shevchuk, Douglas S. Scherr, Sushmita Mukherjee
      Abstract: Objective To explore the potential of multiphoton microscopy (MPM) for rapid evaluation and triaging of ex vivo kidney tissue. MPM is an optical imaging technique that relies on intrinsic tissue emission to generate histological‐resolution images from fresh (unfixed and unstained) tissue. Since MPM does not require any tissue processing which is necessary for conventional histopathology, it can provide a rapid histo‐morphological feedback in real‐time, while preserving the tissue in its native state for future ancillary studies. Materials and methods Fresh neoplastic and non‐neoplastic tissues from nephrectomy specimens (n=40) were imaged with MPM and later submitted for routine histopathology. Results On MPM, normal kidney architecture was evident and clearly distinguishable from tumor. Forty malignant tumors [Clear Cell RCC (CCRCC) =20, Papillary RCC (PRCC) =10, Chromophobe RCC (ChRCC) and Papillary Urothelial Carcinoma (PUC) =5 each, as diagnosed by H&E) were imaged and subtyped as non‐papillary and papillary based on their architecture. Non‐papillary tumors were further classified based on their unique cytoplasmic signatures. CCRCC had a predominant population of cells with fat droplets in cytoplasm. ChRCC had cells with non‐fatty/homogeneous cytoplasm and distinct intra‐cytoplasmic granules. PRCC had single‐cell‐lined papillae with often abundant histiocytes in their core whereas PUC had multi‐layered urothelium‐lined papillae. The diagnostic accuracy of tumor subtyping by two independent uropathologists was 95%. Conclusion MPM can reliably differentiate neoplastic from non‐neoplastic kidney tissue and subtype kidney tumors in fresh, unprocessed tissue. Thus, it might be useful as a rapid real‐time diagnostic tool for the evaluation of kidney biopsies, and surgical margins in partial nephrectomies, to improve overall patient management. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-17T07:36:46.036512-05:
      DOI: 10.1111/bju.13377
  • Adherent perinephric fat at minimally invasive partial nephrectomy is
           associated with adverse perioperative outcomes and malignant renal
    • Authors: Neil J. Kocher; Sudhir Kunchala, Christopher Reynolds, Erik Lehman, Sarah Nie, Jay D. Raman
      Abstract: Objectives To predict adherent perinephric fat (APF) at minimally invasive partial nephrectomy (MIPN), the Mayo Adhesive Probability (MAP) score was developed as a pre‐operative model. We review a contemporary MIPN cohort to determine the impact of MAP score and APF on MIPN outcomes. Patients and Methods 245 patients undergoing MIPN were included. The presence of APF was determined through keywords in operative notes, and radiographic data were obtained from preoperative cross‐sectional imaging. Posterior fat thickness (PFT) was measured between the renal capsule and the posterior abdominal wall at the level of the renal vein. Perinephric stranding was graded on a 0‐3 severity scale. Results 123 men and 122 women with a median age of 55 years, BMI of 31.7, tumor size of 2.7 cm, and nephrometry score of 6 were included. Median posterior fat thickness was 1.79 cm and MAP score was 2.63. 26 patients (10.6%) had evidence of APF at time of renal surgery. Factors predictive of APF included increasing age (P=0.001), male gender (P=0.045), perinephric stranding (P=0.002), PFT (P
      PubDate: 2015-11-17T07:36:27.399025-05:
      DOI: 10.1111/bju.13378
  • Trends in utilization, perioperative outcomes and costs for
           nephroureterectomies in the management of upper tract urothelial carcinoma
           (UTUC): a 10‐year population‐based analysis
    • Abstract: Objective To perform a population‐based study to evaluate contemporary utilization trends, morbidity and costs associated with nephroureterectomies (NU). Contemporary data for NU are largely derived from single academic institution series describing the experience of high‐volume surgeons. It is unclear if the same favorable results occur on a national level. Patients and Methods Using the Premier Hospital Database, we captured patients undergoing a NU with diagnoses of renal pelvis or ureteral neoplasms from 2004 to 2013. We fitted regression models, adjusting for clustering by hospitals and survey weighting to evaluate 90‐day postoperative complications, operating‐room‐time (OT), prolonged length‐of‐stay (pLOS) and direct hospital costs among open, laparoscopic (LNU) and robotic (RNU) approaches. Results After applying sampling and propensity weights we derived a final study cohort of 17,254 ONU, 13,317 LNU and 3,774 RNU for UTUC in the US between 2004 and 2013. During that period, minimally invasive NU (miNU) increased from 36%‐to‐54% while the total number of NUs decreased by nearly 20%. No differences were noted in perioperative outcomes between three surgical approaches, including when the analysis was restricted to highest‐volume hospitals and highest‐volume surgeons. OT was longer for LNU and RNU (p
      PubDate: 2015-11-17T07:25:56.490419-05:
      DOI: 10.1111/bju.13375
  • Comparison of oncological and health related quality of life (HRQOL)
           outcomes between open (ORP) and robotic‐assisted radical
           prostatectomy (RARP) for localized prostate cancer – findings from
           the population‐based Victorian Prostate Cancer Registry (PCR)
    • Authors: Wee Loon Ong; Sue M Evans, Tim Spelman, Paul A Kearns, Declan G Murphy, Jeremy L Millar
      Abstract: Objective To compare the short‐term oncological and HRQOL outcomes between open (ORP) and robotic‐assisted (RARP) radical prostatectomy in the population‐based Victorian Prostate Cancer Registry (PCR). Patients and Methods This is a prospective cohort of prostate cancer patients who had RP (1117 ORP and 885 RARP) between January 2009 and June 2012. The oncological outcomes of interest were: positive surgical margin (PSM) and biochemical recurrence (BCR) (defined as post‐operative PSA >0.2ng/ml). The HRQOL outcomes were: sexual and urinary bother, assessed using the Expanded Prostate Cancer Index Composite (EPIC) at 1‐ and 2‐year post‐diagnosis. Student T‐test or Mann‐Whitney U‐test were used for univariate comparison of continuous variables, and Pearson's chi‐squared test for categorical variables. Bonferonni correction was applied to account for multiple testing, with threshold for significance of P
      PubDate: 2015-11-17T07:21:44.340177-05:
      DOI: 10.1111/bju.13380
  • Outcomes of Unselected Patients with Metastatic Clear‐Cell Renal
           Cell Carcinoma Treated with Front‐Line Pazopanib Therapy Followed by
           Vascular Endothelial Growth Factor Receptor Tyrosine Kinase Inhibitors
           (VEGFR‐TKI) or Mammalian Target of Rapamycin Inhibitors (mTORi): A
           Single Institution Experience
    • Authors: Marc R. Matrana; Tharakeswara Bathala, Matthew T Campbell, Cihan Duran, Aditya Shetty, Purnima Teegavarapu, Sarathi Kalra, Lianchun Xiao, Bradley Atkinson, Paul Corn, Eric Jonasch, Nizar M. Tannir
      Abstract: Background Data regarding unselected patients with metastatic clear‐cell renal cell carcinoma (ccRCC) treated with first‐line pazopanib are limited. Patients and Methods We reviewed records of patients with metastatic ccRCC treated with first‐line pazopanib during 11/09‐11/12. Cox models were fitted to evaluate the association of progression‐free survival (PFS) and overall survival (OS) with patient co‐variables. Results Eighty‐eight patients were identified; 74 were evaluable for response: 2 (3%) had complete response, 27 (36%) had partial response, 36 (49%) had stable disease, and 9 (12%) had progressive disease. Median PFS was 13.7 months (95% CI: 8.7 – 18.3). PFS was correlated with Karnofsky performance score < 80 (HR = 3.26, p < 0.0001) and serum lactate dehydrogenase >1.5 ULN (HR = 3.25, p = 0.0135). Median OS was 29.1 months (95% CI: 20.2 – NA). OS was correlated with brain metastasis (HR = 2.55, p = 0.0089), neutrophilia (HR = 1.179, p = 0.0178), and anemia (HR = 3.51, p = 0.0001). No treatment‐related deaths occurred. Fifty‐three patients received second‐line therapy (VEGFR‐TKI [22], mTORi [22], others [9]); median PFS was 8.6 months (95% CI: 3.3 – 25.7) with VEGFR‐TKI and 5 months (95% CI: 3.5 – 15.2) with mTORi, p = 0.41; median OS was 19.9 months (95% CI: 12.9 – NA) and 14.2 months (95% CI: 8.1 – NA), from initiation of second‐line VEGFR‐TKI or mTORi, respectively, p = 0.37. Conclusions In this retrospective study, first‐line pazopanib confirmed its efficacy in metastatic ccRCC. Trends for longer PFS and OS were observed with VEGFR‐TKI than mTORi after first‐line pazopanib. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-17T07:21:32.514225-05:
      DOI: 10.1111/bju.13374
  • The urological recommendations from the NICE Guideline Suspected Cancer:
           Recognition & Referral June 2015
    • Authors: Edward R. Jefferies; Simon F. Brewster,
      Abstract: NICE have recently published an updated guideline for secondary care cancer referrals (Suspected cancer: recognition and referral NG12 (1)) which updates the CG27 (2005) Referral guidelines for suspected cancer (2). There have been some significant changes to the urgent (two week) referral guidance for urological cancer (see Table 1), especially with regard to the management of haematuria. On behalf of the BAUS Section of Oncology we have summarised their findings salient to our urological practice. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-14T01:02:58.586513-05:
      DOI: 10.1111/bju.13355
  • Pioglitazone and Bladder Cancer
    • Authors: Hannah Warren; Nicholas Raison, Prokar Dasgupta
      Abstract: Last month, Lewis et al published the results of a large, 10 year observational cohort study on the association between the anti‐diabetic drug pioglitazone, and bladder cancer and 10 additional cancers [1]. The study recruited 193,099 diabetic patients over 40 years of age from electronic health records of the Kaiser Permanente Northern California (KPNC) diabetes registry. Use of pioglitazone and other anti‐diabetic medications was collected from prescription records. The KPNC cancer registry was used to identify site specific cancer diagnoses. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-14T00:52:41.27974-05:0
      DOI: 10.1111/bju.13352
  • Extent of Renal Vein Invasion Influences Prognosis in Patients with Renal
           Cell Carcinoma
    • Authors: Mark W. Ball; Michael A. Gorin, Kelly T. Harris, Kevin M. Curtiss, George J. Netto, Christian P. Pavlovich, Phillip M. Pierorazio, Mohamad E. Allaf
      Abstract: Objective To compare oncologic outcomes for segmental versus main renal vein invasion (RVI) in patients with renal cell carcinoma. Patients Methods Patients undergoing extirpative surgery for RCC at our institution from 2003‐2013 were stratified into five groups: T2 (n=135), T3a with fat invasion (n=185), T3a with segmental RVI (n=87), T3a with main RVI (n=64), and T3b disease (n=40). Kaplan‐Meier survival analysis and multivariable Cox regression were performed to determine the impact of segmental RVI on recurrence‐free survival (RFS) and cancer‐specific survival (CSS). Harrell's C index was used to compare the prognostic accuracy of current and proposed staging models. Results At a median follow‐up of 37 months, both RFS and CSS were significantly worse for patients with main RVI as compared to segmental RVI (p = 0.03, p = 0.009, respectively). On multivariable analysis, main RVI had an increased risk of recurrence (HR 2.3, 95% confidence interval [CI] 1.1‐4.4, p = 0.03) and CSS (HR 3.5, 95%CI 1.3‐9.9, p = 0.02) compared to segmental RVI. Sub‐stratifying T3a disease by separating segmental and main RVI improved prognostic accuracy compared to the current staging system for CSS (c indices 0.66 vs 0.59) and RFS (0.70 vs 0.60). Conclusions Main RVI is independently associated with worse RFS and CSS than segmental RVI. These findings may have significance for patient counseling and future staging guidelines. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-14T00:46:55.787952-05:
      DOI: 10.1111/bju.13349
  • A prospective multicentric international study on the surgical outcomes
           and patients’ satisfaction rates of the “Sliding
           Technique” for end‐stage Peyronie's disease with severe
           shortening of the penis and erectile dysfunction
    • Authors: Yvonne Chan; Patrick Fisher, Derya Tilki, Christopher P. Evans
      Abstract: Objective Urethral recurrence (UR) after radical cystectomy is rare but associated with high mortality. With the recently increased use of orthotopic bladder substitution and the questionable benefit of prophylactic urethrectomy, identification of patients at high risk of recurrence, management of the remnant urethra, and treatment of recurrence become critical questions. To summarize the current literature on the diagnosis and management of urethral recurrence after radical cystectomy. Patients and Methods A review of the PubMed database from 1980 to 2014 was performed to identify studies evaluating recurrent urothelial cancer of the urethra after radical cystectomy. The search terms used included urethral recurrence, cystectomy or cystoprostatectomy. Selected studies provided information on the type of urinary diversion performed, the incidence of recurrence, and the time to recurrence. Results Incidence of UR after radical cystectomy ranges from 1‐8% with most recurrences occurring within the first two years after surgery. Increased risk of UR is associated with involvement of the prostate, tumor multifocality, bladder neck involvement, and cutaneous diversion. Median overall survival after urethral recurrence ranges from 6‐54 months and 5‐year disease specific survival after UR is reported between 0‐83%. Conclusion Urethral recurrence remains a relatively rare event. Current literature suggests that urethral wash cytology may be useful in patients with intermediate to high risk recurrence to enable early detection of non‐invasive disease, which may be amenable to conservative therapy prior to urethrectomy. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-11T02:18:58.356987-05:
      DOI: 10.1111/bju.13370
  • Open label study evaluating outpatient urethral sphincter injections of
           onabotulinumtoxinA to treat women with urinary retention due to a primary
           disorder of sphincter relaxation (Fowler's syndrome)
    • Authors: Jalesh N. Panicker; Jai H. Seth, Shahid Khan, Gwen Gonzales, Collette Haslam, Thomas M. Kessler, Clare J. Fowler
      Abstract: Objectives To assess the efficacy, defined as improvement of flow rates by more than 50%, improvement in residual volume and scores on the IPSS questionnaire, and safety of urethral sphincter injections of onabotulinumtoxinA in women with a primary disorder of urethral sphincter relaxation, characterised by an elevated urethral pressure profile and specific findings in the urethral sphincter EMG (Fowler's Syndrome). Patients and methods In this open label pilot institutional review board approved study, ten women) with a primary disorder of urethral sphincter relaxation (elevated urethral pressure profile (UPP), sphincter volume and abnormal EMG) presenting with obstructed voiding (n=5) or in complete urinary retention (n=5) were recruited from a single tertiary referral centre. Baseline symptoms were assessed using the IPSS questionnaire, and urinary flow and post‐void residual volume were measured. After 2% lidocaine injection, 100U of onabotulinumtoxintypeA was injected into the striated urethral sphincter, divided on either side, under EMG guidance. Patients were reviewed at week 1, 4 and 10 post‐treatment and assessed using the IPSS questionnaire, urinary flow rate and post‐void residual volume. The UPP was repeated at week 4. Results The mean patient age was 40 years (range 25‐65), and mean symptom scores on the IPSS questionnaire improved from 25.6 to 14.1, and mean bother score reduced from 6.1 to 3.5 at week 10. As compared to a baseline mean flow rate of 8.12 mls/sec in the women who could void, the flow rate improved to 15.8 mls/sec at week 10. Four out of five women in complete retention could void spontaneously, with a mean flow rate of 14.3 mls/sec at week 10. The mean post‐void residual volume decreased from 260 mls to 89 mls. The mean static UPP improved from 113 to 90 cmH20 at baseline. No serious side effects were reported. Three women with a history of recurrent urinary tract infections developed a urinary tract infection. There were no reports of stress incontinence. Seven out of the ten women opted to return for repeat injections. Conclusion This pilot study demonstrates an improvement in patient‐reported lower urinary tract symptoms, and objective parameters such as flow rate, post‐void residual volume and UPP, ten weeks following urethral sphincter injections of onabotulinumtoxinA. No serious side effects were reported. This treatment could represent a safe outpatient treatment for young women in retention due to a primary disorder of urethral sphincter relaxation. However, a larger study is required to confirm the findings of this pilot study. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-08T03:59:25.436673-05:
      DOI: 10.1111/bju.13342
  • The impact of re‐TUR on clinical outcomes in a large
           multi‐centre cohort of T1‐HG/G3 patients treated with BCG
    • Abstract: Objectives To determine if a re‐TUR in the presence or absence of muscle at the first TUR in T1‐high grade (HG)/G3 bladder cancer patients makes a difference in recurrence, progression, cancer specific (CSS) and overall survival (OS). Methods In a large retrospective multi‐centre cohort of 2451 T1‐HG/G3 patients initially treated with BCG, 935 (38%) had a re‐TUR. According to the presence or absence of muscle in the specimen of the primary TUR, patients were divided in 4 groups: group 1 (no muscle, no re‐TUR), group 2 (no muscle, re‐TUR), group 3 (muscle, no re‐TUR) and group 4 (muscle, re‐TUR). Clinical outcomes were compared across the 4 groups. Results Re‐TUR had a positive impact on recurrence, progression, CSS and OS only if muscle was not present in the primary specimen. Adjusting for the most important prognostic factors, re‐TUR in the absence of muscle had a borderline significant effect on time to recurrence (HR = 0.67, p = 0.08), progression (HR = 0.46, p = 0.06), CSS (HR = 0.31; p = 0.07) and OS (HR = 0.48, p = 0.05). Re‐TUR in the presence of muscle in the primary specimen did not improve the outcome for any of the endpoints. Conclusions Our retrospective analysis suggests that re‐TUR may not be necessary in T1‐HG/G3 patients if muscle is present in the specimen of the primary TUR. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-06T23:59:46.262344-05:
      DOI: 10.1111/bju.13354
  • Advances in Advanced Prostate Cancer – The Continuing Journey
    • Authors: Heather Payne; Reena Davda, Robert Jones, Simon Crabb, Janis Troup, Simon Hughes
      Abstract: Prior to 2004, the uro‐oncology community viewed the management of advanced or metastatic prostate cancer with an air of resigned nihilism. Now, the range of therapeutic options available is the subject of ongoing debate and the British Uro‐oncology Group (BUG) is collating oncologist opinions on the future management of castration‐sensitive disease. Historically, treatment for metastatic prostate cancer was limited to androgen deprivation therapy (ADT) with the aims of delaying disease progression and palliating symptoms. Patients invariably progressed, developing castration‐resistant disease with limited effective therapeutic options. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-04T21:56:38.001681-05:
      DOI: 10.1111/bju.13350
  • Outcome of Living Donor Renal Transplantation in Children with Lower
           Urinary Tract Dysfunction: A Comparative Retrospective Study
    • Abstract: Objectives To compare outcome of renal transplantation (RTx) in children with end stage renal disease (ESRD) due to lower urinary tract dysfunction (LUTD) versus other causes. Patients and methods Database of children < 18 years old who underwent RTx from May 2008 through April 2012 was reviewed. Patients were divided into Group A (LUTD = 29 children) and Group B (other causes of ESRD = 74 children). RTx was performed after achieving low intravesical pressure (< 30 cmH2O) with adequate bladder capacity and drainage. Both groups were compared using student t, Mann‐Whitney, Chi‐square or Exact tests. Graft survival rates (GSR) were evaluated by Kaplan‐Meier curves and Log‐rank test. Results Mean age was 5.05 ± 12.4 (2.2‐18) years. Causes of LUTD were PUV (41.4%), VUR (37.9%), neurogenic bladder (10.3%), Prune Belly Syndrome (3.4%), obstructive megaureter (3.4%) and urethral stricture disease (3.4%). There was no significant difference in age, dialysis duration, or donor type. In Group A, 25/29 (86.2%) patients underwent ≥ 1 surgery to optimize UT for allograft. Pre‐transplant nephrectomy was performed in 15/29 (51.7%), PUV ablation in 9/29 (31%) and ileocystoplasty in 4/29 (13.7%) patients. Mean follow‐up was 4.52 ± 1.55 and 4.07 ± 1.27 years in groups A and B, respectively. There was no significant difference in creatinine and eGFR between both groups at different points of follow‐up. GSR at end of study was 93.1% and 91.1% in groups A and B, respectively (p = 1). According to Kaplan‐Meier survival curves, there was no significant difference in GSR between both groups using the Log‐rank test (p = 0.503). No graft was lost due to urological complications. In Group B, 1 child died due to septicemia. UTI was 24% and 12% in Groups A and B, respectively albeit not significant. No significant difference was found between both groups as regard the incidence of post‐transplantation hydronephrosis. Out of 22 patients with hydronephrosis following transplantation, 3 patients were complicated by UTI. Injection of bulking agents was required in 2 patients for treatment of grade 3 VUR. In the third patient, augmentation cystoplasty was needed. Conclusion Acceptable graft function, survival and UTI rates can be achieved in children with ESRD due to LUTD. Thorough assessment and optimization of LUT together with close follow‐up are keys for successful RTx. This article is protected by copyright. All rights reserved.
      PubDate: 2015-11-02T10:40:27.300731-05:
      DOI: 10.1111/bju.13347
  • Gleason pattern 4, Active Surveillance No More
    • Authors: Niranjan J. Sathianathen; Declan G. Murphy, Roderick C. N. Bergh, Nathan Lawrentschuk
      Abstract: To reduce overtreatment of indolent prostate cancer (PCa), urologists have embraced active surveillance (AS) as a management strategy for low‐risk PCa. However, patterns‐of‐care studies are now demonstrating that AS is also being utilized for patients with intermediate‐risk disease. A contemporary Australian study of 980 men reported that 8.9% of intermediate‐risk men were placed on AS of which 53.8% had Gleason score (GS) 3+4 PCa and 10.4% with 4+3 disease[1]. The most recent update from the CaPSURE database also reflected this trend in AS. However, questions remain about the safety of this practice, particularly as the majority of AS protocols worldwide exclude men with GS4 cancers unless their life expectancy is limited. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-29T23:51:53.834352-05:
      DOI: 10.1111/bju.13333
  • Microscopic hematuria at time of diagnosis is associated with lower
           disease stage in patients with newly diagnosed bladder cancer
    • Authors: Daniel Ramirez; Amit Gupta, Daniel Canter, Brian Harrow, Ryan W. Dobbs, Victor Kucherov, Edward Mueller, Necole Streeper, Matthew A. Uhlman, Robert S. Svatek, Edward M. Messing, Yair Lotan
      Abstract: Objectives To determine whether the severity of hematuria (microscopic or gross) at diagnosis influences the disease stage at presentation in patients diagnosed with bladder cancer. Subjects/Patients And Methods We conducted a multi‐institutional observational cohort study of patients who were newly diagnosed with bladder cancer between August 1999 and May 2012. We reviewed the degree of hematuria, demographic information, clinical and social history, imaging and pathology. The association of hematuria severity with incident tumor stage and grade was evaluated using logistic regression. Results Patients diagnosed with bladder cancer presented with gross hematuria (n=1083, 78.3%), microscopic hematuria (n=189, 13.7%) or without hematuria (n=112, 8.1%). High‐grade disease was found in 64% and 57.1% of patients presenting with gross and microscopic hematuria, respectively and severity of hematuria was not associated with higher grade disease. Stage of disease at for patients presenting with microscopic hematuria was Ta/CIS (68.8%), T1 (19.6%) and ≥T2 (11.6%). Stage of disease at for patients presenting with gross hematuria was Ta/CIS (55.9%), T1 (19.6%) and ≥T2 (17.9%). On multivariate analyses, gross hematuria was independently associated with ≥T2 disease at diagnosis (OR: 1.69, 95%CI 1.05 – 2.71, p = 0.03). Conclusions Among patients with newly diagnosed bladder cancer, presentation with gross hematuria is associated with a more advanced pathologic stage. Earlier detection of disease, before development of gross hematuria, could influence survival in patients with bladder cancer. Type of hematuria at presentation does not impact grade of disease. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-29T23:51:33.376411-05:
      DOI: 10.1111/bju.13345
  • The Urologist's role in Multidisciplinary Management of Placenta Percreta
    • Authors: Briony L. Norris; Wouter Everaerts, Elske Posma, Declan G. Murphy, Mark P. Umstad, Anthony J. Costello, C. David Wrede, Jamie Kearsley
      Abstract: Objectives To evaluate urological interventions in patients with placental adhesive disorders in our collaborative experience at a tertiary referral centre. Patients and Methods We performed a retrospective analysis of a prospectively collected data set, consisting of all women that presented with placental adhesive disorders at the Royal Women's Hospital from August 2009 to September 2013. Patients who required urological intervention were identified and perioperative details were retrieved. Results Of the 49 women that presented with placental adhesive disorders, 36 of them (73.5%) underwent urological interventions. The patients were divided into three groups: planned hysterectomy (n=37), planned conservative management (n=5) and undiagnosed placenta percreta (n=7). In the planned hysterectomy group, 29 patients underwent preoperative cystoscopy and ureteric catheter placement. In 10 patients (34%), the placenta partially invaded the bladder and/or ureter, requiring urological repair. In the conservative management group, four underwent preoperative cystoscopy and ureteric catheter placement and one case required closure of a cystotomy. Of the seven patients with undiagnosed percreta, two were noted to have bladder involvement requiring repair at the time of Caesarean hysterectomy. Conclusion Patients with placental adhesive disorders frequently require urological intervention to prevent or repair injury to the urinary tract. These cases are best managed in specialist centres with multidisciplinary expertise including urologists and interventional radiologists. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-29T02:05:25.144965-05:
      DOI: 10.1111/bju.13332
  • A prediction model for early biochemical failure after radical
           prostatectomy based on the CAPRA‐S score and the presence of
           secondary circulating prostate cells
    • Authors: Nigel P. Murray; Socrates Aedo, Eduardo Reyes, Nelson Orellana, Cynthia Fuentealba, Omar Jacob
      Abstract: Objective To establish a prediction model for early biochemical failure based on the CAPRA‐S score and secondary circulating prostate cells. Patients and Methods A prospective single center study of men who underwent radical prostatectomy as monotherapy for prostate cancer. Clinical‐pathological findings were used to calculate the CAPRA‐S score. 90 days after surgery blood was taken for CPC detection, mononuclear cells were obtained using differential gel centrifugation, and CPCs identified using immunocytochemistry. A CPC was defined as a cell expressing PSA but not CD45. The CPC test was defined as positive or negative. Patients were followed up for up to 5 years, biochemical failure was defined as a PSA >0.2ng/ml. The validity of the CAPRA‐S score was calibrated using partial validation, and Cox proportional hazard regression to build three models, CAPRA‐S, CPC and combined models. Results 321 men participated, mean age 65.5 years, after 5 years of follow up the biochemcial free survival was 98.55%. The model using CAPRA‐S showed a HR of 7.66, that of CPC 34.52 and the combined model showed a HR of 2.60 for CAPRA‐S and 22.5 for CPC. Using the combined model, 23% of men changed from low risk to high risk or vice versa. Conclusion The incorporation of CPC detection significantly increased the discrimination in establishing the probability of biochemcial failure, high risk CAPRA‐S patients who are negative for CPCs have a much better prognosis. The addition of CPC detection gives clinically significant information of who may be eligible for adjuvant therapy. Methods and Patients A single center prospective observational study of men following radical prostatectomy for prostate cancer. CAPRA‐S scores were obtained from the surgical specimen analysis; secondary CPCs were detected using inmunocytochemistry three months post surgery, a positive sample contained ≥1 PSA (+) CD45 (‐) staining cell/blood sample and BF was defined as a serum total PSA >0.20ng/ml. Five year BF was determined using Cox regression analysis for models using the CAPRA‐S, CPC, and combined data, they were compared using a decision analysis curve (DAC), Harrell's C concordance test and predicted versus observed survival using Kaplan‐Meier curves. Results 321 men, mean age 65.5yrs participated, in whom 193 (60%) had secondary CPCs detected. After 5 years of follow up the predicted biochemical free survival was 98.6%. For the DAC, the combined CAPRA‐S/CPC model was superior to both single variable models with a Harrell's C score of 0.86. Using the combined model 23.7% of men changed risk group. Discussion The incorporation of CPC detection into the CAPRA‐S score improved significantly its prognostic value, it identified a low risk CAPRA‐S sub‐group with intermediate risk and a high risk CAPRA‐S subgroup with low risk. The incorporation of CPC detection into the CAPRA‐s score provides clinically important information on possible treatment decisions. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-28T00:40:38.904101-05:
      DOI: 10.1111/bju.13367
  • The prevalence of metabolic syndrome and its components amongst men with
           and without clinical benign prostatic hyperplasia: a large,
           cross‐sectional, UK epidemiological study
    • Authors: Julia R. DiBello; Chris Ioannou, Jonathan Rees, Ben Challacombe, Joe Maskell, Nurul Choudhury, Christof Kastner, Mike Kirby
      Abstract: Objectives To compare the prevalence of (1) the metabolic syndrome and (2) the components of the metabolic syndrome in men aged 50 years and older with and without clinical benign prostate hyperplasia (BPH). Subjects and methods This was a cross‐sectional study using the UK Clinical Practice Research Database (CPRD). Men were selected from the UK CPRD that were ≥50 years of age and still registered as of 31st December 2011. Cohort 1 included men with clinical BPH, and cohort 2 men without clinical BPH that were matched 1:1 to those in cohort 1 by general practice, year of birth and prior years of available history (1 to
      PubDate: 2015-10-26T21:28:56.213779-05:
      DOI: 10.1111/bju.13334
  • Symptom burden and information needs in prostate cancer survivors: A case
           for tailored long‐term survivorship care
    • Abstract: Objectives To determine the relationship between long‐term prostate cancer survivors’ symptom burden and information needs. Subjects/patients and methods We used population‐based data from the Michigan Prostate Cancer Survivor Study (n=2,499). We examined unadjusted differences in long‐term information needs according to symptom burden and performed multivariable logistic regression to examine symptom burden and information needs adjusting for patient characteristics. Results High symptom burden was reported across all domains (sexual 44.4%, urinary 14.4%, vitality 12.7%, bowel 8.4%, emotional 7.6%) with over half of respondents (56%) reporting they needed more information. Top information needs involved recurrence, relationships, and long‐term effects. Prostate cancer survivors with high symptom burden more often searched for information regardless of domain (p
      PubDate: 2015-10-26T00:22:15.381119-05:
      DOI: 10.1111/bju.13329
  • Variation of Serum Prostate‐Specific Antigen in Men with Prostate
           Cancer Managed with Active Surveillance
    • Authors: Behfar Ehdaie; Bing Ying Poon, Daniel D. Sjoberg, Pedro Recabal, Vincent Laudone, Karim Touijer, James Eastham, Peter T. Scardino
      Abstract: Objective To describe fluctuations in PSA levels in men managed with AS to determine if a single PSA increase is a consistent measure to trigger intervention. Patients And Methods We evaluated data on 541 men on AS from 1995 through 2011. PSA variation was described by studying the Kaplan‐Meier probability of patients’ PSA levels reaching 4 or 7 ng/mL, going below those thresholds, and then rising to those thresholds again. We also examined PSA variation by calculating the Kaplan‐Meier probability of a PSA change followed by an equal or greater change in the opposite direction. Results We analyzed data on 541 AS patients with a median of 8 PSA measurements (IQR, 6‐12) on AS for a median of 4 years (IQR, 2‐6). The 5‐year estimate of the probability of reaching a threshold PSA of 7 ng/mL was 40% (95% CI, 35%‐46%) and the 5‐year estimate of subsequently falling below this threshold was 90% (95% CI, 82%‐95%). The 5 year estimate of a PSA direction change was 95% (95% CI, 93‐97%) overall and 56% (95% CI, 51%‐61%) for PSA direction changes of ≥1 ng/mL. Conclusions We observed a high probability of variability in PSA levels for men on AS. The probability of changes in PSA, defined by an increase to specified thresholds or a rise >1ng/mL within 6 months and subsequent decrease of equal or greater value on a subsequent measurement, increases over time. Therefore, a single change in PSA level is not a reliable endpoint for men on AS. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-26T00:01:02.62584-05:0
      DOI: 10.1111/bju.13328
  • Prediction of renal mass aggressiveness using clinical and radiographic
           features: A global, multicenter prospective study
    • Authors: Shay Golan; Scott Eggener, Svetozar Subotic, Eric Barret, Luigi Cormio, Seiji Naito, Ahmet Tefekli, M. Pilar Laguna Pes
      Abstract: Objective To examine the ability of preoperative clinical characteristics to predict histological features of RMs. Materials And Methods Data from consecutive patients with clinical stage I RMs treated surgically between 2010‐2011 in the CROES Renal Mass Registry were collected. Based on surgical histology, tumors were categorized as benign, low aggressiveness cancer, and high aggressiveness cancer. Multivariate logistic regression was used to estimate the probability of the histological group by clinical and radiographic features in the entire cohort and a subcohort of cT1a tumors. The performance of the models was studied by calibration, Nagelkerke's R2, and discrimination (ROC area under the curve). A p
      PubDate: 2015-10-25T23:49:00.14641-05:0
      DOI: 10.1111/bju.13331
  • Surgimesh M‐SLING® Transobturator and Prepubic Four Arm
           Urethral Sling for Post‐Prostatectomy Stress Urinary Incontinence:
           Clinical Prospective Assessment at 24 months
    • Authors: B. Le Portz; O. Haillot, M. Brouziyne, C. Saussine
      Abstract: Objective To assess the tolerance and midterm clinical outcomes regarding the treatment of post‐prostatectomy male incontinence (PPI) with a new four arm mesh sling. Material and Methods This is a French multicentre prospective study for the treatment of PPI, which included 93 patients, subjected to radical prostatectomy at least a year before sling implantation. Data was collected preoperatively, and patients were followed at 3, 12 and 24 months post operatively. Objective outcome parameters included number of pads per day, 24h pad‐test, maximum urinary flow rate (Qmax) and urinary retention. We further analysed the Urinary Symptom Profile (USP®) score, the degree of erectile dysfunction, the patients’ satisfaction level, post‐operative pain, and procedure complications. Catheterisation and hospitalisation periods were also registered. Patients were considered cured if no protection was used and/or daily pad weight
      PubDate: 2015-10-24T09:17:15.032654-05:
      DOI: 10.1111/bju.13368
  • Trends in stage‐specific incidence of prostate cancer in Norway,
           1980‐2010: A population‐based study
    • Abstract: Objectives To estimate changes in the stage distribution of prostate cancer during the time period where opportunistic PSA‐testing was introduced. Subjects and methods Cancer stage, age and year of diagnosis were obtained for all men over the age of 50 diagnosed with prostate cancer in Norway during the period 1980‐2010. Three calendar‐time periods (1980‐1989, 1990‐2000, and 2001‐2010) and three age groups (50‐65, 66‐74, and 75+) were defined. Birth cohorts were categorized into four intervals: 1941. We used Poisson regressions to conduct both a time period and cohort‐based analysis of trends in the incidence of localised, regional and distant cancer for each combination of age groups and calendar‐time periods or birth cohorts, respectively. Additionally, we explored the effect of cohorts on the stage‐specific incidence graphically with a Poisson regression using 5‐year age groups, and by estimating cumulative incidence rates for each birth cohort. Results The annual incidence of localised cancers among men aged 50‐65 and 66‐74 rose from 41.4 and 255.2 per 100,000, respectively, before the introduction of PSA‐testing to 137.9 and 418.7 in 2001‐2010 afterwards, corresponding to 3.3 (CI: 3.1; 3.5) and 1.6 (CI: 1.6; 1.7) fold increases. The incidence of regional cancers increased by a factor seven among men aged
      PubDate: 2015-10-24T09:16:12.379626-05:
      DOI: 10.1111/bju.13364
  • Risk of thromboembolic disease in men with prostate cancer undergoing
           androgen deprivation
    • Abstract: Objectives To investigate the risk of thromboembolic disease (TED) in men with prostate cancer (PCa) on androgen deprivation therapy (ADT) while accounting for known TED risk factors. Materials and Methods TED risk was assessed for 42,263 PCa men on ADT compared to a matched, PCa‐free cohort of 190,930 men. Associations between ADT and deep venous thrombosis (DVT) or pulmonary embolism (PE) were analysed using multivariate Cox proportional hazard regression models. Previous PCa‐related surgeries and the following proxies for disease progression: transurethral resection of the prostate, palliative radiotherapy and nephrostomy, were accounted for. Results Between 1997‐2013, 11,242 PCa men received anti‐androgen (AA) monotherapy, 26,959 gonadotropin‐releasing hormone (GnRH) agonists, 1,091 combined androgen blockade, and 3,789 underwent orchiectomy. When accounting for previous surgeries and proxies of disease progression, GnRH agonist users and surgically castrated men were at increased TED risk versus the comparison cohort, HR: 1.67 (95% CI: 1.40‐1.98) and 1.61 (95% CI: 1.15‐2.28), respectively. Men on AA monotherapy were at decreased risk, HR for DVT: 0.49 (95% CI: 0.33‐0.74). TED risk was highest among those who switched from AA to GnRH agonists, PE HR: 2.55 (95% CI: 1.76‐3.70). This increased from 2.52 (95% CI: 1.54‐4.12) in year one, to 4.05 (95% CI: 2.51‐6.55) in year two. Conclusion TED incidence among men on ADT increased with the duration of therapy and risk was highest for those who switched regimen, thus implicating roles for disease progression as well as ADT in propagating TED risk. Nonetheless, these findings support that only men with a relevant indication should receive systemic ADT. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-24T03:40:05.814888-05:
      DOI: 10.1111/bju.13360
  • Oral enclomiphene citrate raises testosterone and preserves sperm counts
           in obese hypogonadal men, unlike topical testosterone: restoration instead
           of replacement
    • Authors: Edward D. Kim; Andrew McCullough, Jed Kaminetsky
      Abstract: Objectives To determine the effects of daily oral doses of enclomiphene citrate compared with topical testosterone gel treatment on serum total testosterone (TT), luteinising hormone (LH), follicle‐stimulating hormone (FSH), and sperm counts in men with secondary hypogonadism. Patients and Methods Two parallel randomised, double‐blind, double‐dummy, placebo‐controlled, multicentre, phase III studies were undertaken to evaluate two doses of enclomiphene citrate vs testosterone gel (AndroGel®1.62%) on TT, LH, FSH, and sperm counts in overweight men aged 18–60 years with secondary hypogonadism. Men were screened and enrolled in the trials (ZA‐304 and ZA‐305). All enrolled men had early morning serum TT levels in the low or low normal range (≤300 ng/dL; ≤10.4 nmol/L) and had low or normal LH (
      PubDate: 2015-10-23T10:45:44.140562-05:
      DOI: 10.1111/bju.13337
  • Abstracts of the 14th International Kidney Cancer Symposium
    • PubDate: 2015-10-22T08:58:18.611433-05:
      DOI: 10.1111/bju.13365
  • Repeat transurethral resection for non‐muscle‐invasive bladder
           cancer: a contemporary series
    • Authors: Rasha Gendy; Warick Delprado, Phillip Brenner, Andrew Brooks, Graham Coombes, Paul Cozzi, Peter Nash, Manish I. Patel
      Abstract: Objectives To evaluate the depth of transurethral resections of bladder tumour (TURBT), residual cancer rates and up‐staging rates in a contemporary Australian series. Materials and Methods Specimen reports from a single, major reporting pathology centre, servicing a group of urological oncologists in Sydney were obtained for TURBTs performed between October 2008 and February 2013. We examined the depth of TURBT, rates of repeat‐TURBT (re‐TUR) and residual cancer rates at the 3–6 month check cystoscopy. Results One thousand and two hundred and nine transurethral resection specimens retrieved during this period were analysed. There were 162 (13.4%) T1 specimens and 631 (52.2%) Ta specimens, 218 (34.5%) of which were high grade. Muscularis propria was present in 506 (41.9%) specimens in total and in 151 (39.7%) of 380 high‐risk specimens (high grade Ta, T1). Of the 380 high‐risk non‐muscle‐invasive tumours, 85 (22.4%) proceeded to re‐TUR. Of the 48 T1 specimens and 37 Ta high grade specimens that proceeded to re‐TUR, 7 (14.6%) and 1 (2.7%) respectively were upstaged to muscle‐invasive disease. Rates of residual disease/early recurrence at 3–6 months was significantly better for those with re‐TUR compared to those without 56.8% vs 82.5% (P < 0.001) for Ta high grade and 39.6% vs 84% (P = 0.028) for T1 tumours respectively. Conclusion Re‐TUR rates in high‐risk non‐muscle‐invasive bladder cancer are low. However in a contemporary series, the upstaging rates are low, but residual cancer rates high, supporting the need for re‐TUR in this population.
      PubDate: 2015-10-21T01:44:11.715345-05:
      DOI: 10.1111/bju.13265
  • Trends in incidence and survival for upper tract urothelial cancer (UTUC)
           in the state of Victoria – Australia
    • Authors: Richard Woodford; Weranja Ranasinghe, Hau Choong Aw, Shomik Sengupta, Raj Persad
      Abstract: Objective To investigate the incidence and mortality trends of upper tract urothelial cancers (UTUC) in Victoria over the last decade. Patients and Methods Age‐adjusted incidence and mortality rates were calculated for UTUC. These were identified using data from the Victorian Cancer Registry from 2001 until 2011 based on histological diagnoses. Age at diagnosis, sex and demographical location were compared. Results The age‐standardised incidence of UTUC remained stable from 2001 to 2011. There were 278 deaths from UTUC over this period with an overall 5‐year survival rate of 32%. There was no significant difference in survival between 2001–06 and 2007–11 (30% vs 36%, respectively). Lower age at diagnosis was associated with a significant improvement in survival (P = 0.01). Sex and geographical location appeared to have no effect on survival. Conclusion The 5‐year survival rates for UTUC in Victoria are poor, particularly in comparison to worldwide data. In contrast to worldwide trends, the incidence of UTUC appears to be stable. No significant improvement in 5‐year survival rates over the short study period was identified. These findings highlight the difficulties in managing this rare yet deadly malignancy.
      PubDate: 2015-10-21T01:43:27.540925-05:
      DOI: 10.1111/bju.13232
  • Incidence and risk factors of venous thromboembolism after pelvic
           uro‐oncologic surgery – a single center experience
    • Authors: Emily C. Chen; Nathan Papa, Nathan Lawrentschuk, Damien Bolton, Shomik Sengupta
      Abstract: Objective To determine the incidence and assess risk factors for the development of VTE among patients undergoing major pelvic surgery for prostate and bladder cancer in an Australian tertiary referral center. Patients and Methods Consecutive patients undergoing major pelvic uro‐oncologic surgery, namely radical cystectomy and radical prostatectomy over a five‐year period (2009–2013) were identified. Patient variables and types of thromboprophylaxis (pharmacological and/or mechanical) used in this patient cohort were collected for analyses as predictive factors. Results The overall incidence of VTE was 1.8%. Patients undergoing radical cystectomy were more likely to suffer a VTE event compared to patients having radical prostatectomy. In this cohort, the risk factors for VTE include, prolonged operative time of greater than 4 hours (h), lymph node dissection (LND) and patients requiring blood transfusions. Conclusion Patients undergoing major pelvic uro‐oncologic surgery have an approximately 1.8% risk of developing VTE. Risk factors identified in this study should be used to guide the use of early and prolonged thromboprophylaxis.
      PubDate: 2015-10-21T01:43:06.684409-05:
      DOI: 10.1111/bju.13238
  • Men with a negative real‐time MRI/ultrasound‐fusion guided
           targeted biopsy but prostate cancer detection on TRUS‐guided random
           biopsy – what are the reasons for targeted biopsy failure'
    • Abstract: Objective To examine the value of additional TRUS‐guided random biopsy (RB) in patients with negative MRI/Ultrasound‐fusion guided targeted biopsy (TB) and to identify possible reasons for TB failure. Patients and Methods Subgroup analysis of 61 men with prostate cancer (PCa) detection by 10‐core RB but negative TB in a cohort of 408 men with suspicious multiparemetric MRI (mpMRI) between January 2012 and January 2015. Consensus re‐reading of mpMRI (using both PI‐RADS version 1 and version 2) of each suspicious lesion blinded to the biopsy results, followed by an un‐blinded anatomic correlation of the lesion on mpMRI to the biopsy result. The potential reasons for TB failure were estimated for each lesion. Definition of clinically significant PCa according to Epstein criteria and stratification into risk groups according to the EAU guideline. Results RB detected significant PCa in 64% (39/61) and intermediate/high risk PCa in 57% (35/61). The initial reading of mpMRI identified 90 suspicious lesions (PI‐RADS ≥3) in the cohort. Blinded consensus re‐reading of the mpMRI led to PI‐RADS score downgrading of 45 (50%) lesions and upgrading of 13 (14%) lesions. Thus negative TB could be explained by a false high initial PI‐RADS score for 32 (34%) lesions and sampling of the target lesion by RB in the corresponding anatomic site for 36 of 90 lesions (40%) in 35 of 61 (57%) patients. Sampling the target lesion by RB was most likely for lesions with PI‐RADS scores 4/5 and a Gleason score ≥7. 70 PCa lesions (67% Gleason score 6) in 44 (72%) patients were sampled from prostatic sites with no abnormalities on mpMRI. Conclusion In case of TB failure, RB still detected a high rate of significant PCa. The main reason for a negative TB was a TB error, compensated by positive sampling of the target lesion by the additional RB and the second reason for TB failure was a false high initial PI‐RADS score. The challenges of both MRI diagnostics and prostate lesion sampling are evident in our collective and support the integration of RB into the TB workflow. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-20T23:52:40.040317-05:
      DOI: 10.1111/bju.13327
  • Immunotherapy for Bladder Cancer: Rediscovering an Old Friend
    • Abstract: The history of bladder cancer treatment is intimately linked with the use of immunotherapy. In 1990 intravesical bacillus Calmette‐Guerin (BCG) to treat non‐muscle invasive bladder cancer (NMIBC) became the first approved cancer immunotherapy. Early in the twentieth century, Albert Calmette and Camille Guerin, developed the eponymous BCG vaccine from a strain of Mycobacterium bovis found on the udder of an infected cow. Although it was successfully developed as a tuberculosis vaccine, BCG was ineffective as a therapy in the majority of cancers (1). This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-20T23:52:11.397044-05:
      DOI: 10.1111/bju.13330
  • Abstracts of “The 38th Annual Scientific Meeting of Indonesian
           Urological Association”
    • PubDate: 2015-10-20T08:16:09.614743-05:
      DOI: 10.1111/bju.13359
  • Aquablation ‐ Image Guided Robotically‐Assisted Waterjet
           Ablation of the Prostate: Initial Clinical Experience
    • Authors: Peter Gilling; Rana Reuther, Arman Kahokehr, Mark Fraundorfer
      Abstract: Introduction This first‐in‐man study was designed to demonstrate the safety and feasibility of Aquablation. This is a novel minimally invasive water ablation therapy combining image guidance and robotics (AquaBeam®) for the targeted and heat‐free removal of prostatic tissue in men suffering from lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Patients and Methods A prospective, non‐randomized, single‐center trial in men between the ages of 50 – 80 years of age with moderate‐to‐severe LUTS was conducted. Under real‐time image‐based ultrasonic guidance, AquaBeam technology enables surgical planning and mapping, and leads to a controlled heat‐free resection of the prostate using a high‐velocity saline stream. Patients were evaluated at one, three, and six months. Results Fifteen patients were treated with Aquablation under general anaesthesia. The mean age was 73 years (range of 59 to 86 years) and a mean prostate size of 54 ml (range of 27 to 85 ml). A significant median lobe was present in 6 of the 15 subjects. The mean International Prostate Symptom Score (IPSS) was 23 and peak urinary flow rate (Qmax) was 8.4 ml/s at baseline. The mean procedural time was 48 minutes with a mean Aquablation treatment time of 8 minutes. All procedures were technically successful with no serious or unexpected adverse events. All but one patient had removal of catheter on day one, and the majority of patients were discharged on the first postoperative day. No patient required a blood transfusion, and post‐operative sodium changes were negligible. No serious 30 day adverse events occurred. One patient underwent a second Aquablation treatment within ninety days of the first procedure. The mean IPSS score statistically improved from 23.1 at baseline to 8.6 at 6 months (P
      PubDate: 2015-10-19T02:44:45.85447-05:0
      DOI: 10.1111/bju.13358
  • Indoor cold exposure and nocturia: a cross‐sectional analysis of the
           HEIJO‐KYO study
    • Authors: Keigo Saeki; Kenji Obayashi, Norio Kurumatani
      Abstract: Objectives To investigate the association between indoor cold exposure and the prevalence of nocturia among elderly, we conducted the present study. Subjects and methods Temperature in the living room and bedroom of 1065 home dwelling elderly volunteers (≥60 years) was measured for 48 h. Nocturia (≥2 voids per night) and nocturnal urine production were determined using an urination diary and nocturnal urine collection, respectively. Results The mean age of participants was 71.9±7.1 (standard deviation) years, and the prevalence of nocturia was 30.8%. A 1°C decrease in daytime indoor temperature was associated with higher odds ratio (OR) for nocturia (1.064, 95% confidence interval (CI) 1.016–1.114, p = 0.008), independent of outdoor temperature and other potential confounders such as basic characteristics (age, gender, body mass index, alcohol intake, smoking), comorbidities (diabetes, renal dysfunction), medications (calcium channel blocker, diuretics, sleeping pills), socioeconomic status (education, household income), nighttime dipping of ambulatory blood pressure, daytime physical activity, objectively measured sleep efficiency, and urinary melatonin excretion. The association stayed significant after adjustment for nocturnal urine production rate (OR 1.084, 95% CI 1.032–1.138, p = 0.001). Conclusions Indoor cold exposure during daytime was independently associated with nocturia among elderly participants. The mechanism is explained by cold‐induced detrusor over activity. The prevalence of nocturia could be reduced by modification of the indoor thermal environment. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-19T02:23:42.060006-05:
      DOI: 10.1111/bju.13325
  • Population‐based assessment of cancer specific mortality after local
           tumour ablation or observation for kidney cancer: a competing risks
    • Authors: Alessandro Larcher; Vincent Trudeau, Maxine Sun, Katharina Boehm, Malek Meskawi, Zhe Tian, Nicola Fossati, Paolo Dell'Oglio, Umberto Capitanio, Alberto Briganti, Shahrokh F. Shariat, Francesco Montorsi, Pierre I. Karakiewicz
      Abstract: Objectives To examine the potential difference in cancer specific mortality that could distinguish between local tumour ablation (LTA) and observation (OBS) for patients with kidney cancer using competing risks regression. Patients and methods The study focused on 1860 patients with cT1a kidney cancer treated with either LTA or OBS between 2000 and 2009 in the Surveillance Epidemiology and End Results‐Medicare database. Propensity‐score matching was used. Cancer specific mortality (CSM) represented the study outcome. Multivariable competing risks regression analyses adjusting for other‐cause mortality as well as patient (including comorbidities) and tumour characteristics were fitted. Results Overall, fewer patients had LTA vs. OBS (30% vs. 70%; n=553 vs. n=1307). Compared to OBS patients, LTA patients were younger (median age 77 vs. 78 years; p
      PubDate: 2015-10-16T10:22:37.842208-05:
      DOI: 10.1111/bju.13326
  • Urethral atrophy after implantation of an artificial urinary sphincter:
           fact or fiction'
    • Authors: Simon Bugeja; Stella L. Ivaz, Anastasia Frost, Daniela E. Andrich, Anthony R. Mundy
      Abstract: Objectives To investigate the concept of urethral ‘atrophy’ which is often cited as a cause of recurrent incontinence after initially successful implantation of an artificial urinary sphincter (AUS); and to investigate the specific cause of the malfunction of the AUS in these patients and address their management. Patients and methods Between January 2006 and May 2013, 50 consecutive patients (mean age 54.3 years) with recurrent incontinence had their AUS (AMS800™) explored for malfunction and replaced with a new device composed of exactly the same size components, unless there was a particular reason to use something different. Average time to replacement of the device was 10.1 years. Mean follow‐up after replacement of the device was 24.7 months. All patients without an obvious cause for their recurrent incontinence had preoperative urodynamic evaluation including measurement of the Valsalva leak point pressure (VLPP) and the retrograde cuff occlusive pressure (RCOP). After explantation of the AUS in patients without any apparent abnormality of the device at the time of replacement the pressure generated by the explanted pressure regulating balloon (PRB) was measured manometrically, when this was possible. In a select group of six consecutive patients of this type the fibrous capsule surrounding the old cuff was incised then excised to expose and evaluate the underlying corpus spongiosum. Results In 31 of the 50 (62%) undergoing exploration a specific cause for the malfunction of their AUS was defined. In the other 19 patients (38%) no cause was found, either preoperatively or at the time of exploration, other than a low VLPP and RCOP. A typical ‘waisted’ or ‘hour‐glass’ appearance of the underlying corpus spongiosum was demonstrable, to some degree, on explanting the cuff in all cases. In the 6 patients in whom the restrictive sheath surrounding the cuff was excised, the urethral circumference immediately returned to normal after the compressive effect of the sheath was released. Manometry of the explanted PRBs, when this was possible, showed a loss of pressure in all instances. Replacement of the explanted AUS with a new device with the same size cuff and PRB in 14 of these 19 patients was successful in 12 (85.7%). Conclusion These results and other theoretical considerations suggest that recurrent incontinence, years after initially successful implantation of an AUS is because of material failure of the PRB, probably due to age, and consequent loss of its ability to generate the pressure it was designed to produce, and that urethral atrophy does not occur. Simply replacing the old device with a new one with the same characteristics, unless there is a particular reason to do otherwise, is usually successful and avoids the complications of alternatives such as as cuff downsizing or implanting a PRB with a higher pressure range or implantation of a second cuff or transcorporeal cuff placement, all of which have been advocated in these patients. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-12T21:24:16.681728-05:
      DOI: 10.1111/bju.13324
  • Conjoint Urological Society of Australia and New Zealand (USANZ) and
           Urogynaecological Society of Australasia (UGSA) Guidelines on the
           management of adult non‐neurogenic overactive bladder
    • Authors: Vincent Tse; Jennifer King, Caroline Dowling, Sharon English, Katherine Gray, Richard Millard, Helen O'Connell, Samantha Pillay, Jeffrey Thavaseelan
      Abstract: Due to the myriad of treatment options available and the potential increase in the number of patients afflicted with overactive bladder (OAB) who will require treatment, the Female Urology Special Advisory Group (FUSAG) of the Urological Society of Australia and New Zealand (USANZ), in conjunction with the Urogynaecological Society of Australasia (UGSA), see the need to move forward and set up management guidelines for physicians who may encounter or have a special interest in the treatment of this condition. These guidelines, by utilising and recommending evidence‐based data, will hopefully assist in the diagnosis, clinical assessment, and optimisation of treatment efficacy. They are divided into three sections: Diagnosis and Clinical Assessment, Conservative Management, and Surgical Management. These guidelines will also bring Australia and New Zealand in line with other regions of the world where guidelines have been established, such as the American Urological Association, European Association of Urology, International Consultation on Incontinence, and the National Institute for Health and Care Excellence guidelines of the UK.
      PubDate: 2015-10-12T00:31:10.358883-05:
      DOI: 10.1111/bju.13246
  • Is there a place for cytoreduction in metastatic prostate cancer'
    • Authors: Fairleigh Reeves; Anthony J. Costello
      Abstract: Cytoreductive treatment in metastatic prostate cancer (mPCa) primarily refers to local control of the primary tumour by radical prostatectomy (RP) or radiotherapy. However, extirpative treatment of limited metastatic disease by stereotactic body radiotherapy (SBRT) or surgical resection may further reduce or even possibly eliminate disease burden. This comment piece explores the theory and evidence for RP in the setting of mPCa. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-10T02:26:08.822078-05:
      DOI: 10.1111/bju.13323
  • Robotic Partial Nephrectomy with Intracorporeal Renal Hypothermia Using
           Ice Slush: Step‐by‐step Technique and matched comparison to
           warm ischemia
    • Authors: Daniel Ramirez; Peter Caputo, Jayram Krishnan, Homayoun Zargar, Jihad H. Kaouk
      Abstract: Objectives Renal hypothermia protects against effects of ischemia and permits longer pedicle clamp times during robotic partial nephrectomy (RPN). Our objective is to outline our step‐by‐step technique for intracorporeal renal cooling during RPN. Patients and materials Patient selection was performed during preoperative clinic visit. Inclusion criteria included cases where warm ischemia was estimated to be > 30 minutes during pre‐operative assessment as determined by patients with complex renal masses. Special equipment required for this procedure include an Ecolab Hush Slush machine (Microtek Medical Inc., Columbus, MS) a Mon‐a‐therm needle thermocouple device (Covidien, Mansfield, MA), and 6 modified 20 mL syringes. Patients are arranged in 60 degree modified flank position with the operative table flexed slightly at the level of the anterior superior iliac spine (ASIS). For introduction of temperature probe and ice slush, an additional 12mm trocar is placed along the mid‐axillary line beneath the costal margin. Modified 10/20 cc syringes are prefilled with ice slush for instillation via accessary trocar. Perioperative and 6 month functional outcomes were compared to a cohort of patients who underwent RPN with warm ischemia in a 2:1 matched fashion. Matching was performed based on preoperative eGFR, ischemia time and RENAL score. Results Strategies for successful intracorporeal renal cooling include: (1) placement of accessory port directly over the kidney. (2) Uniform ice consistency and modified syringes. (3) Sequential clamping of renal artery and vein. (4) Protection of the neighboring intestine with a laparoscopic sponge. (5) Complete mobilization of the kidney. Kidney temperature is monitored via needle thermocoupler device while core body temperature is concurrently monitored via esophageal probe in real time. Renal function was assessed by measuring serum creatinine, eGFR and MAG‐3 renal scan perioperatively and at 6‐month follow up. In the separate matched analysis, cold ischemia during RPN was found to be associated with a 12.9% improvement in preservation of postoperative eGFR. No difference was seen in either group at 6 month follow up. Conclusions RPN with intracorporeal renal hypothermia using ice slush is technically feasible and may improve post‐operative renal function in the short‐term. Our technique for intracorporeal hypotheramia is cost‐effective, simple and highly reproducible. This article is protected by copyright. All rights reserved.
      PubDate: 2015-10-05T05:22:46.996978-05:
      DOI: 10.1111/bju.13346
  • Diagnosing secondary hypogonadism: important consequences for fertility
           and reversibility
    • Authors: John Dean; Mario Maggi, Bert-Jan Boer, Wayne Hellstrom, Mohit Khera, Edward D Kim, Andrew McCullough, Frederick Wu, Michael Zitzmann
      Abstract: Hypogonadism (HG, testicular failure in men) has become a controversial and much misunderstood condition. Many men perceive testosterone as a panacea for the ills of ageing and “Low-T clinics” have sprung up to meet their demands, even though testosterone is often not the answer. In light of the unprecedented rise in testosterone prescriptions in recent years, particularly amongst middle-aged men, the US Food and Drug Administration (FDA) issued a Safety Communication in May 2015 intended to restrict the use of testosterone. This article is protected by copyright. All rights reserved.
      PubDate: 2015-09-11T09:16:28.472415-05:
      DOI: 10.1111/bju.13316
  • Training in minimally invasive surgery in urology EAU‐ICUD
    • Authors: Henk der Poel; Willem Brinkman, Ben Cleynenbreugel, Panagiotis Kallidonis, Jens-Uwe Stolzenburg, Evangelos Liatsikos, Kamran Ahmed, Oliver Brunckhorst, Mohammed Shamim Khan, Minh Do, Roman Ganzer, Declan G Murphy, Simon Van Rij, Philip E Dundee, Prokar Dasgupta
      Abstract: Objectives To describe the progress in training for minimal invasive surgery (MIS) in urology Methods A group of experts in the field provided input to come to recommendations for MIS training. A literature search was done on MIS training in general and specific for urological procedures. Results A literature search showed the rapidly developing options for e‐learning, box and virtual training and suggested that box training is a relatively cheap and effective means of improving laparoscopic skills. Development of non‐technical skills is an integral part of surgical skills training and should be included in training curricula. The application of modular training of surgical procedures showed more rapid skills acquiring. Training curricula for minimal invasive surgery in urology are being developed in both US and Europe. Conclusion Training in MIS has shifted from “see‐one‐do‐one‐teach‐one” to a structured learning from e‐learning to skills lab and modular training settings. This article is protected by copyright. All rights reserved.
      PubDate: 2015-09-09T11:32:39.096762-05:
      DOI: 10.1111/bju.13320
  • Pathologic gleason 8‐10: do all men do poorly' results from the
           search database
    • Authors: Sean Fischer; Daniel Lin, Ross M. Simon, Lauren Howard, William J. Aronson, Martha K. Terris, Christopher J. Kane, Christopher L. Amling, Matt R. Cooperberg, Stephen J. Freedland, Adriana C. Vidal
      Abstract: Objective To determine whether there are subsets of men with pathologic high‐grade disease (Gleason 8‐10) who have particularly high or low 2‐year BCR risk after radical prostatectomy (RP) when stratified into groups based on combinations of pathologic features such as surgical margins (SM), extracapsular extension (ECE) and seminal vesicle invasion (SVI). Methods We identified 459 patients treated with RP with pathologic Gleason 8‐10 in the SEARCH database. Patients were stratified into 5 groups based on pathological characteristics – Group 1: men with negative surgical margins and no extracapsular extension (‐SM/‐ECE), Group 2 (+SM/‐ECE), Group 3 (‐SM/+ECE), Group 4 (+SM/+ECE), and Group 5: men with SVI (+SVI). Cox proportional hazards models and the log‐rank test were used to compare BCR among the groups. Results At 2‐years post‐RP, pathological group was significantly correlated with BCR (log‐rank, p
      PubDate: 2015-09-09T05:17:39.519598-05:
      DOI: 10.1111/bju.13319
  • A patterns of care and health economic analysis of robotic radical
           prostatectomy in the Australian public health system
    • Authors: Marnique Basto; Niranjan Sathianathan, Luc te Marvelde, Shane Ryan, Jeremy Goad, Nathan Lawrentschuk, Anthony J Costello, Daniel Moon, Alexander Heriot, Jim Butler, Declan G Murphy
      Abstract: Objective To compare patterns of care and perioperative outcomes of robotic prostatectomy to other surgical approaches, and create an economic model to assess the viability of robotic prostatectomy in the public case‐mix funding system. Patients and Methods We retrospectively reviewed all radical prostatectomies (RP) performed for localised prostate cancer in Victoria, Australia, from the Victorian Admitted Episode Dataset (VAED), a large administrative database that records all hospital inpatient episodes in Victoria, Australia's second most populous state. The first database from July 2010 to April 2013 (n=5130) was utilised to compare length of hospital stay (LOS) and blood transfusion rates (BTR) between surgical approaches. This was subsequently integrated into an economic model. A second database (n=5581) was extracted between July 2010 and June 2013, three full financial years, to depict patterns of care and make future predictions for the 2014‐15 financial year, and to perform a hospital volume analysis. We then created an economic model to evaluate the incremental cost of robotic assisted radical prostatectomy (RARP) over open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP) incorporating the cost offset from differences in LOS and BTR. The economic model constructs estimates of the diagnosis related group (DRG) costs of ORP and LRP, adds the gross cost of the surgical robot (capital, consumables, maintenance and repairs), and manipulates these DRG costs to obtain a DRG cost per day which can be used to estimate the cost offset associated with RARP in comparison with ORP and LRP. Economic modelling was performed around a base‐case scenario, assuming a 7‐year robot lifespan and 124 robotic cases performed per financial year, and one and two‐way sensitivity analyses performed for the 4‐arm da Vinci SHD, Si and Si dual surgical systems. Results We identified 5581 patients who underwent radical prostatectomy in 20 Victorian hospitals utilising an open, laparoscopic or robotic surgical approach in the public and private sector. Overall, the majority of RP is performed in the Victorian private sector 4233 (75.8%), with an overall 11.5% decrease in the total number of RPs performed over the three‐year study period. In the most recent financial year 820 (47%), 765 (44%) and 173 (10%) underwent RARP, ORP and LRP respectively. In the same timeframe, RARP accounted for 26% and 53% of all RPs in the public and private sector respectively. Victorian public hospitals perform a median number of 14 RPs per year, 40% of hospitals perform less than ten per year. In the public system, RARP had a mean (±SD) LOS of 1.4 days (±1.3) compared to LRP 3.6 days (±2.7) and ORP 4.8 days (±3.5) (p
      PubDate: 2015-09-09T05:14:33.471566-05:
      DOI: 10.1111/bju.13317
  • In parallel comparative evaluation between multiparametric mri, pca3 and
           phi in predicting pathologically confirmed significant prostate cancer in
           men eligible for active surveillance
    • Authors: F Porpiglia; F Cantiello, S De Luca, M Manfredi, A Veltri, F Russo, A Sottile, R Damiano
      Abstract: Objective To assess the performance capabilities of multiparametric Magnetic Resonance Imaging (mpMRI), Prostate Health Index (PHI) and Prostate Cancer Antigen 3 gene (PCA3) in predicting the presence of pathologically confirmed significant Prostate Cancer (PCSPCa), according to the European Randomized Study of Screening Prostate Cancer (ERSPC) definition, in a same cohort of patients who underwent Radical Prostatectomy (RP) but eligible for Active Surveillance (AS). Materials and Methods An observational retrospective study was performed in 120 prostate cancer (PCa) patients treated with robot‐assisted RP but eligible for AS according to Prostate Cancer Research International: Active Surveillance (PRIAS) criteria. Blood and urinary specimens were collected before initial prostate biopsy for PHI and PCA3 measurements, respectively. In addition, all patients underwent preoperatively and after 6‐8 weeks from biopsy to mpMRI with a 1.5T scanner using a 4‐5 channel phase array coil combined with an endorectal coin. mpMRI images were assessed and diagrams depicting prostate sextants were used to designate regions of abnormalities within the prostate. Findings in the prostate were assigned to one of five categories according Prostate Imaging‐Reporting and Data System guidelines (PI‐RADS) and considered positive for PCa if final PI‐RADS was >3 and negative if ≤3. Results A pathologically confirmed reclassification was observed in 55 patients (45.8%). mpMRI demonstrated a good specificity and negative predictive value (0.61 and 0.73, respectively) for ruling out a PCSPCa compared with PHI and PCA3. On multivariate analyses and after one thousand bootstrapping resampling, the inclusion of both PHI and mpMRI significantly increased the accuracy of the base model in predicting PCSPCa. Particularly, to predict PCSPCa, the base model had an AUC of 0.71 which significantly increased by 4% with the addition of PHI (AUC=0.75; p
      PubDate: 2015-09-09T05:14:15.916936-05:
      DOI: 10.1111/bju.13318
  • To Clamp or Not to Clamp' Long‐Term Functional Outcomes for
           Elective Off‐Clamp Laparoscopic Partial Nephrectomy
    • Authors: Paras H. Shah; Arvin K. George, Daniel M. Moreira, Manaf Alom, Zhamshid Okhunov, Simpa Salami, Nikhil Waingankar, Michael J. Schwartz, Manish A. Vira, Lee Richstone, Louis R. Kavoussi
      Abstract: Objective To evaluate whether elective off‐clamp laparoscopic partial nephrectomy affords long‐term renal functional benefit compared to the on‐clamp approach. Subjects/Patients and Methods This is a retrospective review of patients who underwent elective laparoscopic partial nephrectomy between 2006 and 2011. Patients were followed longitudinally for up to 5 years. 315 patients with radiographic evidence of a solitary renal mass and normal‐appearing contralateral kidney underwent elective laparoscopic partial nephrectomy; 209 were performed on‐clamp versus 106 off‐clamp. One patient who required conversion from laparoscopic to open partial nephrectomy was excluded from the study. Additionally, 4 patients in the on‐clamp cohort who underwent subsequent radical nephrectomy for local‐regional recurrence were excluded from longitudinal functional evaluation after their procedure. The primary objective was to evaluate differences in postoperative estimated glomerular filtration rate between hilar clamping groups. Subgroup analyses were performed for patients with clamp times >30 minutes and those with baseline renal insufficiency (estimated glomerular filtration rate 0.05). Univariable and multivariable analyses did not demonstrate significant differences in postoperative estimated glomerular filtration rate between both groups among all‐comers, those with clamp times >30 min, and patients w/ baseline renal insufficiency. Risk of chronic kidney disease was not diminished by the off‐clamp approach with up to 5 years of follow‐up. Conclusions Progressive recovery of renal function after hilar clamping in the elective setting eclipses short‐term functional benefit achieved with off‐clamp laparoscopic partial nephrectomy by 6 months; no significant difference in estimated glomerular filtration rate or percent incidence of chronic kidney disease exists between on‐clamp and off‐clamp cohorts with up to 5‐year follow‐up. As such, eliminating transient ischemia during elective laparoscopic partial nephrectomy does not confer clinical benefit. This article is protected by copyright. All rights reserved.
      PubDate: 2015-09-08T07:40:24.281247-05:
      DOI: 10.1111/bju.13309
  • Functional roles of the bladder alpha1‐adrenoceptors in the
    • Authors: Naoki Aizawa; Rino Sugiyama, Koji Ichihara, Tetsuya Fujimura, Hiroshi Fukuhara, Yukio Homma, Yasuhiko Igawa
      Abstract: Objectives To clarify the involvement of bladder α1‐adrenoceptors (α1‐ARs) in the afferent pathways, we investigated effects of silodosin and BMY7378, a selective α1A‐ or α1D‐AR antagonist, respectively, on single unit afferent nerve fiber activities (SAAs) of the primary bladder afferent nerves and its relationship with microcontractions in rats. Materials and Methods Sixty‐three female Sprague‐Dawley rats were anesthetized with urethane. The SAAs of Aδ‐ and C‐fibers generated from left L6 dorsal roots were identified by electrical stimulation of the left pelvic nerve and bladder distension. After measuring baselines of SAA during constant filling cystometry, the procedure was repeated with intravenous (0.3‐30 μg/kg) or intravesical (10 μM) administration of each antagonist. In separate animals, the bladder was filled with saline until the intravesical pressure reached 30 cmH2O, and kept under an isovolumetric condition, then the recording was performed with vehicle and silodosin (0.3 μg/kg) administered intravenously. Results Thirty‐three Aδ‐fibers and 33 C‐fibers were isolated from 63 rats. SAAs of Aδ‐fibers, but not C‐fibers, were dose‐dependently decreased after both intravenous and intravesical administrations of each of the antagonists. In the experiments under the bladder isovolumetric condition, silodosin‐administration significantly decreased the SAAs of Aδ‐fibers, but not C‐fibers, compared with vehicle‐administration. There was no significant effect on either the mean basal bladder pressure or microcontractions. Conclusion The present study suggests that both α1A‐ or α1D‐ARs in the rat bladder are involved in the activation of the bladder mechanosensory Aδ‐fibers during bladder filling, and that this activation may not be related to bladder microcontractions. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-31T10:51:24.468878-05:
      DOI: 10.1111/bju.13313
  • Prostate cancer risk prediction using the novel versions of the ERSPC and
           PCPT risk calculators: Independent validation and comparison in a
           contemporary European cohort
    • Abstract: Objectives To externally validate and compare the two novel versions of the ERSPC‐ prostate cancer (PCa) risk‐calculator (RC) and PCPT‐RC. Patients and methods All men who underwent a transrectal prostate biopsy in a European tertiary care centre between 2004 and 2012 were retrospectively identified. The probability of detecting PCa and significant PCa (Gleason score ≥7) was calculated for each man using the novel versions of the ERSPC‐RC (DRE‐based version 3 / 4) and the PCPT‐RC (version 2.0) and compared with the biopsy results. Calibration and discrimination were assessed using the calibration slope method and the area under the receiver operating characteristic curve (AUC), respectively. Additionally, decision curve analyses were performed. Results Of 1996 men, 483 (24%) were diagnosed with PCa and 226 (11%) with significant PCa. Calibration of the two RCs was comparable, although the PCPT‐RC was slightly superior in the higher risk prediction range for any and significant PCa. Discrimination of the ERSPC‐ and PCPT‐RC was comparable for any PCa (AUCs: 0.65 vs. 0.66), while the ERSPC‐RC was somewhat better for significant PCa (AUCs: 0.73 vs. 0.70). Decision curve analyses revealed a comparable net benefit for any PCa and a slightly greater net benefit for significant PCa using the ERSPC‐RC. Conclusions In our independent external validation, both updated RCs showed less optimistic performance compared to their original reports particularly for the prediction of any PCa. Risk prediction of significant PCa, which is important to avoid unnecessary biopsies and reduce overdiagnosis and overtreatment, was better for both RCs and slightly superior using the ERSPC‐RC. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-31T10:50:07.974025-05:
      DOI: 10.1111/bju.13314
  • A Positive Family History as risk factor for Prostate Cancer in a
           Population‐based Study with organized PSA‐Screening: Results
           of the Swiss ERSPC (Aarau)
    • Abstract: Objective To assess the value of positive family history (FH) as a risk factor for prostate cancer (PCa) incidence and grade among men undergoing organized PSA‐screening in a population‐based study. Patients and Methods The study cohort comprised all attendees of the Swiss arm of the ERSPC with systematic PSA‐tests every 4 years. Men reporting first‐degree relative(s) diagnosed with PCa were considered to have a positive FH. Biopsy was exclusively PSA‐triggered with a threshold of 3ng/ml. Primary endpoint was PCa diagnosis. Kaplan‐Meier and Cox regression analyses were used. Results Of 4,932 attendees with a median age of 60.9 (IQR 57.6‐65.1) years, 334 (6.8%) reported a positive FH. Median follow‐up duration was 11.6 years (IQR 10.3‐13.3). Cumulative PCa incidence was 60/334 (18%, positive FH) and 550/4,598 (12%, negative FH) (OR 1.6, 95%CI 1.2‐2.2, p=0.001), respectively. In both groups, most PCa diagnosed had a low grade. There were no significant differences of PSA at diagnosis, biopsy Gleason score or Gleason score on pathologic specimen among men who underwent radical prostatectomy between both groups, respectively. On multivariable analysis, age (HR 1.04, 95% CI 1.02‐1.06), baseline PSA (HR 1.13 95% CI 1.12‐1.14), and FH (HR 1.6, CI 1.24‐2.14) were independent predictors for overall PCa incidence (p
      PubDate: 2015-08-31T10:22:04.258927-05:
      DOI: 10.1111/bju.13310
  • Active Surveillance in localized prostate cancer: Comparison of incidental
           tumors (T1a/b) and tumors diagnosed by core needle biopsy (T1c/T2a).
           Results from the HAROW Study
    • Authors: Jan Herden; Sebastian Wille, Lothar Weissbach
      Abstract: Objective To conduct a comparative prospective analysis of patients with incidental T1a/T1b‐prostate cancer (IPC) and prostate cancer (PCa) diagnosed by core needle biopsy treated by active surveillance (AS) in terms of inclusion criteria, progression and switch to deferred treatment. Patients and Methods HAROW is an observational outcomes research study on the management of localized PCa. Treating urologists were reporting clinical parameters, information on therapy and clinical course of disease at 6‐month intervals. With respect to therapy, merely recommendations were made; the final decision of the therapeutic modality rested with the treating physician. Results Out of 2957 HAROW patients, 447 chose AS. The median follow‐up was 28.3 months. T‐categories T1a, T1b, T1c and T2a were diagnosed in 81, 18, 292 and 56 patients, respectively. The IPC patient group displayed lower PSA levels (4.2 vs. 6.1 ng/mL) and more co‐morbidities. The IPC group had fewer re‐biopsies (25.3% vs. 43.2%) and fewer changes to invasive treatment (12.1% vs. 25.9%). No significant differences were found with respect to the criteria for discontinuation, subsequent therapies and histological findings after radical prostatectomy. Conclusion Urologists are highly inclined to use AS as a therapeutic option in IPC. More IPC patients continued on AS, which was also associated with the fact that the indication for a re‐biopsy was less stringently observed. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-31T10:15:35.05587-05:0
      DOI: 10.1111/bju.13308
  • Patterns of prescription and adherence to EAU Guidelines of androgen
           deprivation therapy in prostate cancer: an Italian multicenter
           cross‐sectional analysis from the CHOsIng treatment for prostate
           canCEr (CHOICE) study
    • Abstract: Objective To evaluate the patterns of prescription of androgen deprivation therapy (ADT) in patients with prostate cancer (PCa) and the adherence to European Association Urology (EAU) guidelines for ADT prescription. Methods The CHOsIng treatment for prostate canCEr (CHOICE) study was an Italian multicenter cross‐sectional study conducted from December 2010 to January 2012. A total of 1386 patients treated with ADT for PCa (first prescription or renewal of ADT) were selected. According to EAU guidelines, the cohort was categorized in discordant ADT (Group A) and concordant ADT (Group B). Results The final cohort included 1075 patients with a geographical distribution including North‐Italy in 627 (58.3%), Center‐Italy in 233 (21.7%) and South‐Italy in 215 (20.0%). In the category of patients treated with primary ADT, a total of 125 (56.3%) were classified as low‐risk according to D'Amico Classification. According to EAU guidelines, 285 (26.51%) and 790 (73.49%) were classified as discordant (Group A) and concordant (Group B) respectively. In Group A, patients were more likely to receive primary ADT (57.5%; 164/285) than RP (30.9%; 88/285), RT (6.7%; 19/285) or RP + RT (17.7%; 14/285) (p
      PubDate: 2015-08-31T10:15:02.927678-05:
      DOI: 10.1111/bju.13307
  • Transperineal template prostate mapping biopsies: an evaluation of
           different protocols in detection of clinically significant prostate cancer
    • Authors: M Valerio; C Anele, S C Charman, J der Meulen, A Freeman, C Jameson, P B Singh, M Emberton, H U Ahmed
      Abstract: Objectives To determine whether modified transperineal template prostate mapping (TTPM) biopsy protocols, altering the template or the biopsy density, have sensitivity and negative predictive value equal to full 5mm TTPM. Materials and Methods Retrospective analysis of an institutional registry including treatment‐naïve men undergoing 5mm TTPM analysed in 20 zones fashion. The value of three modified strategies was assessed by comparing the information provided by selected zones against full 5mm TTPM. Strategy 1 did not consider the findings of anterior areas; strategies 2 and 3 simulated a reduced biopsy density by excluding intervening zones. A bootstrapping technique was employed to calculate reliable estimates of sensitivity and negative predictive value of these three strategies with respect to detection of clinically significant disease (maximum cancer core length >/= 4mm and/or Gleason score >/= 3+4). Results 391 men with median age 62 years (IQR 58‐67) were included. Median PSA and PSA density were 6.9 ng/ml (IQR 4.8‐10) and 0.17 (IQR 0.12‐0.25), respectively. A median of 6 cores (IQR 2‐9) out of 48 taken per man (IQR 33‐63) were positive for prostate cancer. No cancer was detected in 67 men (17%), whilst low, intermediate and high risk disease was identified in 78 (20%), 80 (21%) and 166 (42%), respectively. Strategy 1, 2 and 3 had sensitivities of 78% (95% CI 73‐84%), 85% (95% CI 80‐90%) and 84% (95% CI 79‐89%), respectively. The negative predictive values of the three strategies was at 73% (95% CI 67‐80%), 80% (95% CI 74‐86%) and 79% (95% CI 72‐84%), respectively. Conclusion Altering the template or decreasing sampling density has a substantial negative impact on the ability of TTPM to rule out clinically significant disease. This should be considered when modified TTPM strategies are performed to select men for tissue‐preserving approaches, and when modified TTPM are employed to validate new diagnostic tests. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-30T23:51:51.259818-05:
      DOI: 10.1111/bju.13306
  • Factors predicting outcome in micropercutaneous nephrolithotomy
           (Microperc): results from a large single centre experience
    • Authors: Arvind Ganpule; Jaspreet Singh Chhabra, Vinayak Kore, Shashikant Mishra, Ravindra Sabnis, Mahesh Desai
      Abstract: Objective To present our single center experience of the microperc technique and define its role in the management of renal calculi and to analyze the factors predicting outcome. Patients and methods We retrospectively analyzed data of 139 patients who underwent microperc for renal calculi between June 2010 and November 2014 at our institution. The factors analyzed were demographic variables which included age, sex, stone volume, stone density (Hounsfield unit), stone location, and intra and perioperative variables such as operative time, hemoglobin drop, stone clearance and complications. Results The mean age of the patients was 38.99± 17 (9 month to 73 years) years, the mean stone volume was 1095± 1035 (105 to 6650) mm3 and the mean stone density in Hounsfield units was 1298 ± 263. The duration of operation was 50.15 ± 9.8 (35‐85) min. The mean hospital stay was 2.36 ± 0.85 (2–5) days and the mean drop in the hemoglobin level was 0.63 ± 0.84 (0–3.7) gm%. 8 patients had renal colic that was managed by antispasmodics and 4 patients had renal colic severe enough to warrant Double‐J stenting and 3 patients had urinary tract infection which were managed with appropriate antibiotics. Microperc could be completed in 130 patients, with 119 (91.53%) patients being rendered completely stone free and in 11 (8.46%) cases there were some residual fragments seen on imaging. On multi‐variate analysis stone number, volume and density (Hounsfield units) were found to be significant predictors of clearance. Conversion to mini or standard percutaneous nephrolithotomy was required in 9 (6.47%) cases, with intra operative complications and stone number being the significant factors warranting conversion on a multivariate basis. Conclusion The outcomes in our study suggest that Microperc is a promising treatment modality for solitary renal stones with volumes
      PubDate: 2015-08-29T02:33:53.578891-05:
      DOI: 10.1111/bju.13263
  • Risk Factors for Recurrence After Surgery in Non‐ metastatic RCC
           with Thrombus; a Contemporary Multicenter Analysis
    • Abstract: Objective Few studies of renal cell cancer with tumor thrombus have evaluated the risk of recurrence after attempted curative surgery. The objective of this study was to determine predictors of postsurgical recurrence for non‐metastatic patients with RCC and venous thrombus. Methods Records from consecutive non‐metastatic RCC patients with tumor thrombus treated surgically from 2000 to 2012 at three centers were reviewed. Univariable and multivariable analysis was used to evaluate the association of risk factors for post‐surgical recurrence. Results A total of 465 non‐metastatic patients were identified including patients with thrombus present in: renal vein 257 (55.3%), infrahepatic IVC 144 (31.0%), and suprahepatic IVC 64 (13.8%). Median follow‐up was 28.3 months (IQR 12.2‐56.4) with metastatic RCC developing in 188 (40.5%) patients. Independent predictors of recurrence included: BMI ≤20 (HR 2.66; 95% CI 1.29‐5.49), low pre‐operative hemoglobin (HR 1.54; 95% CI 1.07‐2.20), perinephric fat invasion (HR 1.51; 95% CI 1.09‐2.10), IVC thrombus height (HR 2.64; 95% CI 1.47‐4.74), tumor diameter (HR 1.04 95% CI 1.00‐1.09), nuclear grade (HR 1.56 95% CI 1.12‐2.15), and non‐clear cell histology (2.13; 1.30‐3.50). Independently predictive variables were used to create a recurrence model for 3 risk groups based on 0, 1‐2, or >2 risk factors respectively. Five‐year RFS was significantly different in favorable risk (79.1%) compared to intermediate risk (55.1%) or high risk (22.1%) patients, p
      PubDate: 2015-08-25T10:43:14.713069-05:
      DOI: 10.1111/bju.13268
  • Non‐steroidal Anti‐inflammatory Drug use Not Associated with
           Erectile Dysfunction Risk: Results from the Prostate Cancer Prevention
    • Authors: Darshan P Patel; Jeannette M Schenk, Amy Darke, Jeremy B Myers, William O Brant, James M Hotaling
      Abstract: Objective To evaluate associations of NSAID use and risk of ED, considering indications for NSAID use. Patients and Methods Data are from 4,726 men in the placebo arm of the Prostate Cancer Prevention Trial (PCPT) without evidence of ED at baseline. Incident ED was defined as mild/moderate (decrease in normal function) and severe (absence of function). Proportional hazards models were used to estimate covariate‐adjusted associations of NSAID–related medical conditions and time‐dependent NSAID use with ED risk. Results Arthritis (HR: 1.56), chronic musculoskeletal pain (HR: 1.35), general musculoskeletal complaints (HR:1.36), headaches (HR:1.44), sciatica (HR:1.50), and atherosclerotic disease (HR:1.60) were all significantly associated with increased risk of, mild/moderate ED, while only general musculoskeletal complaints (HR:1.22), headaches (HR:1.47) and atherosclerotic disease (HR:1.60) were associated with increased risk of severe ED. Non‐aspirin NSAID use was associated with an increased risk of mild/moderate ED (HR: 1.16, p=0.02) and Aspirin use was associated with an increased risk of severe ED (HR: 1.16, p=0.03, respectively). Associations of NSAID use with ED risk were attenuated after controlling for indications of NSAID use. Conclusions The modest associations of NSAID use with ED risk in this cohort were likely due to confounding indications of NSAID use. NSAID use was not associated with ED risk. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-25T10:34:55.805052-05:
      DOI: 10.1111/bju.13264
  • Increased use of partial nephrectomy to treat high‐risk disease
    • Authors: Matthew J. Maurice; Hui Zhu, Simon P. Kim, Robert Abouassaly
      Abstract: Objectives To evaluate partial nephrectomy use in patients at higher risk for clinical progression, using a large national database of American patients. Patients and methods We performed a retrospective review of patients with cN0/cM0 renal cell carcinoma from 2003‐2011 using the National Cancer Data Base. Our primary endpoint was partial nephrectomy use for high‐risk disease, defined as ≥1 adverse pathologic feature(s), namely pT3 stage, high grade, or unfavorable histologic subtype). Our secondary endpoint was positive surgical margins associated with high‐risk disease after partial nephrectomy. Time trends were analyzed using the asymptotic Cochran‐Armitage trend test. Relationships between patient, provider, and pathologic factors and the likelihood of partial nephrectomy were assessed using multivariate logistic regression. Results Of 183,886 surgically treated patients, 27.4% underwent partial nephrectomy. Over time, partial nephrectomy use increased overall (17.4‐39.7%) and in tumors with ≥1 adverse pathologic feature(s) (8.5‐24.2%) (p
      PubDate: 2015-08-25T10:28:51.225439-05:
      DOI: 10.1111/bju.13262
  • Comparison of the efficacy and safety of 2 mg and 4 mg tolterodine
           combined with an α‐blocker in men with lower urinary tract
           symptoms and overactive bladder: A randomised controlled trial
    • Abstract: Objective To evaluate the efficacy and safety of low‐dose (2 mg) tolterodine extended release (ER) with an α‐blocker versus standard‐dose (4 mg) tolterodine ER with an α‐blocker for the treatment of men with residual storage symptoms after α‐blocker monotherapy. Patients and Methods This was a 12‐week, single‐blind, randomised, parallel‐group, non‐inferiority trial that included men with residual storage symptoms despite receiving at least 4 weeks of α‐blocker treatment. Inclusion criteria were total International Prostate Symptom Score (IPSS) ≥12, IPSS‐quality of life item score ≥3, and ≥8 micturitions and ≥2 urgency episodes per 24 hours. The primary outcome was change in the total IPSS score from baseline. Bladder diary variables, patient‐reported outcomes, and safety were also assessed. Results Patients were randomly assigned to addition of either 2 mg tolterodine ER (n=47) or 4 mg tolterodine ER (n=48) to α‐blocker therapy for 12 weeks. Patients in both treatment groups demonstrated significant improvement in total IPSS score (‐5.5 and ‐6.3, respectively), micturition per 24 hours (‐1.3 and ‐1.7, respectively), and nocturia per night (‐0.4 and ‐0.4, respectively). Changes in IPSS, bladder diary variables, and patient‐reported outcomes were not significantly different between the treatment groups. All interventions were well tolerated by patients. Conclusions These results suggest that 12 weeks of low‐dose tolterodine ER add‐on therapy is comparable to standard‐dose tolterodine ER add‐on therapy in terms of efficacy and safety for patients experiencing residual storage symptoms after receiving α‐blocker monotherapy. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-25T10:28:22.599679-05:
      DOI: 10.1111/bju.13267
  • Evaluation of pT0 prostate cancer in radical prostatectomy patients
    • Authors: Daniel M. Moreira; Boris Gershman, Laureano J. Rangel, Stephen A. Boorjian, R. Houston Thompson, Igor Frank, Matthew K. Tollefson, Matthew T. Gettman, R. Jeffrey Karnes
      Abstract: Objective To evaluate the incidence, predictors and oncologic outcomes of pT0 prostate cancer (PCa). Methods Retrospective analysis of 20,222 men undergoing RP for PCa at Mayo Clinic from 1987 to 2012. Disease recurrence was defined as follow‐up prostate‐specific antigen (PSA) >0.4ng/mL or biopsy‐proven local recurrence. Systemic progression was defined as development of metastatic disease on imaging. Comparisons of baseline characteristics between pT0 and non‐pT0 were done with chi‐square and tests. Recurrence‐free survival was estimated using the Kaplan‐Meier method and compared with log‐rank test. Results A total of 62 (0.3%) men had pT0 in the RP specimen. In univariable analysis, pT0 was significantly associated with older age (P=0.045), lower PSA (P=0.002), lower clinical stage (P
      PubDate: 2015-08-25T10:24:32.108315-05:
      DOI: 10.1111/bju.13266
  • Robot‐assisted partial nephrectomy in cystic tumors: analysis of the
           Vattikuti Global Quality Initiative in Robotic Urologic Surgery
           (GQI‐RUS) database
    • Abstract: Objective Limited data are available concerning the outcome of robot‐assisted partial nephrectomy (RAPN) in cystic tumors. To evaluate outcomes of RAPN in cystic tumors, analyzing a large, multi‐institutional, retrospective series of RAPN. Patients and Methods We evaluated 465 patients who received RAPN for either cystic or solid tumors from 2010 to 2013 and included in the multi‐institutional, retrospective GQI‐RUS database Univariable and multivariable linear and logistic regression models addressed the association of cystic tumors with perioperative outcomes. Results Fifty‐four (12%) tumors were cystic. Cystic tumors were associated with significantly lower operative time (t ‐3.9; p
      PubDate: 2015-08-25T10:23:55.167877-05:
      DOI: 10.1111/bju.13256
  • Suicide and accidental deaths among patients with loco‐regional
           prostate cancer
    • Abstract: Introduction Patients with cancer are at increased risk of suicide. Further, evidence suggests a relationship between suicides and deaths due to accidents and externally caused injuries. We sought to determine if American men with prostate cancer (PCa) are at increased risk of suicide/accidental death compared to other cancers, and if the receipt of definitive treatment alters this association. Material & Methods Demographic, socio‐economic and tumor characteristics of men with PCa and men with other solid malignancies were extracted from the Surveillance, Epidemiology and End Results (1988‐2010). Poisson regression models were fitted to compare the incidence of suicidal and accidental deaths in PCa vs. other solid cancers. Multivariate Cox regression was used to determine if receipt of definitive primary treatment impacted the risk of suicide or accidental death in men with localized/regional PCa. Results Risk of suicidal and accidental death was significantly lower in men with PCa [1165 (0.2%) and 3,199 (0.6%)] than men with other cancers [2,232 (0.2%) and 4,501 (0.5%) respectively], except within the first year of diagnosis (adjusted relative risk [ARR]=3.98 [95%CI 3.02‐5.23] and ARR=4.22 [95%CI 3.24‐5.51] respectively, 0‐3 months after diagnosis). Men with non‐metastatic PCa who were white, uninsured, or recommended but did not receive treatment (HR vs. treated=1.44, 95% CI 1.20‐1.72, and 1.44, 95% CI 1.30‐1.59, both p
      PubDate: 2015-08-25T10:23:40.480303-05:
      DOI: 10.1111/bju.13257
  • The impact of change in serum C ‐reactive protein level on the
           prediction of effects of molecular targeted therapy in metastatic renal
           cell carcinoma patients
    • Authors: Jun Teishima; Kohei Kobatake, Hiroyuki Kitano, Hirotaka Nagamatsu, Kousuke Sadahide, Keisuke Hieda, Shunsuke Shinmei, Koichi Shoji, Shogo Inoue, Tetsutaro Hayashi, Yoji Inoue, Shinya Ohara, Koji Mita, Akio Matsubara
      Abstract: Objectives To investigate the impact of pretreatment serum C‐reactive protein (CRP) level and its change after targeted therapy on the anti‐tumor effect of targeted agents. Patients and methods Serum CRP level in 190 cases of molecular targeted therapy for metastatic RCC (mRCC) was measured before starting the prescription of molecular targeted agents and when CT scanning showed the maximum effect. Cases in which pretreatment CRP level was 0.5 mg/dL or higher were classified into a “higher CRP” group and others into a “lower CRP” group. The higher CRP group was further classified into two subgroups, i.e., those whose serum CRP level decreased after molecular targeted therapy (“decreased CRP” subgroup), and those whose level did not decrease after therapy (“non‐decreased CRP” subgroup). All cases were also classified according to their other clinical backgrounds, and the progression‐free survival (PFS) rates of each subgroup were compared. Results Of 190 cases, 97 were categorized as lower CRP and 93 as higher CRP, with 50 and 43 cases in the higher CRP group categorized as decreased and non‐decreased CRP subgroups, respectively. As to the maximum effects of the targeted therapy determined based on the RECIST criteria in the lower group, the rate of cases with complete response (CR) and partial response (PR) was significantly higher (P=0.0016) and that with progressive disease (PD) was significantly lower (P=0.0001) than in the higher CRP group. In higher CRP group, the rate of cases with PD in the decreased CRP subgroup was significantly lower (P
      PubDate: 2015-08-25T10:21:54.110272-05:
      DOI: 10.1111/bju.13260
  • Budget impact of incorporating one instillation of hexaminolevulinate
           hydrochloride blue‐ light cystoscopy in trans‐urethral bladder
           tumour resection for non‐muscle invasive bladder cancer patients in
    • Abstract: Objectives To explore the cost impact on Swedish healthcare of incorporating one instillation of hexaminolevulinate hydrochloride (HAL) blue light cystoscopy into the transurethral resection of bladder tumours (TURBT) in patients with suspected new or recurrent non‐muscle invasive bladder cancer (NMIBC). Materials and Methods A decision tree model was built based on European Association of Urology guidelines for the treatment and management of NMIBC. Input data was compiled from two recent studies comparing recurrence rates of bladder cancer in patients undergoing TURBT with the current standard of care (SOC) of white light cystoscopy, or with the SOC and HAL blue light cystoscopy. Using this published data with clinical cost data for surgical and outpatient procedures and pharmaceutical costs the model reported on clinical and economic differences associated with the two treatment options. Results This model demonstrates the significant clinical benefits likely to be observed through the incorporation of HAL blue light cystoscopy for TURBT in terms of reductions in recurrences of bladder cancer. Analysis of economic outputs of the model found that the use of one instillation of HAL for TURBT in all Swedish NMIBC patients is likely to be cost neutral or cost saving over 5 years relative to the current SOC of white light cystoscopy. Conclusions The results of this analysis provide additional health economic rationale for the incorporation of a single instillation of HAL blue light cystoscopy for TURBT in the treatment of NMIBC patients in Sweden. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-25T10:19:09.098462-05:
      DOI: 10.1111/bju.13261
  • “Button Type” Bipolar Plasma Vaporization of the Prostate
           Compared with Standard Transurethral Resection: A Systematic Review and
           Meta‐Analysis of short‐term outcome studies
    • Authors: Marcelo Langer Wroclawski; Arie Carneiro, Rodrigo Dal Moro Amarante, Carlos Eduardo Bonafe Oliveira, Victor Shimanoe, Bianca Alves Vieira Bianco, Paulo Kouiti Sakuramoto, Antonio Carlos Lima Pompeo
      Abstract: Objective To evaluate the surgical morbidity and effectiveness in the improvement of symptoms, comparing Button type bipolar plasma vaporization (BTPV) versus Transurethral Prostate Resection (TURP). Materials and Methods We conducted a literature search of published articles until November 2014. Only prospective and randomised studies with comparative data between BTPV and conventional TURP (mono‐ or bipolar) were included in this review. Results Six articles were selected for the analyses. In a total of 871 patients evaluated, 522 were submitted to TURP and 349 to BTPV. There was a tendency to a higher transfusion rate in the TURP group, being observed in 2 cases submitted to BTPV (0.006%) and in 16 cases submitted to TURP (0.032%) (p=0.06). The number of complications was similar between groups (OR: 0.33, IC: 0.8‐1.31, p=0.12, I2=86%). In a subdivision by severity, 10.7% (14/131) and 14.6% (52/355) of the complications were classified as severe (Clavien 3 or 4) in patients submitted to BTPV and TURP, respectively (p=0.02). The average time of indwelling catheter was significantly lower in the patients underwent BTPV (SMD: ‐0.84; IC: ‐1.54‐0.14; p=0.02; I2=81%). Both treatments were related to a significant improvement of symptoms and postoperative IPSS was similar in both groups, regardless of the procedure performed (SMD: 0.09, 95%CI: ‐1.56‐1.73, p=0.92). Conclusion Button‐Type plasma vaporisation is an efficient and safe treatment of BPH. The improvement of urinary symptoms and overall complications are comparable to conventional TURP. However, BTVP appears to be associated with a lower rate of major complications. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-24T05:34:24.181414-05:
      DOI: 10.1111/bju.13255
  • The value of MR/US fusion prostate biopsy platforms in prostate cancer
           detection, a systematic review
    • Authors: Maudy Gayet; Anouk van der Aa, Harrie P. Beerlage, Bart Ph. Schrier, Peter F.A. Mulders, Hessel Wijkstra
      Abstract: Background Despite limitations considering the presence, staging and aggressiveness of prostate cancer, systematic ultrasound (US) guided biopsies are still the golden standard in the diagnosis of prostate cancer. Recently, promising results have been published about targeted prostate biopsies using MR/US fusion platforms. Different platforms are FDA‐registered and have, mostly subjective, strengths and weaknesses. To our knowledge, no systematic review exists that objectively compared prostate cancer detection rates between the different platforms available. Objective To assess the value of the different MR/US fusion platforms in prostate cancer detection with platform guided targeted prostate biopsies compared to systematic biopsies and other ways of MR/US fusion (cognitive fusion or in‐bore MR fusion), we reviewed well‐designed prospective randomized and non‐randomized trials. Data sources A systematic review of English articles published between January 1st, 2004 and February 17th, 2015 using PubMed, Embase and Cochrane Library databases was performed. Search terms included: prostate cancer, MR/ultrasound(US) fusion and targeted biopsies. Study selection Extraction of articles was performed by two authors (M.G. and A.A.) and were evaluated by the other authors. Randomized and non‐randomized prospective clinical trials comparing targeted prostate biopsies using a MR/US fusion platform and systematic randomized prostate biopsies or other ways of targeted prostate biopsies (cognitive fusion or MR in‐bore fusion) were included. Data extraction methods and data synthesis 11 of 1865 studies met the inclusion criteria, involving seven different fusion platforms and 2626 subjects: 1119 biopsy naïve, 1433 with prior negative biopsy, 50 not mentioned (either biopsy naïve or with prior negative biopsy) and 24 on active surveillance (which were disregarded). The QUADAS‐2 tool was used to assess the quality of included articles. No clear advantage of MR/US fusion guided‐biopsies can be observed regarding cancer detection rates (CDRs) of all PCas. However, MR/US fusion guided‐biopsies tend to give a higher CDR of clinically significant PCas in our analysis. Limitations Important limitations of this systematic review include the limited number of included studies, lack of a general definition of clinically significant prostate cancer, the heterogenous study population and a reference test with low sensitivity and specificity. Conclusions Today, a limited number of prospective studies have reported CDRs of fusion platforms. Although MR/US fusion targeted‐biopsies has proved its value in men with prior negative biopsies, general use of this technique in diagnosis of prostate cancer should only be performed after critical consideration. Before bringing MR/US fusion guided biopsies in general practice, there is a need of more prospective studies in PCa diagnosis. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-03T09:58:36.431583-05:
      DOI: 10.1111/bju.13247
  • Pre‐operative double J stent placement in ureteral and renal stone
           treatment: results from the Clinical Research Office of Endourological
           Society URS Global Study
    • Authors: Dean Assimos; Alfonso Crisci, Daniel Culkin, Wei Xue, Anita Roelofs, Mordechai Duvdevani, Mahesh Desai, Jean la Rosette,
      Abstract: Objective To compare outcomes with the use a pre‐operative double J stent in ureteral and renal stone treatment with ureteroscopy (URS). Methods The Clinical Research Office of the Endourological Society (CROES) URS Global Study collected prospective data on consecutive patients with ureteral or renal stones treated with URS at 114 centres around the world for 1 yr. Pre‐operative double J stent placement was used in a subset of patients. To examine the relationship of a pre‐operative double J stent placement on stone free rate (SFR), length of hospital stay (LOHS), operation duration and complications (rate and severity), the Inverse Probability Weighted Regression Adjustment (IPWRA) was used. Results Of the 8189 patients with ureteral stones a comparison was made of 978 (11.9%) and 7133 patients with and without a pre‐operative double J stent, respectively. Of the 1622 patients with renal stones, 590 (36.4%) underwent preoperative stenting with a double J stent and 1002 did not. In renal stone treatment, a pre‐operative stent placement increased SFRs and operation time. A borderline significant decrease in intra‐operative complications was observed. For ureteral stone treatment, a pre‐operative stent placement was associated with longer operating time and decreased LOHS. No difference in SFRs and complications were observed. One major limitation of the study is that the reason for a double J stent placement was not identified preoperatively. Conclusions The use of a double J stent increases SFRs and decreases complications in patients with renal stones but not in those with ureteral stones. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-03T09:57:54.161267-05:
      DOI: 10.1111/bju.13250
  • Urinary fistula after robotic partial nephrectomy: a multicenter analysis
           of 1791 patients
    • Authors: Aaron M. Potretzke; B. Alexander Knight, Homayoun Zargar, Jihad H. Kaouk, Ravi Barod, Craig G. Rogers, Alon Mass, Michael D. Stifelman, Michael H. Johnson, Mohamad E. Allaf, R. Sherburne Figenshau, Sam B. Bhayani
      Abstract: objectives to evaluate the incidence of and risk factors for a urine leak in a large multicenter, prospective database of robotic partial nephrectomy (rpn). patients and methods a database of 1791 rpn from five centers was reviewed for urine leak as a complication of rpn. patients with postoperative urine leaks were compared to patients without postoperative urine leaks on a variety of patient and tumor characteristics. fisher's exact test was used for qualitative variables and wilcoxon sum‐rank tests were used for quantitative variables. a review of the literature on partial nephrectomy and urine leak was conducted. results urine leak was noted in 14/1791 (0.78%) patients who underwent rpn. mean nephrometry score of the entire cohort was 7.2 ± 1.9, and 8.0 ± 1.9 in patients who developed urine leak. the median postoperative day of presentation was 13 (range 3‐32). patients with urine leak presented in delayed fashion with fever (14%), gastrointestinal complaints (29%), and pain (36%). eight patients required admission (57%), while eight (57%) and nine (64%) had a drain or stent placed, respectively. drains and stents were removed after a median of eight (range 4‐13) and 21 days (8‐83), respectively. variables associated with urine leak included tumor size (p = 0.021), hilar location (p = 0.025), operative time (p=0.006), warm ischemia time (p = 0.005), and pelvicaliceal repair (p = 0.018). upon literature review, the historical incidence of leak ranged from 1.0‐17.4% for opn and 1.6‐16.5% for lpn. conclusion the incidence of urine leak after rpn is very low and may be predicted by some preoperative factors, affording better patient counseling of risks. the low urine leak may be attributed to the enhanced visualization and suturing technique that accompanies the robotic approach. This article is protected by copyright. all rights reserved.
      PubDate: 2015-08-01T02:52:21.777462-05:
      DOI: 10.1111/bju.13249
  • Association between very small tumor size and increased
           cancer‐specific mortality following radical prostatectomy in
           node‐positive prostate cancer
    • Authors: Vinayak Muralidhar; Brandon A. Mahal, Michelle D. Nezolosky, Clair J. Beard, Felix Y. Feng, Neil E. Martin, Jason A. Efstathiou, Toni K. Choueiri, Mark M. Pomerantz, Christopher J. Sweeney, Quoc-Dien Trinh, Matthew G. Vander Heiden, Paul L. Nguyen
      Abstract: Objective To determine whether very small prostate cancers present in patients who also have lymph node (LN) metastases represent a particularly aggressive disease variant compared to larger node‐positive tumors. Subjects/Patients and Methods We identified 37,501 patients diagnosed with prostate cancer between 1988 and 2001 treated with radical prostatectomy within the Surveillance, Epidemiology, and End Results database. The primary study variables were tumor size by largest dimension (stratified into: (1) microscopic focus only or 1 mm; (2) 2‐15 mm; (3) 16‐30 mm; (4) greater than 30 mm), regional LN involvement, and the corresponding interaction term. We evaluated the risk of 10‐year prostate cancer‐specific mortality (PCSM) using the Fine‐Gray model for competing risks after controlling for race, tumor grade, T stage, receipt of radiation, number of dissected LNs, number of positive LNs, year of diagnosis, and age at diagnosis. Results Median follow‐up was 11.8 years. There was a significant interaction between tumor size and LN involvement (P‐interaction < 0.001). In the absence of LN involvement (N=36,561), the risk of 10‐year PCSM increased monotonically with increasing tumor size. Among patients with LN involvement (N=940), those with the smallest tumors had increased 10‐year PCSM compared to patients with tumors sized 2‐15 mm (24.7% vs. 11.8%; adjusted hazard ratio [AHR] = 2.84; 95% confidence interval [CI], 1.21 to 6.71; P = 0.017) or 16‐30 mm (24.7% vs. 15.5%; AHR = 3.12; 95% CI, 1.51 to 6.49; P = 0.002) and similar 10‐year PCSM compared to those with tumors greater than 30 mm (24.7% vs. 24.9%; P = 0.156). Conclusion In prostate cancer patients with LN involvement, very small tumor size may predict for higher PCSM compared with some larger tumors, even after controlling for other prognostic variables. These tumors might be particularly aggressive, beyond what is captured by pathological assessment of tumor grade and stage. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-01T02:32:45.127856-05:
      DOI: 10.1111/bju.13248
  • Adrenalectomy: a retroperitoneal procedure
    • Authors: SS Goonewardene; M Brown, BJ Challacombe
      Abstract: The investigation and management of adrenal masses are part of the core urology syllabus in both the UK and overseas (e.g. Australasia). Despite this, most adrenal pathologies are treated by endocrine surgeons, with a general surgical background. However, some regions of the UK do not have access to endocrine surgeons. Moreover, with any type of surgery, especially high risk surgery, high case volume is important to optimise outcomes. With regard to this, most urologists undertaking renal surgery will perform a median of 20‐30 nephrectomies per year (from a national total of >8000 nephrectomies) and as part of this procedure, the adrenal gland is often routinely removed. In comparison, there are approximately 570 adrenalectomies conducted per year in the UK by endocrine surgeons, with an average of 13 per surgeon. Single centre institutions in America may do a median of 60‐70 procedures per year [1]. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-27T23:56:27.848239-05:
      DOI: 10.1111/bju.13245
  • Differential Effects of Isomers of Clomiphene Citrate on Reproductive
           Tissues in Male Mice
    • Authors: Gregory K. Fontenot; Ronald D. Wiehle, Joseph S. Podolski
      Abstract: Objectives To determine in a chronic dosing study the oral toxicity potential of the test substances Enclomiphene citrate and Zuclomiphene citrate when administered to male mice by oral gavage. Methods A chronic dosing study was conducted utilizing test substances Enclomiphene citrate and Zuclomiphene citrate administered to male mice daily by oral gavage. Mice were divided into five treatment groups (Group I: Placebo; Group II: 40 MPK (mg/kg body weight)\day Enclomiphene citrate; Group III: 4 MPKday Enclomiphene citrate; Group IV: 40 MPKday Zuclomiphene citrate; Group V: 4 MKP/day Zuclomiphene citrate. Body weights were measured. Serum samples and tissues were obtained from each animal for analysis. Results In a chronic dose study in mice, profound effects on the Leydig cells, epididymis, seminal vesicles and kidneys were seen as well as effects on testosterone (T), follicle stimulating hormone (FSH) and luteinizing hormone (LH) secretion that were associated with zuclomiphene treatment only. Treatment with the isolated enclomiphene isomer has positive effects on testosterone production and no effects on testicular histology. Conclusions This work suggests that un‐opposed high dose of zuclomiphene can have pernicious effects on male mammalian reproductive organs. The deleterious effects seen when administering Zuclomiphene citrate in male mice justifies the case for a monoisomeric preparation and the development of Enclomiphene citrate, for clinical use in human males to increase serum levels of testosterone and maintaining sperm counts. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-27T23:55:50.476157-05:
      DOI: 10.1111/bju.13244
  • On the origin of spontaneous activity in the bladder
    • Authors: N Kushida; C H Fry
      Abstract: Objectives To characterise separately the pharmacological profiles of spontaneous contractions from the mucosa and detrusor layers of the bladder wall and to describe the relationship in mucosa between ATP release and spontaneous contractions. Materials and Methods Spontaneous contractions were measured (36°C) from isolated mucosa or detrusor preparations, and intact (mucosa+detrusor) preparations from guinea‐pig bladders. Potential modulators were added to the superfusate. Percentage smooth muscle was measured in haematoxylin and eosin stained sections. ATP release was measured in superfusate samples from a fixed point above the preparation using a luciferin‐luciferase assay. Results The magnitude of spontaneous contractions was in the order intact>mucosa>detrusor. Percentage smooth muscle was least in mucosa and greatest in detrusor preparations. The pharmacological profiles of spontaneous contractions were different in mucosa and detrusor in response to P2X or P2Y receptor agonists, adenosine and capsaicin. Intact preparations showed responses intermediate to those from mucosa and detrusor preparations. Low extracellular pH generated large changes in detrusor, but not mucosa preparations. Mucosa preparations released ATP in a cyclical manner, followed by variations in spontaneous contractions. ATP release was greater in mucosa compared to detrusor, augmented by carbachol and reversed by the M2‐selective antagonist methoctramine. Conclusions The different pharmacological profiles of bladder mucosa and detrusor implies different pathways for contractile activation. Intermediate responses from intact preparations also implies functional interaction. The temporal relationship between cyclical variation of ATP release and amplitude of spontaneous contractions is consistent with ATP release controlling spontaneous activity. Carbachol‐mediated ATP release was independent of active contractile force. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-24T10:04:27.22425-05:0
      DOI: 10.1111/bju.13240
  • Prostate Biopsy Decisions: One Size Fits All Approach with Total PSA is
           Out and a Multivariable Approach with the Prostate Health Index is In
    • Authors: Stacy Loeb
      Abstract: The days of using one PSA threshold to trigger a biopsy for all men are over, and the field has moved toward a more individualized approach to prostate biopsy decisions taking into account each patient's specific set of risk factors. Foley et al. provide compelling evidence supporting the use of the Prostate Health Index (phi) as part of this multivariable approach to prostate biopsy decisions.[1] There is now a large body of evidence showing that phi is more specific for prostate cancer than total PSA and percent free PSA, as was concluded in a 2014 systematic review.[2] This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-05T10:24:59.659737-05:
      DOI: 10.1111/bju.13195
  • Knowledge, Attitudes and Beliefs towards Management of Men with Locally
           Advanced Prostate Cancer following Radical Prostatectomy: An Australian
           Survey of Urologists
    • Authors: Bernadette (Bea) Brown; Jane Young, Andrew B Kneebone, Andrew J Brooks, Amanda Dominello, Mary Haines
      Abstract: Objective To investigate Australian urologists’ knowledge, attitudes and beliefs, and the association of these with treatment preferences relating to guideline‐recommended adjuvant radiotherapy for men with adverse pathologic features following radical prostatectomy. Subjects and methods A nationwide mailed and web‐based survey of Australian urologist members of the Urological Society of Australia and New Zealand (USANZ). Results 157 surveys were included in the analysis (45% response rate). Just over half of respondents (57%) were aware of national clinical practice guidelines for the management of prostate cancer. Urologists’ attitudes and beliefs towards the specific recommendation for post‐operative adjuvant radiotherapy for men with locally advanced prostate cancer were mixed. Just over half agreed the recommendation is based on a valid interpretation of the underpinning evidence (54.1%, 95% CI [46%, 62.2%]) but less than one third agreed adjuvant radiotherapy will lead to improved patient outcomes (30.2%, 95% CI [22.8%, 37.6%]). Treatment preferences were varied, demonstrating clinical equipoise. A positive attitude towards the clinical practice recommendation was significantly associated with treatment preference for adjuvant radiotherapy (rho = .520, p
      PubDate: 2015-01-14T03:53:29.770426-05:
      DOI: 10.1111/bju.13037
  • Scientific impact and beyond
    • Authors: Prokar Dasgupta; Scott Millar, Jo Wixon
      First page: 833
      PubDate: 2015-11-06T02:11:28.347054-05:
      DOI: 10.1111/bju.13357
  • Surgery is possible: now let's prove its superior efficacy!
    • Authors: Peter C. Albertsen
      First page: 834
      PubDate: 2015-11-06T02:11:31.256127-05:
      DOI: 10.1111/bju.13153
  • How can we improve surgical outcomes'
    • First page: 835
      PubDate: 2015-11-06T02:11:23.892664-05:
      DOI: 10.1111/bju.13056
  • Frozen section during partial nephrectomy: an unreliable test that changes
    • Authors: Grant D. Stewart; Grenville Oades
      First page: 836
      PubDate: 2015-11-06T02:11:21.936157-05:
      DOI: 10.1111/bju.13046
  • Are men who are biopsied without prior prostate magnetic resonance imaging
           getting substandard care'
    • Authors: Mark Emberton
      First page: 837
      PubDate: 2015-11-06T02:11:21.31173-05:0
      DOI: 10.1111/bju.13067
  • Cabazitaxel for the therapy of metastatic castration‐resistant
           prostate cancer in the aftermath of the CHAARTED trial
    • Authors: Sumanta K. Pal; Guru Sonpavde
      First page: 839
      PubDate: 2015-11-06T02:11:27.171779-05:
      DOI: 10.1111/bju.13098
  • Is the modified sliding technique the way forward in Peyronie's
    • Authors: Giulio Garaffa; David J. Ralph
      First page: 840
      PubDate: 2015-11-06T02:11:27.72688-05:0
      DOI: 10.1111/bju.13161
  • Effective non‐technical skills are imperative to
           robot‐assisted surgery
    • Authors: Oliver Brunckhorst; Muhammad S. Khan, Prokar Dasgupta, Kamran Ahmed
      First page: 842
      PubDate: 2015-05-11T04:56:10.886494-05:
      DOI: 10.1111/bju.12934
  • Long‐term outcomes of robot‐assisted radical prostatectomy:
           Where do we stand'
    • Authors: Francesco Montorsi; Giorgio Gandaglia, Alberto Briganti
      First page: 845
      PubDate: 2015-05-23T02:37:54.260401-05:
      DOI: 10.1111/bju.12981
  • Radical treatment of localised prostate cancer in the elderly
    • Authors: Wouter Everaerts; Simon Van Rij, Fairleigh Reeves, Anthony Costello
      First page: 847
      Abstract: Elderly men are more likely to be diagnosed with aggressive cancer, but are often inappropriately denied curative treatment. Biological rather than chronological age should be used to decide if a patient will profit from radical treatment. Therefore, every man aged >70 years should undergo a health assessment using a validated tool before making treatment decisions. Fit elderly men with intermediate‐ or high‐risk disease should be offered standard curative local treatment in keeping with guidelines for younger men. Vulnerable and frail elderly men warrant geriatric intervention before treatment. In the case of vulnerable patients, this intervention may render them suitable for standard care. When considering radical prostatectomy outcomes a ‘bifecta’ of oncological control and continence is appropriate, as erectile dysfunction (although prevalent) has a much smaller impact on quality of life than in younger patients. Radiotherapy is an alternative to radical prostatectomy in men with a life expectancy of
      PubDate: 2015-06-03T04:10:28.895859-05:
      DOI: 10.1111/bju.13128
  • A review of detrusor overactivity and the overactive bladder after radical
           prostate cancer treatment
    • First page: 853
      Abstract: There are various forms of treatment for prostate cancer. In addition to oncologic outcomes, physicians, and increasingly patients, are focusing on functional and adverse outcomes. Symptoms of overactive bladder (OAB), including urinary frequency, urgency and incontinence, can occur regardless of treatment modality. This article examines the prevalence, pathophysiology and options for treating OAB after radical prostate cancer treatment. OAB seems to be more common and severe after radiation therapy than after surgical therapy and even persisted longer with complications, suggesting an advantage for surgery over radiotherapy. Because OAB that occurs after radical prostate surgery or radiotherapy can be difficult to treat, it is important that patients are made aware of the potential development of OAB during counselling before decisions regarding treatment choice are made. To ensure a successful outcome of both treatments, it is imperative that clinicians and non‐specialists enquire about and document pretreatment urinary symptoms and carefully evaluate post‐treatment symptoms.
      PubDate: 2015-07-03T22:17:02.333129-05:
      DOI: 10.1111/bju.13078
  • Recourse to radical prostatectomy and associated short‐term outcomes
           in Italy: a country‐wide study over the last decade
    • Authors: Giacomo Novara; Vincenzo Ficarra, Filiberto Zattoni, Ugo Fedeli
      First page: 862
      Abstract: Objective To estimate time trends in the recourse to radical prostatectomy (RP) and associated short‐term outcomes after RP in Italy, as population‐based data on RP adoption and outcomes are available mainly from Northern America and Northern Europe. Patients and Methods All RPs for prostate cancer performed between 2001 and 2010 were extracted from the Italian national archive of hospital discharge records. Age‐specific and age‐standardised RP rates were computed. The effect of procedural volume on in‐hospital mortality, complications, and length of stay (LOS) was estimated by multilevel regression models. Results In all, 144 432 RPs were analysed. Country‐wide RP rates increased between 2001 and 2004, and thereafter remained stable, with large differences between geographical areas. The mean hospital volume increased in the first study years, without centralisation but due to increasing RP numbers at the population level. The median LOS declined from 10 to 8 days over the study period (mean from 11.7 to 9.2 days). In‐hospital mortality declined from 0.16% in 2001 to 0.07% in 2010. In‐hospital mortality, LOS, and the prevalence of complications increased with age, and decreased with year of surgery. Compared with very low‐volume hospitals, procedures performed in high‐volume hospitals were associated with decreased in‐hospital mortality, in‐hospital complications, and LOS. Conclusions The study adds evidence on rapidly changing trends in RP rates in Italy, on improving in‐hospital outcomes, and on their association with procedural volume.
      PubDate: 2015-03-23T05:03:58.124349-05:
      DOI: 10.1111/bju.13000
  • Frozen section during partial nephrectomy: does it predict positive
    • Authors: Jennifer Gordetsky; Michael A. Gorin, Joe Canner, Mark W. Ball, Phillip M. Pierorazio, Mohamad E. Allaf, Jonathan I. Epstein
      First page: 868
      Abstract: Objective To investigate the clinical utility of frozen section (FS) analysis performed during partial nephrectomy (PN) and its influence on intra‐operative management. Patients and Methods We performed a retrospective analysis of consecutive PN cases from 2010 to 2013. We evaluated the concordance between the intra‐operative FS diagnosis and the FS control diagnosis, a postoperative quality assurance measure performed on all FS diagnoses after formalin fixation of the tissue. We also evaluated the concordance between the intra‐operative FS diagnosis and the final specimen margin. Operating reports were reviewed for change in intra‐operative management for cases with a positive or atypia FS diagnosis, or if the mass was sent for FS. Results A total of 576 intra‐operative FSs were performed in 351 cases to assess the PN tumour bed margin, 19 (5.4%) of which also had a mass sent for FS to assess the tumour type. The concordance rate between the FS diagnosis and the FS control diagnosis was 98.3%. There were 30 (8.5%) final positive specimen margins, of which four (13.3%) were classified as atypia, 17 (56.7%) as negative and nine (30%) as positive on FS diagnosis. Intra‐operative management was influenced in six of nine cases with a positive FS diagnosis and in one of nine cases with an FS diagnosis of atypia. Conclusions The relatively high false‐negative rate, controversy over the prognosis of a positive margin, and inconsistency in influencing intra‐operative management are arguments against the routine use of FS in PN cases.
      PubDate: 2015-03-23T05:19:07.418853-05:
      DOI: 10.1111/bju.13011
  • Comparison of systematic transrectal biopsy to transperineal magnetic
           resonance imaging/ultrasound‐fusion biopsy for the diagnosis of
           prostate cancer
    • Authors: Angelika Borkowetz; Ivan Platzek, Marieta Toma, Michael Laniado, Gustavo Baretton, Michael Froehner, Rainer Koch, Manfred Wirth, Stefan Zastrow
      First page: 873
      Abstract: Objectives To compare targeted, transperineal magnetic resonance imaging (MRI)/ultrasound (US)‐fusion biopsy to systematic transrectal biopsy in patients with previous negative or first prostate biopsy and to evaluate the gain in diagnostic information with systematic biopsies in addition to targeted MRI/US‐fusion biopsies. Patients and Methods In all, 263 consecutive patients with suspicion of prostate cancer were investigated. All patients were evaluated by 3‐T multiparametric MRI (mpMRI) applying the European Society of Urogenital Radiology criteria. All patients underwent MRI/US‐fusion biopsy transperineally (mean nine cores) and additionally a systematic transrectal biopsy (mean 12 cores). Results In all, 195 patients underwent repeat biopsy and 68 patients underwent first biopsy. The median age was 66 years, median PSA level was 8.3 ng/mL and median prostate volume was 50 mL. Overall, the prostate cancer detection rate was 52% (137/263). MRI/US‐fusion biopsy detected significantly more cancer than systematic prostate biopsy (44% [116/263] vs 35% [91/263]; P = 0.002). In repeat biopsy, the detection rate was 44% (85/195) in targeted and 32% (62/195) in systematic biopsy (P = 0.002). In first biopsy, the detection rate was 46% (31/68) in targeted and 43% (29/68) in systematic biopsy (P = 0.527). In all, 80% (110/137) of biopsy confirmed prostate cancers were clinically significant. For the upgrading of Gleason score, 44% (32/72) more clinically significant prostate cancer was detected by using additional targeted biopsy than by systematic biopsy alone. Conversely, 12% (10/94) more clinically significant cancer was found by systematic biopsy additionally to targeted biopsy. Conclusions MRI/US‐fusion biopsy was associated with a higher detection rate of clinically significant prostate cancer while taking fewer cores, especially in patients with prior negative biopsy. Due to a high portion of additional tumours with Gleason score ≥7 detected in addition to targeted biopsy, systematic biopsy should still be performed additionally to targeted biopsy.
      PubDate: 2015-04-27T03:55:34.071356-05:
      DOI: 10.1111/bju.13023
  • Final quality of life and safety data for patients with metastatic
           castration‐resistant prostate cancer treated with cabazitaxel in the
           UK Early Access Programme (EAP) (NCT01254279)
    • Authors: Amit Bahl; Susan Masson, Zafar Malik, Alison J. Birtle, Santhanam Sundar, Rob J. Jones, Nicholas D. James, Malcolm D. Mason, Satish Kumar, David Bottomley, Anna Lydon, Simon Chowdhury, James Wylie, Johann S. Bono
      First page: 880
      Abstract: Objective To compile the safety profile and quality of life (QoL) data for patients with metastatic castration‐resistant prostate cancer (mCRPC) treated with cabazitaxel in the UK Early Access Programme (UK EAP). Patients and Methods A total of 112 patients participated at 12 UK cancer centres. All had mCRPC with disease progression during or after docetaxel. Patients received cabazitaxel 25 mg/m2 every 3 weeks with prednisolone 10 mg daily for up to 10 cycles. Safety assessments were performed before each cycle and QoL was recorded at alternate cycles using the EQ‐5D‐3L questionnaire and visual analogue scale (VAS). The safety profile was compiled after completion of the UK EAP and QoL measures were analysed to record trends. No formal statistical analysis was carried out. Results The incidences of neutropenic sepsis (6.3%), grade 3 and 4 diarrhoea (4.5%) and grade 3 and 4 cardiac toxicity (0%) were low. Neutropenic sepsis episodes, though low, occurred only in patients who did not receive prophylactic granulocyte‐colony stimulating factor. There were trends towards improved VAS and EQ‐5D‐3L pain scores during treatment. Conclusions The UK EAP experience indicates that cabazitaxel might improve QoL in mCRPC and represents an advance and a useful addition to the armamentarium of treatment for patients whose disease has progressed during or after docetaxel. In view of the potential toxicity, careful patient selection is important.
      PubDate: 2015-06-16T00:28:49.658146-05:
      DOI: 10.1111/bju.13069
  • Determination of optimal drug dose and light dose index to achieve
           minimally invasive focal ablation of localised prostate cancer using
           WST11‐vascular‐targeted photodynamic (VTP) therapy
    • First page: 888
      Abstract: Objective To determine the optimal drug and light dose for prostate ablation using WST11 (TOOKAD® Soluble) for vascular‐targeted photodynamic (VTP) therapy in men with low‐risk prostate cancer. Patients and Methods In all, 42 men with low‐risk prostate cancer were enrolled in the study but two who underwent anaesthesia for the procedure did not receive the drug or light dose. Thus, 40 men received a single dose of 2, 4 or 6 mg/kg WST11 activated by 200 J/cm light at 753 nm. WST11 was given as a 10‐min intravenous infusion. The light dose was delivered using cylindrical diffusing fibres within hollow plastic needles positioned in the prostate using transrectal ultrasonography (TRUS) guidance and a brachytherapy template. Magnetic resonance imaging (MRI) was used to assess treatment effect at 7 days, with assessment of urinary function (International Prostate Symptom Score [IPSS]), sexual function (International Index of Erectile Function [IIEF]) and adverse events at 7 days, 1, 3 and 6 months after VTP. TRUS‐guided biopsies were taken at 6 months. Results In all, 39 of the 40 treated men completed the follow‐up. The Day‐7 MRI showed maximal treatment effect (95% of the planned treatment volume) in men who had a WST11 dose of 4 mg/kg, light dose of 200 J/cm and light density index (LDI) of >1. In the 12 men treated with these parameters, the negative biopsy rate was 10/12 (83%) at 6 months, compared with 10/26 (45%) for the men who had either a different drug dose (10 men) or an LDI of 1 resulted in treatment effect in 95% of the planned treatment volume and a negative biopsy rate at 6 months of 10/12 men (83%).
      PubDate: 2015-04-21T23:32:49.84143-05:0
      DOI: 10.1111/bju.12816
  • Number of positive preoperative biopsy cores is a predictor of positive
           surgical margins (PSM) in small prostates after robot‐assisted
           radical prostatectomy (RARP)
    • Authors: Patrick H. Tuliao; Kyo C. Koo, Christos Komninos, Chien H. Chang, Young D. Choi, Byung H. Chung, Sung J. Hong, Koon H. Rha
      First page: 897
      Abstract: Objective To determine the impact of prostate size on positive surgical margin (PSM) rates after robot‐assisted radical prostatectomy (RARP) and the preoperative factors associated with PSM. Patients and Methods In all, 1229 men underwent RARP by a single surgeon, from 2005 to August of 2013. Excluded were patients who had transurethral resection of the prostate, neoadjuvant 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 prostate size groups: 45 g (group 3). Multivariate analysis determined predictors of PSM and biochemical recurrence (BCR). Results Console time and blood loss increased with increasing prostate size. There were more high‐grade tumours in group 1 (group 1 vs group 2 and group 3, 33.9% vs 25.1% and 25.6%, P = 0.003 and P = 0.005). PSM rates were higher in prostates of 20 ng/dL, Gleason score ≥7, T3 tumour, and ≥3 positive biopsy cores. In group 1, preoperative stage T3 [odds ratio (OR) 3.94, P = 0.020] and ≥3 positive biopsy cores (OR 2.52, P = 0.043) were predictive of PSM, while a PSA level of >20 ng/dL predicted the occurrence of BCR (OR 5.34, P = 0.021). No preoperative factors predicted PSM or BCR for groups 2 and 3. Conclusion A preoperative biopsy with ≥3 positive cores in men with small prostates predicts PSM after RARP. In small prostates with PSM, a PSA level of >20 ng/dL is a predictor of BCR. These factors should guide the choice of therapy and indicate the need for closer postoperative follow‐up.
      PubDate: 2015-06-02T01:07:30.392783-05:
      DOI: 10.1111/bju.12888
  • Perioperative outcomes of cytoreductive nephrectomy in the UK in 2012
    • Authors: Benjamin L. Jackson; Sarah Fowler, Simon T. Williams,
      First page: 905
      Abstract: Objectives To define the perioperative morbidity and 30‐day mortality of cytoreductive nephrectomy (CN) using the British Association of Urological Surgeons (BAUS) nephrectomy dataset for 2012, the first year of public reporting of individual surgeon outcomes in the UK. Patients and Methods All nephrectomies recorded in the database in 2012 were analysed, and cytoreductive cases identified. Outcome measures were: blood loss of >1000 mL, transfusion requirement, intra‐ and postoperative 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 In all, 279 cases were undertaken by 141 surgeons in 90 centres. World Health Organization (WHO) Performance Status (PS) was 0 or 1 in 72.4% (202 cases). Open nephrectomy was performed in 59% (163 cases), with the remainder laparoscopic. The conversion rate for laparoscopy was 14% (16 cases). In all, 40 patients underwent preoperative tyrosine‐kinase inhibitor treatment. No significant differences in outcome were observed for this group. The 30‐day mortality was 1.79%. Intraoperative complications occurred in 11.9% and postoperative complications in 20.8%. Complications of Clavien–Dindo grade ≥ III occurred in 8%. Blood loss of >1000 mL occurred in 15.4% of cases and 24.1% of patients required a perioperative transfusion. Tumour of >10 cm was an independent risk factor for blood loss of >1000 mL (P = 0.021) and intraoperative complications (P = 0.021). The number of metastatic sites was an independent predictor of blood loss of >1000 mL (P = 0.001) and transfusion requirement (P = 0.026) WHO PS of ≥2 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 tumours of >10 cm, number of metastatic sites and WHO PS of ≥2. The balance of risk and benefit for CN should be carefully considered for patients with poor PS or extensive metastases.
      PubDate: 2015-05-05T08:55:38.592373-05:
      DOI: 10.1111/bju.12890
  • An evaluation of the ‘weekend effect’ in patients admitted
           with metastatic prostate cancer
    • First page: 911
      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 and 2009, admitted patients with a diagnosis of prostate cancer and concomitant metastases were identified. Rates of in‐hospital mortality, complications, use 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 after a weekday vs 10.9% after a weekend admission (P < 0.001). Patients admitted over the weekend were more likely to be treated at rural (17.8% vs 15.7%), non‐teaching (57.6% vs 53.7%) and low‐volume hospitals (53.4% vs 49.4%) (all P < 0.001) compared with weekday admissions. They presented higher rates of organ failure (25.2% vs 21.3%), and were less likely to undergo an interventional procedure (10.6% vs 11.4%) (all P < 0.001). More patients admitted over the weekend had pneumonia (12.2% vs 8.8%), pyelonephritis (18.3% vs 14.1%) and sepsis (4.5% vs. 3.5%) (all P < 0.001). In multivariate analysis, weekend admission was associated with an increased likelihood of complications (odds ratio [OR] 1.15, 95% confidence Interval [CI] 1.11–1.19) and mortality (OR 1.20, 95% CI 1.14–1.27). Conclusion In patients with mCaP weekend admissions are associated with a significant increase in mortality and morbidity. Our findings suggest that weekend patients may present with more acute medical issues; alternatively, the quality of care over the weekend may be inferior.
      PubDate: 2015-06-04T02:48:02.601785-05:
      DOI: 10.1111/bju.12891
  • A comparative analysis of robotic vs laparoscopic retroperitoneal lymph
           node dissection for testicular cancer
    • Authors: Kelly T. Harris; Michael A. Gorin, Mark W. Ball, Phillip M. Pierorazio, Mohamad E. Allaf
      First page: 920
      Abstract: Objective To compare the safety and perioperative outcomes of robotic retroperitoneal lymph node dissection (R‐RPLND) vs laparoscopic RPLND (L‐RPLND). Patients and Methods Our Institutional Review Board‐approved retrospective testicular cancer registry was queried for patients who underwent a primary unilateral R‐RPLND or L‐RPLND by a single surgeon for a stage I testicular non‐seminomatous germ cell tumour. Groups were compared for differences in baseline and outcome variables. Results Between July 2006 and July 2014, 16 R‐RPLND and 21 L‐RPLND cases were performed by a single surgeon. Intra‐ and perioperative outcomes including operative time, estimated blood loss, lymph node yield, complicate rate, and ejaculatory status were similar between groups (all P > 0.1). Conclusions As an early checkpoint, R‐RPLND appears comparable to L‐RPLND in terms of safety and perioperative outcomes. It remains unclear if R‐RPLND offers any tangible benefits over standard laparoscopy.
      PubDate: 2015-05-25T03:06:22.56754-05:0
      DOI: 10.1111/bju.13121
  • Robot‐assisted radical cystectomy with intracorporeal urinary
           diversion: impact on an established enhanced recovery protocol
    • First page: 924
      Abstract: Objectives To assess the impact of the introduction of robot‐assisted radical cystectomy (RARC) on an established enhanced recovery programme (ERP) and to examine the effect on mortality and morbidity rates, transfusion rates, and length of stay (LOS). Patients and Methods Data on 102 consecutive patients undergoing RARC with full intracorporeal reconstruction were obtained from our prospectively updated institutional database. These data were compared to previously published retrospective results from three separate groups of patients undergoing open radical cystectomy (ORC) at our centre. Our primary focus was perioperative outcomes including transfusion rate, complication rates, 30‐ and 90‐day mortality rates, and LOS. Results The demographics of the comparative groups showed no significant difference in age, gender distribution, and American Society of Anesthesiologists grade. A significant reduction in transfusion rate was seen in RARC vs ORC (P < 0.001). The median LOS for the RARC group was 8 vs 13 days for the ORC group (P < 0.001). There was trend to a lower total complication rate (48% vs 31%). The 30‐ and 90‐day mortality rates were equivalent between the groups (2%). Conclusions Introduction of RARC and intracorporeal reconstruction represents the single biggest impact on our ERP, with significant reduction in transfusion rates and LOS, and a trend towards a lower complication rate.
      PubDate: 2015-07-14T08:12:40.688005-05:
      DOI: 10.1111/bju.13171
  • Hypothermic machine perfusion improves Doppler ultrasonography resistive
           indices and long‐term allograft function after renal
           transplantation: a single‐centre analysis
    • Authors: Marie S. Dion; Thomas B. McGregor, Vivian C. McAlister, Patrick P. Luke, Alp Sener
      First page: 932
      Abstract: Objectives To evaluate whether hypothermic machine perfusion (HMP) of transplanted kidneys can improve long‐term renal allograft function compared with static cold storage (CS). Methods We evaluated whether graft Doppler ultrasonography resistive indices improved with the use of HMP compared with CS preservation, and examined whether these improvements were predictive of long‐term graft function. A total of 30 kidney transplants (15 pairs) were examined. One of the kidney pairs 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 ultrasonography was performed on days 1 and 7 after transplantation and resistive indices were evaluated. The estimated glomerular filtration rate (eGFR) was monitored for 24 months after transplantation. Results Despite longer cold ischaemia times, kidneys maintained with HMP had lower resistive indices (P = 0.005) with correspondingly higher eGFR throughout the follow‐up. Subgroup analysis showed that the HMP‐induced improvement in postoperative eGFR was greatest in kidneys obtained from donation 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 has a positive impact on long‐term allograft function compared with CS in the population of recipients of DCD kidneys.
      PubDate: 2015-05-24T21:07:12.42944-05:0
      DOI: 10.1111/bju.12960
  • Changing trends in the causes and management of male urethral stricture
           disease in China: an observational descriptive study from 13 centres
    • First page: 938
      Abstract: Objective To determine whether there have been any changes in the causes and management of urethral strictures in China. Patients and Methods The data from 4 764 men 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 causes and management of urethral strictures. Results The most common cause of urethral strictures was trauma, which occurred in 2 466 patients (51.76%). The second most common cause was iatrogenic injures, which occurred in 1 643 patients (34.49%). The most common techniques to treat urethral strictures were endourological surgery (1 740, 36.52%), anastomotic urethroplasty (1 498, 31.44%) and substitution urethroplasty (1 039, 21.81%). A comparison between the first 3 years and the last 3 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 last 3 years.
      PubDate: 2015-05-18T22:06:25.818717-05:
      DOI: 10.1111/bju.12945
  • The cost‐effectiveness of sacral nerve stimulation (SNS) for the
           treatment of idiopathic medically refractory overactive bladder (wet) in
           the UK
    • Authors: Silke Walleser Autiero; Natalie Hallas, Christopher D. Betts, Jeremy L. Ockrim
      First page: 945
      Abstract: Objective To estimate the long‐term cost‐effectiveness of specialised treatment options for medically refractory idiopathic overactive bladder (OAB) wet. Patients and Methods The cost‐effectiveness of competing treatment options for patients with medically refractory idiopathic OAB wet was estimated from the perspective of the National Health Service in the UK. We compared sacral nerve stimulation (SNS) with percutaneous nerve evaluation (PNE) or tined‐lead evaluation (TLE) with optimal medical therapy (OMT), botulinum toxin type A (BoNT‐A) injections, and percutaneous tibial nerve stimulation (PTNS). We used a Markov model with a 10‐year time horizon for all treatment options with the exception of PTNS, which has a time horizon of 5 years. Costs and effects (measured as quality‐adjusted life years) were calculated to derive incremental cost‐effectiveness ratios (ICERs). Direct medical resources included are: device and drug acquisition costs, pre‐procedure and procedure costs, and the cost of managing adverse events. Deterministic sensitivity analyses were performed to test robustness of results. Results At 5 years, SNS (PNE or TLE) was more effective and less costly than PTNS. Compared with OMT at 10 years, SNS (PNE or TLE) was more costly and more effective, and compared with BoNT‐A, SNS PNE was less costly and more effective, and SNS TLE was more costly and more effective. Decreasing the BoNT‐A dose from 150 to 100 IU marginally increased the 10 year ICERs for SNS TLE and PNE (SNS PNE was no longer dominant). However, both SNS options remained cost‐effective. Conclusion In the management of patients with idiopathic OAB wet, the results of this cost‐utility analysis favours SNS (PNE or TLE) over PTNS or OMT, and the most efficient treatment strategy is SNS PNE over BoNT‐A over a 10‐year period.
      PubDate: 2015-06-25T04:21:37.931144-05:
      DOI: 10.1111/bju.12972
  • Internet‐based treatment of stress urinary incontinence: 1‐
           and 2‐year results of a randomized controlled trial with a focus on
           pelvic floor muscle training
    • First page: 955
      Abstract: Objectives To evaluate the long‐term effects of two non‐face‐to‐face treatment programmes for stress urinary incontinence (SUI) based on pelvic floor muscle training (PFMT). Subjects and Methods The present study was a randomized controlled trial with online recruitment of 250 community‐dwelling women aged 18–70 years with SUI ≥ one time/week. Diagnosis was based on validated self‐assessed questionnaires, 2‐day bladder diary and telephone interview with a urotherapist. Consecutive computer‐generated block randomization was carried out with allocation by an independent administrator to 3 months of treatment with either an internet‐based treatment programme (n = 124) or a programme sent by post (n = 126). Both interventions focused mainly on PFMT. The internet group received continuous e‐mail support from a urotherapist, whereas the postal group trained on their own. Follow‐up was performed after 1 and 2 years via self‐assessed postal questionnaires. The primary outcomes were symptom severity (International Consultation on Incontinence Questionnaire Short Form [ICIQ‐UI SF]) and condition‐specific quality of life (ICIQ‐Lower Urinary Tract Symptoms Quality of Life [ICIQ‐LUTSqol]). Secondary outcomes were the Patient Global Impression of Improvement, health‐specific quality of life (EQ‐visual analogue scale [EQ‐VAS]), use of incontinence aids, and satisfaction with treatment. There was no face‐to‐face contact with the participants at any time. Analysis was based on intention‐to‐treat. Results We lost 32.4% (81/250) of participants to follow‐up after 1 year and 38.0% (95/250) after 2 years. With both interventions, we observed highly significant (P < 0.001) improvements with large effect sizes (>0.8) for symptoms and condition‐specific quality of life (QoL) after 1 and 2 years, respectively. No significant differences were found between the groups. The mean (sd) changes in symptom score were 3.7 (3.3) for the internet group and 3.2 (3.4) for the postal group (P = 0.47) after 1 year, and 3.6 (3.5) for the internet group and 3.4 (3.3) for the postal group (P = 0.79) after 2 years. The mean changes (sd) in condition‐specific QoL were 5.5 (6.5) for the internet group and 4.7 the for postal group (6.5) (P = 0.55) after 1 year, and 6.4 (6.0) for the internet group and 4.8 (7.6) for the postal group (P = 0.28) after 2 years. The proportions of participants perceiving they were much or very much improved were similar in both intervention groups after 1 year (internet, 31.9% [28/88]; postal, 33.8% [27/80], P = 0.82), but after 2 years significantly more participants in the internet group reported this degree of improvement (39.2% [29/74] vs 23.8% [19/80], P = 0.03). Health‐specific QoL improved significantly in the internet group after 2 years (mean change in EQ‐VAS, 3.8 [11.4], P = 0.005). We found no other significant improvements in this measure. At 1 year after treatment, 69.8% (60/86) of participants in the internet group and 60.5% (46/76) of participants in the postal group reported that they were still satisfied with the treatment result. After 2 years, the proportions were 64.9% (48/74) and 58.2% (46/79), respectively. Conclusion Non‐face‐to‐face treatment of SUI with PFMT provides significant and clinically relevant improvements in symptoms and condition‐specific QoL at 1 and 2 years after treatment.
      PubDate: 2015-06-03T03:43:17.142744-05:
      DOI: 10.1111/bju.13091
  • Penile lengthening and widening without grafting according to a modified
           ‘sliding’ technique
    • Authors: Paulo H. Egydio; Franklin E. Kuehhas
      First page: 965
      Abstract: Objective To present the feasibility and safety of penile length and girth restoration based on a modified ‘sliding’ technique for patients with severe erectile dysfunction (ED) and significant penile shortening, with or without Peyronie's disease (PD). Patients and Methods Between January 2013 and January 2014, 143 patients underwent our modified ‘sliding’ technique for penile length and girth restoration and concomitant penile prosthesis implantation. It is based on three key elements: (i) the sliding manoeuvre for penile length restoration; (ii) potential complementary longitudinal ventral and/or dorsal tunical incisions for girth restoration; and (iii) closure of the newly created rectangular bow‐shaped tunical defects with Buck's fascia only. Results In all, 143 patients underwent the procedure. The causes of penile shortening and narrowing were: PD in 53.8%; severe ED with unsuccessful intracavernosal injection therapy in 21%; post‐radical prostatectomy 14.7%; androgen‐deprivation therapy, with or without brachytherapy or external radiotherapy, for prostate cancer in 7%; post‐penile fracture in 2.1%; post‐redo‐hypospadias repair in 0.7%; and post‐priapism in 0.7%. In patients with ED and PD, the mean (range) deviation of the penile axis was 45 (0‒100)°. The mean (range) subjective penile shortening reported by patients was 3.4 (1‒7) cm and shaft constriction was present in 53.8%. Malleable penile prostheses were used in 133 patients and inflatable penile prostheses were inserted in 10 patients. The median (range) follow‐up was 9.7 (6‒18) months. The mean (range) penile length gain was 3.1 (2‒7) cm. No penile prosthesis infection caused device explantation. The average International Index of Erectile Function (IIEF) score increased from 24 points at baseline to 60 points at the 6‐month follow‐up. Conclusion Penile length and girth restoration based on our modified sliding technique is a safe and effective procedure. The elimination of grafting saves operative time and, consequently, decreases the infection risk and costs associated with surgery.
      PubDate: 2015-04-27T03:55:49.910865-05:
      DOI: 10.1111/bju.13065
  • Characterisation of the contractile dynamics of the resting ex vivo
           urinary bladder of the pig
    • Authors: Roger G. Lentle; Gordon W. Reynolds, Patrick W.M. Janssen, Corrin M. Hulls, Quinten M. King, John Paul Chambers
      First page: 973
      Abstract: Objectives To characterise the area and movements of ongoing spontaneous localised contractions in the resting porcine urinary bladder and relate these to ambient intravesical pressure (Pves), to further our understanding of their genesis and role in accommodating incoming urine. Materials and Methods We used image analysis to quantify the areas and movements of discrete propagating patches of contraction (PPCs) on the anterior, anterolateral and posterior surfaces of the urinary bladders of six pigs maintained ex vivo with small incremental increases in volume. We then correlated the magnitude of Pves and cyclic changes in Pves with parameters derived from spatiotemporal maps. Results Contractile movements in the resting bladder consisted only of PPCs that covered around a fifth of the surface of the bladder, commenced at various sites, and were of ≈6 s in duration. They propagated at around 6 mm/s, mainly across the anterior and lateral surface of the bladder by various, sometimes circular, routes in a quasi‐stable rhythm, and did not traverse the trigone. The frequencies of these rhythms were low (3.15 cycles/min) and broadly similar to those of cyclic changes in Pves (3.55 cycles/min). Each PPC was associated with a region of stretching (positive strain rate) and these events occurred in a background of more constant strain. The amplitudes of cycles in Pves and the areas undergoing PPCs increased after a sudden increase in Pves but the frequency of cycles of Pves and of origin of PPCs did not change. Peaks in Pves cycles occurred when PPCs were traversing the upper half of the bladder, which was more compliant. The velocity of propagation of PPCs was similar to that of transverse propagation of action potentials in bladder myocytes and significantly greater than that reported in interstitial cells. The size of PPCs, their frequency and their rate of propagation were not affected by intra‐arterial dosage with tetrodotoxin or lidocaine. Conclusions The origin and duration of PPCs influence both Pves and cyclic variation in Pves. Hence, propagating rather than stationary areas of contraction may contribute to overall tone and to variation in Pves. Spatiotemporal mapping of PPCs may contribute to our understanding of the generation of tone and the basis of clinical entities such as overactive bladder, painful bladder syndrome and detrusor overactivity.
      PubDate: 2015-06-13T00:53:46.063574-05:
      DOI: 10.1111/bju.13132
  • Online and social media presence of Australian and New Zealand urologists
    • Authors: Nicholas Davies; Declan G. Murphy, Simon Rij, Henry H. Woo, Nathan Lawrentschuk
      First page: 984
      Abstract: Objective To assess the online and social media presence of all practising Australian and New Zealand urologists. Subjects and Methods In July 2014, all active members of the Urological Society of Australia and New Zealand (USANZ) were identified. A comprehensive search of Google and each social media platform (Facebook, Twitter, LinkedIn and YouTube) was undertaken for each urologist to identify any private websites or social media profiles. Results Of the 435 urologists currently practising in Australia and New Zealand, 305 (70.1%) have an easily identifiable social media account. LinkedIn (51.3%) is the most commonly used form of social media followed by Twitter (33.3%) and private Facebook (30.1%) accounts. About half (49.8%) have a private business website. The average number of social media accounts per urologist is 1.42 and 16 urologists (3.7%) have an account with all searched social media platforms. Over half of those with a Twitter account (55.9%) follow a dedicated urology journal club and have a median (range) number of ‘followers’ of 12 (1–2 862). Social media users had a median (range) of 2 (0–8 717) ‘tweets’ on Twitter, 2 (1–45) LinkedIn posts and 1 (1–14) YouTube video. Conclusion This study represents a unique dataset not relying on selection or recall bias but using data freely available to patients and colleagues to gauge social media presence of urologists. Most Australian and New Zealand urologists have a readily identifiable online and social media presence, with widespread and consistent use across both countries.
      PubDate: 2015-06-15T01:26:15.245796-05:
      DOI: 10.1111/bju.13159
  • Does transition from the da Vinci Si® to Xi robotic platform impact
           single‐docking technique for robot‐assisted laparoscopic
    • Authors: Manish N. Patel; Ahmed Aboumohamed, Ashok Hemal
      First page: 990
      Abstract: Objectives To describe our robot‐assisted nephroureterectomy (RNU) technique for benign indications and RNU with en bloc excision of bladder cuff (BCE) and lymphadenectomy (LND) for malignant indications using the da Vinci Si® and da Vinci Xi robotic platform, with its pros and cons. The port placement described for Si can be used for standard and S robotic systems. This is the first report in the literature on the use of the da Vinci Xi robotic platform for RNU. Patients and Methods After a substantial experience of RNU using different da Vinci robots from the standard to the Si platform in a single‐docking fashion for benign and malignant conditions, we started using the newly released da Vinci Xi robot since 2014. The most important differences are in port placement and effective use of the features of da Vinci Xi robot while performing simultaneous upper and lower tract surgery. Patient positioning, port placement, step‐by‐step technique of single docking RNU‐LND‐BCE using the da Vinci Si and da Vinci Xi robot are shown in an accompanying video with the goal that centres using either robotic system benefit from the hints and tips. The first segment of video describes RNU‐LND‐BCE using the da Vinci Si followed by the da Vinci Xi to highlight differences. There was no need for patient repositioning or robot re‐docking with the new da Vinci Xi robotic platform. Results We have experience of using different robotic systems for single docking RNU in 70 cases for benign (15) and malignant (55) conditions. The da Vinci Xi robotic platform helps operating room personnel in its easy movement, allows easier patient side‐docking with the help of its boom feature, in addition to easy and swift movements of the robotic arms. The patient clearance feature can be used to avoid collision with the robotic arms or the patient's body. In patients with challenging body habitus and in situations where bladder cuff management is difficult, modifications can be made through reassigning the camera to a different port with utilisation of the retargeting feature of the da Vinci Xi when working on the bladder cuff or in the pelvis. The vision of the camera used for da Vinci Xi was initially felt to be inferior to that of the da Vinci Si; however, with a subsequent software upgrade this was much improved. The base of the da Vinci Xi is bigger, which does not slide and occasionally requires a change in table placement/operating room setup, and requires side‐docking especially when dealing with very tall and obese patients for pelvic surgery. Conclusions RNU alone or with LND‐BCE is a challenging surgical procedure that addresses the upper and lower urinary tract simultaneously. Single docking and single robotic port placement for RNU‐LND‐BCE has evolved with the development of different generations of the robotic system. These procedures can be performed safely and effectively using the da Vinci S, Si or Xi robotic platform. The new da Vinci Xi robotic platform is more user‐friendly, has easy installation, and is intuitive for surgeons using its features.
      PubDate: 2015-07-18T10:58:13.929089-05:
      DOI: 10.1111/bju.13210
  • Extreme Obesity Does Not Predict Poor Cancer Outcomes Following Surgery
           for Renal Cell Cancer
    • Abstract: Objective To evaluate if extreme obesity (BMI ≥ 40) is associated with perioperative outcomes, overall survival (OS), cancer‐specific survival (CSS), or recurrence‐free survival (RFS) after surgical treatment for RCC. Patients and Methods After IRB approval, an institutional database identified patients treated surgically between January 2000 and December 2014 with pathologic diagnosis of RCC. Comprehensive clinical and pathologic data were reviewed. Kaplan‐Meier analyses were used to estimate OS, RFS, and CSS. Univariate and multivariate Cox proportional hazards analysis was used to evaluate for associations with OS, CSS and RFS in patients with extreme obesity among other known predictive variables. Results A total 100 (11.9%) patients were identified with BMI ≥ 40 and 743 (88.1%) with BMI
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