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J. of Marriage and Family     Hybrid Journal   (Followers: 18, SJR: 3.241, h-index: 98)
J. of Mass Spectrometry     Hybrid Journal   (Followers: 23, SJR: 1.207, h-index: 92)
J. of Medical Imaging and Radiation Oncology     Hybrid Journal   (Followers: 3, SJR: 0.513, h-index: 26)
J. of Medical Primatology     Hybrid Journal   (Followers: 2, SJR: 0.527, h-index: 30)
J. of Medical Radiation Sciences     Open Access   (Followers: 2)
J. of Medical Virology     Hybrid Journal   (Followers: 6, SJR: 1.058, h-index: 89)
J. of Metamorphic Geology     Hybrid Journal   (Followers: 6, SJR: 3.008, h-index: 75)
J. of Microscopy     Hybrid Journal   (Followers: 3, SJR: 0.765, h-index: 76)
J. of Midwifery & Women's Health     Hybrid Journal   (Followers: 27, SJR: 0.503, h-index: 36)
J. of Molecular Recognition     Hybrid Journal   (Followers: 2, SJR: 1.012, h-index: 60)
J. of Money, Credit and Banking     Hybrid Journal   (Followers: 26, SJR: 2.128, h-index: 61)
J. of Morphology     Hybrid Journal   (Followers: 3, SJR: 0.767, h-index: 49)
J. of Multi-Criteria Decision Analysis     Hybrid Journal   (Followers: 2)
J. of Multicultural Counseling and Development     Hybrid Journal   (Followers: 1, SJR: 0.267, h-index: 25)
J. of Muscle Foods     Hybrid Journal   (Followers: 3, SJR: 0.274, h-index: 24)
J. of Neurochemistry     Hybrid Journal   (SJR: 2.075, h-index: 172)
J. of Neuroendocrinology     Hybrid Journal   (Followers: 5, SJR: 1.417, h-index: 83)
J. of Neuroimaging     Hybrid Journal   (Followers: 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: 19, SJR: 1.185, h-index: 38)
J. of Nursing Scholarship     Hybrid Journal   (Followers: 5, SJR: 1.258, h-index: 49)
J. of Obstetric, Gynecologic, & Neonatal Nursing     Hybrid Journal   (Followers: 19, SJR: 0.647, h-index: 42)
J. of Obstetrics and Gynaecology Research     Hybrid Journal   (Followers: 14, 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: 3, SJR: 1.033, h-index: 57)
J. of Organizational Behavior     Hybrid Journal   (Followers: 32, SJR: 3.102, h-index: 95)
J. of Orthopaedic Research     Hybrid Journal   (Followers: 15, SJR: 1.505, h-index: 106)
J. of Paediatrics and Child Health     Hybrid Journal   (Followers: 16, SJR: 0.594, h-index: 51)
J. of Pathology     Hybrid Journal   (Followers: 8, SJR: 4.402, h-index: 131)
J. of Pathology : Clinical Research     Open Access  
J. of Peptide Science     Hybrid Journal   (Followers: 18, SJR: 0.641, h-index: 47)
J. of Periodontal Research     Hybrid Journal   (SJR: 0.781, h-index: 58)
J. of Personality     Hybrid Journal   (Followers: 12, SJR: 2.266, h-index: 83)
J. of Petroleum Geology     Hybrid Journal   (Followers: 5, SJR: 0.524, h-index: 24)
J. of Pharmaceutical Sciences     Hybrid Journal   (Followers: 136, SJR: 1.284, h-index: 113)
J. of Philosophy of Education     Hybrid Journal   (Followers: 9, SJR: 0.687, h-index: 20)
J. of Phycology     Hybrid Journal   (Followers: 6, SJR: 1.148, h-index: 84)
J. of Physical Organic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.64, h-index: 48)
J. of Phytopathology     Hybrid Journal   (Followers: 3, SJR: 0.503, h-index: 37)
J. of Pineal Research     Hybrid Journal   (Followers: 1, SJR: 2.189, h-index: 81)
J. of Plant Nutrition and Soil Science     Hybrid Journal   (Followers: 3, SJR: 0.846, h-index: 49)
J. of Policy Analysis and Management     Hybrid Journal   (Followers: 12, SJR: 1.531, h-index: 47)
J. of Policy and Practice In Intellectual Disabilities     Hybrid Journal   (Followers: 12, SJR: 0.62, h-index: 10)
J. of Political Philosophy     Hybrid Journal   (Followers: 31, SJR: 1.21, h-index: 31)
J. of Polymer Science Part A: Polymer Chemistry     Hybrid Journal   (Followers: 119, SJR: 1.211, h-index: 109)
J. of Polymer Science Part B: Polymer Physics     Hybrid Journal   (Followers: 22, SJR: 1.222, h-index: 96)
J. of Polymer Science Part C : Polymer Letters     Hybrid Journal   (Followers: 5)
J. of Popular Music Studies     Hybrid Journal   (Followers: 8, SJR: 0.199, h-index: 3)
J. of Product Innovation Management     Hybrid Journal   (Followers: 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: 50, SJR: 0.529, h-index: 39)
J. of Psychological Issues in Organizational Culture     Hybrid Journal   (Followers: 4)
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 Rapid Methods and Automation In Microbiology     Hybrid Journal   (Followers: 2)
J. of Regional Science     Hybrid Journal   (Followers: 10, SJR: 2.642, h-index: 42)
J. of Religious Ethics     Hybrid Journal   (Followers: 5, SJR: 0.2, h-index: 10)
J. of Religious History     Hybrid Journal   (Followers: 18, SJR: 0.179, h-index: 7)
J. of Renal Care     Hybrid Journal   (Followers: 1, SJR: 0.468, h-index: 13)
J. of Research In Reading     Hybrid Journal   (Followers: 10, SJR: 0.789, h-index: 23)
J. of Research in Science Teaching     Hybrid Journal   (Followers: 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: 6, SJR: 1.851, h-index: 55)
J. of Risk & Insurance     Hybrid Journal   (Followers: 11, SJR: 0.925, h-index: 36)
J. of School Health     Hybrid Journal   (Followers: 7, SJR: 1.099, h-index: 52)
J. of Sensory Studies     Hybrid Journal   (Followers: 3, SJR: 1.136, h-index: 30)
J. of Separation Science     Hybrid Journal   (Followers: 8, SJR: 1.148, h-index: 71)
J. of Sexual Medicine     Hybrid Journal   (Followers: 7, SJR: 1.403, h-index: 65)
J. of Sleep Research     Hybrid Journal   (Followers: 11, SJR: 1.259, h-index: 73)
J. of Small Animal Practice     Hybrid Journal   (Followers: 8, SJR: 0.71, h-index: 44)
J. of Small Business Management     Hybrid Journal   (Followers: 11, SJR: 1.117, h-index: 51)
J. of Social Issues     Hybrid Journal   (Followers: 18, SJR: 0.965, h-index: 72)
J. of Social Philosophy     Hybrid Journal   (Followers: 16, SJR: 0.156, h-index: 15)
J. of Sociolinguistics     Hybrid Journal   (Followers: 15, 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: 8)
J. of Surgical Oncology     Hybrid Journal   (Followers: 2, SJR: 1.263, h-index: 75)
J. of Synthetic Lubrication     Hybrid Journal  
J. of Systematics Evolution     Open Access   (Followers: 4, SJR: 0.647, h-index: 22)
J. of Texture Studies     Hybrid Journal   (Followers: 2, SJR: 0.773, h-index: 33)
J. of the American Association of Nurse Practitioners     Partially Free   (Followers: 3, SJR: 0.46, h-index: 27)
J. of the American Ceramic Society     Hybrid Journal   (Followers: 23, SJR: 1.247, h-index: 129)
J. of the American Geriatrics Society     Hybrid Journal   (Followers: 22, SJR: 2.112, h-index: 151)
J. of the American Society for Information Science and Technology     Hybrid Journal   (Followers: 80, SJR: 1.745, h-index: 83)
J. of the American Water Resources Association     Hybrid Journal   (Followers: 18, SJR: 1.072, h-index: 61)
J. of the Association for Information Science and Technology     Hybrid Journal   (Followers: 7)
J. of the CardioMetabolic Syndrome     Hybrid Journal   (Followers: 1)
J. of the European Academy of Dermatology and Venereology     Hybrid Journal   (Followers: 10, SJR: 1.422, h-index: 58)
J. of the Experimental Analysis of Behavior     Hybrid Journal   (Followers: 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: 27, 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)

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Journal Cover   BJU International
  [SJR: 1.812]   [H-I: 104]   [67 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1464-4096 - ISSN (Online) 1464-410X
   Published by John Wiley and Sons Homepage  [1607 journals]
  • Comparison of systematic transrectal biopsy to transperineal
           MRI/ultrasound‐fusion biopsy for the diagnosis of prostate cancer
    • Authors: Angelika Borkowetz; Ivan Platzek, Marieta Toma, Michael Laniado, Gustavo Baretton, Michael Froehner, Rainer Koch, Manfred Wirth, Stefan Zastrow
      Abstract: Objectives • To compare targeted, transperineal MRI/ultrasound‐fusion biopsy to systematic transrectal biopsy in patients with previous negative or first prostate biopsy. • To evaluate the gain in diagnostic information with systematic biopsies in addition to targeted MRI/ultrasound‐fusion biopsies. Patients and methods • 263 consecutive patients with suspicion of prostate cancer (PCa) were investigated. • All patients were evaluated by 3 Tesla multiparametric magnetic resonance imaging (mpMRI) applying the European Society of Urogenital Radiology (ESUR) criteria. • All patients underwent MRI/ultrasound‐fusion biopsy transperineally (mean nine cores) and additionally a systematic transrectal biopsy (mean 12 cores). Results • 195 patients underwent repeat biopsy and 68 patients underwent first biopsy. • Median age was 66yrs, median PSA‐level was 8.3ng/mL, median prostate volume was 50mL. Overall, PCa detection rate was 52% (137/263). • MRI/ultrasound‐fusion biopsy detected significantly more PCa than systematic prostate biopsy (44% (116/263) vs. 35% (91/263); p=0.0023). In repeat biopsy, the detection rate was 44% (85/195) in targeted and 32% (62/195) in systematic biopsy (p=0.0023). In first biopsy, the detection rate was 46% (31/68) in targeted and 43% (29/68) in systematic biopsy (p=0.5271). • 80% (110/137) of biopsy‐proven PCa were clinically significant. • Regarding the upgrading of Gleason Score (GS), 44% (32/72) more clinically significant PCa was detected by using additional targeted biopsy compared to systematic biopsy alone. Conversely, 12% (10/94) more clinically significant cancer was found by systematic biopsy additionally to targeted biopsy. Conclusions • MRI/ultrasound‐fusion biopsy was associated with a higher detection rate of clinically significant PCa while taking fewer cores both, especially in patients with prior negative biopsy. • Due to a high portion of additional tumours with GS ≥ 7 detected in addition to targeted biopsy, systematic biopsy should still be performed additionally to targeted biopsy.
      PubDate: 2015-04-27T03:55:34.071356-05:
      DOI: 10.1111/bju.13023
  • Retrograde transport of radiolabelled botulinum neurotoxin type a (bont/a)
           to the central nervous system following intradetrusor injection in rats
    • Authors: Dionysia Papagiannopoulou; Lina Vardouli, Fotios Dimitriadis, Apostolos Apostolidis
      Abstract: Objectives to investigate the potential distribution of radiolabelled BoNT/A in the central nervous system (CNS) after bladder injection in normal rats, by using the gamma emitting radionuclide technetium‐99m (99mTc). Materials and Methods BoNT/A was radiolabelled by pre‐treatment with 2‐iminothiolane and incubation with 99mTc‐gluconate. The labelled toxin 99mTc‐BoNT/A was purified by size‐exclusion high‐performance liquid chromatography. Twenty‐four female Wistar rats were evenly injected in the bladder wall with either 99mTc‐ΒοΝΤ/Α (n=12) or free 99mTc (n=12). Four rats from each group were sacrificed at 1, 3 and 6 hours post injection, respectively. The bladder, L6‐S1 spinal cord (SC) segment and L6‐S1 dorsal root ganglia (DRG) were harvested and their radioactivity counted in a gamma scintillation detector. Results were calculated as % Injected Dose (I.D.) per gram tissue. The paired t‐test was used for comparison of means of 99mTc‐ΒοΝΤ/Α radioactivity versus free 99mTc in the tissues of interest. Results Radiolabelled BoNT/A had high radiochemical stability of 70% after 24h. Gradual accumulation of 99mTc‐ΒοΝΤ/Α was seen in the DRG up to 6h post injection (p=0.04 and p=0.029 compared to 1h and 3h respectively), while no accumulation was detected for free 99mTc. Consequently, 99mTc‐ΒοΝΤ/Α radioactivity in the DRG was higher than free 99mTc radioactivity (3.18±0.67%I.D./g vs 0.19±0.10% I.D./g., p=0.002 6h post injection). Values for 99mTc‐ΒοΝΤ/Α radioactivity in the SC were higher compared to free 99mTc but not significantly. The bladder retained higher dosages of 99mTc‐ΒοΝΤ/Α compared to free 99mTc at all time‐points. Conclusions Significant accumulation of the radiolabelled toxin in the lumbosacral DRG together with a less significant uptake in the respective SC segment as opposed to free radioactivity provide first evidence of BoNT/A's retrograde transport to the CNS following bladder injection in rats. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-24T14:57:47.157613-05:
      DOI: 10.1111/bju.13163
  • Responder and health‐related quality of life analyses in men with
           lower urinary tract symptoms treated with a fixed‐dose combination
    • Authors: Marcus J. Drake; Roman Sokol, Karin Coyne, Zalmai Hakimi, Jameel Nazir, Julie Dorey, Monique Klaver, Klaudia Traudtner, Isaac Odeyemi, Matthias Oelke, Philip Kerrebroeck,
      Abstract: Objective To evaluate the effect of a fixed–dose combination (FDC) of solifenacin and an oral controlled absorption system (OCAS™) formulation of tamsulosin (TOCAS) on health–related quality of life (HRQoL) in men with lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH). Patients and methods Men with moderate‐to‐severe storage symptoms and voiding symptoms were treated for 12 weeks with FDC of solifenacin 6 mg or 9 mg plus TOCAS (0.4 mg), TOCAS monotherapy (0.4 mg) or placebo in a randomised, double‐blind study (NEPTUNE). The co‐primary endpoints were Total Urgency Frequency Score (TUFS) and total International Prostate Symptom Score (IPSS). HRQoL was assessed by several secondary endpoints: IPSS QoL index, overactive bladder questionnaire (OAB‐q), and Patient Global Impression (PGI) scale. The correlation between symptom improvement (TUFS) and HRQoL was assessed by Spearman rank correlation coefficients. Single and double responder analyses, using subjective and objective measures, were also performed. Results In the responder analyses, men treated with FDC of solifenacin 6 mg plus TOCAS consistently demonstrated significantly improved outcomes compared with placebo (8/8 responder analyses performed) and TOCAS (6/8 responder analyses performed). There was a significant correlation (p
      PubDate: 2015-04-24T01:31:11.738056-05:
      DOI: 10.1111/bju.13162
  • Bone Scan Index predicts outcome in patients with metastatic hormone
           sensitive prostate cancer
    • Authors: Mads Hvid Poulsen; Janne Rasmussen, Lars Edenbrandt, Poul Flemming Høilund‐Carlsen, Oke Gerke, Allan Johansen, Lars Lund
      Abstract: Objective To evaluate the Bone Scan Index (BSI) for prediction of castration resistance and prostate cancer specific survival. In a retrospective material, we used a novel computer‐assisted software for automated detection/quantification of bone metastases by BSI. Prostate cancer patients are M‐staged by whole‐body bone scintigraphy (WBS) and categorized as M0 or M1. Within the M1 group, there is a wide range of clinical outcomes. The BSI was introduced a decade ago providing quantification of bone metastases by estimating the percentage of bone involvement. Being too time consuming, it never gained widespread clinical use. Subjects & methods A total of 88 patients with prostate cancer awaiting initiation of androgen deprivation due to metastases were included. WBS was performed using a two‐headed gamma camera. BSI was obtained using the automated platform EXINI bone (EXINI Diagnostics AB, Lund, Sweden). In Cox proportional hazard models, time to castration resistant prostate cancer (CRPC) and prostate cancer specific survival were modelled as the dependent variables, whereas PSA, Gleason score and BSI were used as explanatory factors. For Kaplan‐Meier estimates, BSI groups were dichotomously split into: BSI
      PubDate: 2015-04-24T01:21:34.977608-05:
      DOI: 10.1111/bju.13160
  • Risk factors for mesh erosion after female pelvic floor reconstructive
           surgery: a systematic review and meta‐analysis
    • Authors: Tuo Deng; Banghua Liao, Deyi Luo, Hong Shen, Kunjie Wang
      Abstract: Objectives To explore the risk factors for mesh erosion after female pelvic floor reconstructive surgery based on published literature. Materials and Methods A systematic literature search of the Pubmed, Embase, Cochrane Library, CBM, CNKI and VIP databases was performed to identify the studies related to the risk factors for mesh erosion after female pelvic floor reconstruction published before December 2014. Summary unadjusted odds ratio (OR) with 95% confidence interval (CI) was calculated to assess the strength of associations between the factors and mesh erosion. Results A total of 25 studies containing 7084 patients were included in our systematic review and meta‐analysis. Statistically significant differences in mesh erosion after female pelvic floor reconstruction were found in elder age vs. younger age (OR = 0.96, 95% CI: 0.94‐0.98), more parities vs. less parities (OR = 1.27, 95% CI: 1.07‐1.51), the presence of premenopausal / estrogen replacement therapy (ERT) (OR = 1.36, 95% CI: 1.03‐1.79), diabetes mellitus (OR = 1.87, 95% CI: 1.35‐2.57), smoking (OR = 2.35, 95% CI: 1.80‐3.08), concomitant pelvic organ prolapse (POP) surgery (OR = 0.37, 95% CI: 0.16‐0.84), concomitant hysterectomy (OR = 1.46, 95% CI: 1.03‐2.07), preservation of uterus at surgery (OR = 0.22, 95% CI: 0.08‐0.63), and senior surgeons operation vs. junior surgeons operation (OR = 0.42, 95% CI: 0.30‐0.58). Conclusion Our study indicated that younger age, more parities, premenopausal / ERT, diabetes mellitus, smoking, concomitant hysterectomy, and junior surgeons operation were significant risk factors for mesh erosion after female pelvic floor reconstructive surgery. Moreover, concomitant POP surgery and preservation of uterus may be the potential protective factors for mesh erosion. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-24T01:18:18.897774-05:
      DOI: 10.1111/bju.13158
  • Online and Social Media Presence of Australian and New Zealand Urologists
    • Authors: Nicholas Davies; Declan G Murphy, Simon Rij, Henry H Woo, Nathan Lawrentschuk
      Abstract: Objective To assess the online and social media presence of all practising Australian and New Zealand urologists. Materials 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 utilised form of social media followed by Twitter (33.3%) and private Facebook (30.1%) accounts. Approximately half (49.8%) have a private business website. The average number of social media accounts per urologist is 1.42 and sixteen 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 of 12 ‘followers (range 1‐2862)’. Social media users had a median of two ‘tweets’ on Twitter (range 0‐8717), two LinkedIn posts (range 1‐45) and one YouTube video (range 1‐14). Conclusion This study represents a unique dataset not relying on selection or recall bias but using data freely available to public and colleagues to gauge social media presence of urologists. The majority of Australian and New Zealand urologists have a readily identifiable online and social media presence, with widespread and consistent use across both countries. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-24T01:17:59.824133-05:
      DOI: 10.1111/bju.13159
  • Physical activity as a risk factor for prostate cancer diagnosis: a
           prospective biopsy cohort analysis
    • Authors: Cosimo De Nunzio; Fabrizio Presicce, Riccardo Lombardo, Fabiana Cancrini, Stefano Petta, Alberto Trucchi, Mauro Gacci, Luca Cindolo, Andrea Tubaro
      Abstract: Objectives To assess the association between physical activity, evaluated by the Physical activity scale for elderly (PASE) questionnaire, and prostate cancer (PC) risk in a consecutive series of men undergoing prostate biopsy. Materials and Methods From 2011 onwards, a consecutive men undergoing 12‐core prostate biopsy were enrolled into a prospective database. Indications for a prostatic biopsy were a PSA value ≥ 4 ng/ml and/or a positive digital rectal examination (DRE). Body mass index (BMI) and waist circumferences were measured before the biopsy. Fasting blood samples were collected before biopsy and tested for: total PSA, glucose, HDL, trygliceridemia levels. Blood pressure was recorded. Metabolic syndrome (MetS) was defined according to the Adult Treatment panel III. PASE questionnaire was collected before the biopsy. Results 286 patients were enrolled with a median age and PSA of 68 (IQR 62/74) years and 6.1 ng/ml (IQR 5/8.8) respectively. Median BMI was26.4 kg/m2 (IQR: 24.6/29); median waist circumference was 102 cm (IQR: 97/108) and 75 patients (26%) presented a Metabolic syndrome. One‐hundred and six patients (37%) had prostate cancer on biopsy. Patients with PC presented an higher PSA (6.7 ng/ml, IQR: 5/10 vs 5.6 ng/ml, IQR: 4.8/8; p= 0.007) and a lower LogPASE score (2.03 (1.82/2.18) vs 2.10 (1.92/2.29); p=0.005). On multivariate analysis, in addition to well‐recognized risk factors such as age, PSA, prostate volume, LogPASE score was an independent risk factor for prostate cancer diagnosis (OR: 0.146, 95%CI: 0.037 ‐ 0.577; p= 0.006). Log PASE was also an independent predictor of high‐grade cancer (OR: 0.07, 95% CI: 0.006‐0.764; p= 0.029). Conclusion In our single centre study, an increased physical activity evaluated by the PASE questionnaire is associated with a reduced risk of PC and of high‐grade prostate cancer on biopsy. Further studies should clarify the molecular pathways behind this association. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-24T01:01:43.162692-05:
      DOI: 10.1111/bju.13157
  • “Percutaneous Nephrolithotomy in the Super Obese (BMI
           ≥ 50):Overcoming the Challenges.”
    • Authors: Mohamed Keheila; David Leavitt, Riccardo Galli, Piruz Motamedinia, Nithin Theckumparampil, Micheal Siev, David Hoenig, Arthur Smith, Zeph Okeke
      Abstract: Objective To analyze our experience, outcomes and lessons learned with percutaneous nephrolithotomy (PCNL) in the super obese (body mass index ≥ 50 kg/m2). Materials and Methods In this institutional review board approved study we retrospectively reviewed our PCNL database between July 2011 and September 2014 and identified all patients with a BMI ≥ 50 kg/m2. Patient demographics, perioperative outcomes and complications were determined. Additionally, a number of special PCNL considerations in the super obese that can maximize safe outcomes are outlined. Results Twenty‐one PCNLs performed on 17 super obese patients were identified. Mean patient age was 54.8 years. Mean body mass index (BMI) was 57.2 kg/m2. Mean stone area was 1037 mm2. Full staghorn stones were appreciated in 6 patients and partial staghorns in 4 patients. Mean operative time was 106 minutes and mean hemoglobin drop was 1.2 g/dl. Overall stone free rate was 87%. There were four total complications: two Clavien grade II, one Clavien IIIb and one Clavien IVb. We identified several special considerations for safely preforming PCNL in the suber obese including using extra‐long nephroscopes and graspers, using custom cut extra long access sheaths with suture “tails” secured to easily retrieve the sheath, choosing the shortest possible access tract, readily employing flexible nephroscopes, placing nephroureteral tubes rather than nephrostomy tubes postoperatively, and meticulous patient positioning and padding. Conclusion With appropriate perioperative considerations and planning, PCNL is feasible and safe in the super obese. Stone clearance is comparable to that of prior reported PCNL series in the morbidly obese, and is achievable with few complications. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-18T02:21:57.017131-05:
      DOI: 10.1111/bju.13155
  • Long‐term outcomes of high risk bladder cancer screening cohort
    • Authors: Nathan Starke; Nirmish Singla, Ahmed Haddad, Yair Lotan
      Abstract: Purpose To evaluate long‐term outcomes of patients at high risk of bladder cancer (BC) who participated in a BC screening trial. Materials and methods High‐risk patients based on age ≥50 years, ≥10 pack‐years smoking, and/or ≥15 years environmental exposure enrolled in one‐time screening trial using NMP‐22 assay (3/2006‐11/2007) at Dallas VA hospital. Subsequent detection of smoking related malignancies (Bladder, lung and renal cell carcinoma) was determined through Jan 31, 2014. Multivariable regression analysis was used to determine factors associated with BC diagnosis and survival. Results Cohort included 925 subjects: 886 patients (95.8%) were smokers and 613 (66.3%) had hazardous occupational exposure. At initial screen, 57 patients had positive NMP22 test and 2 had BC. Another 9 (1.0%) patients were diagnosed with BC during median follow‐up of 78.4 months. All BCs were non‐invasive (Ta); low grade (n=7) and high grade (n=4). RCC and lung cancer were diagnosed in 10 (1.1%) and 18 (1.9%) patients, respectively. 134 patients died including 3 from RCC and 12 from lung cancer, but none from BC. Factors associated with worse overall survival on MVA: lung cancer (HR 5.06, p60 pack years smoking history (HR 4.51, p=0.037). Conclusion At 6.5 years of follow‐up, no patients in this high‐risk cohort developed muscle invasive BC. Lung cancer, hematuria and >60 pack years smoking history are independent predictors of mortality. Other cause mortality is an important consideration in patients undergoing BC screening. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-18T02:15:59.419168-05:
      DOI: 10.1111/bju.13154
  • Prostatic arterial embolization for the treatment of LUTS due to benign
           prostatic hyperplasia:A comparative study of medium and large size
    • Authors: Maoqiang Wang; Liping Guo, Feng Duan, Kai Yuan, Guodong Zhang, Kai Li, Jieyu Yan, Yan Wang, Haiyan Kang
      Abstract: Objectives To compare the outcomes of prostatic arterial embolization (PAE) in treating large prostates (>80 mL) in comparison with medium‐sized prostates (50‐80 mL), largely to determine whether size may affect the outcome of PAE. Patients and methods A total of 115 patients (mean, 71.5 years) diagnosed with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) that was refractory to medical treatment underwent PAE. Group A (n=64) included patients with a mean prostate volume of 129 mL; group B (n=51) included patients with a mean prostate volume of 64 mL. PAE was performed using 100‐μm particles. Follow‐up was performed using the international prostate symptoms score (IPSS), quality of life (QoL), peak urinary flow rate (Qmax), post‐void residual volume (PVR), the international index of erectile function short form (IIEF‐5), prostatic specific antigen (PSA) and prostate volume (PV) measured by magnetic resonance (MR) imaging, at 1, 3, 6 and every 6 months thereafter. Results There were no significant differences in baseline IPSS, QoL, Qmax, PVR, PSA, or IIEF‐5, between groups. Technical success rate was 93.8% in group A and 96.8% in group B (P=0.7). A total of 101 patients (55 patients in group A and 46 patients in group B) had completed the follow‐up with a mean of 17 months (range 12–33 months). Compared with the baseline, there were significant improvements in IPSS, QoL, Qmax, PV, and PVR in both groups after PAE. The outcomes in group A were significantly better (group A vs group B mean±SD) regarding IPSS (‐14±6.5 vs ‐10.5±5.5), Qmax (6.0±1.5 vs 4.5±1.0), PVR (‐80.0±25.0 vs ‐60.0±20.0), PV (‐54.5±18.0 [‐42.3%] vs ‐18.5±5.0 [‐28.9%]), and QoL (‐3.0±1.5 vs ‐2.0±1.0) with P values
      PubDate: 2015-04-07T11:22:03.642318-05:
      DOI: 10.1111/bju.13147
  • Comparing long‐term outcomes between primary versus progressive
           muscle invasive bladder cancer after radical cystectomy
    • Authors: Marco Moschini; Vidit Sharma, Paolo Dell'oglio, Vito Cucchiara, Giorgio Gandaglia, Francesco Cantiello, Fabio Zattoni, Federico Pellucchi, Alberto Briganti, Rocco Damiano, Francesco Montorsi, Andrea Salonia, Renzo Colombo
      Abstract: Objective To assess the impact of primary or progressive status on recurrence‐free survival (RFS), cancer specific mortality (CSM) and overall mortality (OM) after radical cystectomy (RC) for muscle invasive bladder cancer (MIBC). Patients and Methods Overall, 768 consecutive patients underwent RC due to MIBC at our institution between 2000 and 2012. Primary MIBC was defined as no previous history of BCa and progressive was defined as recorded previous treated non‐MIBC that had progressed to MIBC. The median follow‐up was 85 (60‐109) months. Univariate and multivariate Cox regression models were used to compare RFS, CSM, and OM between these two cohorts. Results Overall, 475 (61.8%) patients had primary and 293 (38.2%) patients had progressive MIBC. There were no differences between the two groups in terms of demographics, pathological and perioperative complications (all p>0.1). The 10‐year rates of RFS, CSM, and OM for primary vs. progressive status were 43% vs. 36% (p=0.01), 43% vs. 37% (p=0.01), and 35% vs 28% (p=0.03), respectively. On multivariable Cox regression analyses, progressive status remained significantly associated with a higher rate of RFS (HR: 1.47, 95%CI: 1.12‐1.79, p=0.03) (Table 2), CSM (HR: 1.42, 95%CI: 1.07‐1.89, p=0.01) (Table 2), and OM (HR: 1.42, 95%CI: 1.13‐1.65, p=0.02). Conclusions Among patients treated with RC due to MIBC, progressive status is associated with a higher CSM, OM and recurrence rate after RC. Our study thus provides an impetus to improve risk sub‐stratification when bladder cancer is still at the NMIBC stage, be it through new biomarkers or improved imaging, as a subset of NMIBC are likely to benefit from early RC. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-07T11:11:16.864512-05:
      DOI: 10.1111/bju.13146
  • Over the horizon ‐ future innovations in global urology
    • Authors: Nicholas J Campain; Ruaraidh P MacDonagh, Kien Alfred Mteta, John S McGrath,
      Abstract: In the previous two commentary articles we have discussed some of the issues surrounding global urology, with a focus on sub‐Saharan Africa where the burden of urological disease is greatest. Coupled with low levels of infrastructure, funding and resources, the urological training environment is complex, with most urological care being provided by non‐specialists. Accepting the challenges of working in this environment, we look ahead to potential developments and innovations to improve global urological care. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-04T02:46:11.848675-05:
      DOI: 10.1111/bju.13145
  • Risk of Prostate Cancer Mortality in Men with a History of Prior Cancer
    • Authors: Kathryn T. Dinh; Brandon A. Mahal, David R. Ziehr, Vinayak Muralidhar, Yu‐Wei Chen, Vidya B. Viswanathan, Michelle D. Nezolosky, Clair J. Beard, Toni K. Choueiri, Neil E. Martin, Peter F. Orio, Christopher J. Sweeney, Quoc‐Dien Trinh, Paul L. Nguyen
      Abstract: Objectives To describe outcomes of patients with prostate cancer (PCa) diagnosed after another malignancy and identify factors associated with PCa death in this population, as little is known about the clinical significance of PCa as a subsequent malignancy. Patients and methods We studied 18,225 men diagnosed with PCa after another malignancy from 1973 to 2006. We compared demographic and clinical variables and proportion of death from PCa versus prior malignancy with T‐test and chi‐squared analyses. Fine and Gray's regression was used to consider the effect of treatment on PCa death. We then studied a second cohort of 88,013 men with PCa as a first or second malignancy to describe current diagnostic and treatment patterns. Results One in seven men died from PCa in our first cohort. More died from PCa following colorectal cancer (16.8 vs. 13.7%), melanoma (13.4 vs. 7.56%), and oral cancer (19.1 vs. 4.04%), but fewer following bladder, kidney, lung, leukemia and non‐Hodgkin's lymphoma (all p
      PubDate: 2015-04-04T02:17:41.264842-05:
      DOI: 10.1111/bju.13144
  • Improving Multivariable Prostate Cancer Risk Assessment Using The Prostate
           Health Index
    • Authors: Robert W Foley; Laura Gorman, Neda Sharifi, Keefe Murphy, Helen Moore, Alexandra V Tuzova, Antoinette S Perry, T Brendan Murphy, Dara J Lundon, R William G Watson
      Abstract: Objectives To analyse the clinical utility of a prediction model incorporating both clinical information as well as a novel biomarker in order to inform the decision for prostate biopsy in an Irish cohort. Patients and Methods Serum isolated from 250 men from three tertiary referral centres with pre‐biopsy blood draws was analysed for total PSA, free PSA and p2PSA. From this, the phi score was calculated (phi=(p2PSA/fPSA)*√tPSA). Their clinical information was used to derive their risk according to the Prostate Cancer Prevention Trial risk model (PCPT). Two clinical prediction models were created via multivariable regression consisting of age, family history, abnormality on digital rectal exam, prior negative biopsy and either PSA or phi score respectively. Calibration plots, receiver‐operating characteristic (ROC) curves as well as decision curves were generated to assess the performance of the three models. Results The PSA model and phi model were both highly calibrated in this cohort, with the phi model demonstrating the best correlation between predicted probabilities and actual outcome. The areas under the ROC curve for the phi model, PSA model and PCPT were 0.77, 0.71 & 0.69 respectively for the prediction of PCa and 0.79, 0.72 & 0.72 for the prediction of high grade PCa. Decision curve analysis demonstrated a superior net benefit of the phi model over both the PSA model and PCPT in the diagnosis of PCa and high grade PCa over the entire range of risk probabilities. Conclusion A logical and standardised approach to the use of clinical risk factors can allow for more accurate risk stratification of men under investigation for PCa. The measurement of p2PSA and the integration of this biomarker into a clinical prediction model can further increase the accuracy of risk stratification, helping to better inform the decision for prostate biopsy in a referral population. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-03T08:23:58.385061-05:
      DOI: 10.1111/bju.13143
  • UK practice of nephrectomy for benign disease. Results from the British
           Association of Urological Surgeons (BAUS) nephrectomy database
    • Authors: B Zelhof; IG McIntyre, SM Fowler, RD Napier‐Hemy, DM Burke, BR Grey,
      Abstract: Objective To summarise the UK urologists’ practice with regards to nephrectomy for benign disease documenting the indications, procedural techniques and outcomes. Patients and Methods All patients undergoing nephrectomy for a benign condition in 2012 were identified from the BAUS nephrectomy database. Recorded parameters included the technique of surgery, the type of minimal invasive procedure, operative time, blood loss, transfusion rate, conversion rate, intra and post operative complications, and mortality rate. Cases were also sub‐analysed according to their pathologies to determine the differences in complication rate between stone disease, pyelonephritis, non‐functioning kidney and others benign lesions. To contextualise procedural complexity, the simple nephrectomy (SN) data were compared with that obtained from the BAUS stage T1 radical nephrectomy (RN) audit. Results A total of 1093 nephrectomies were performed (537 non‐functioning kidneys, 142 stone disease, 129 nephrectomies secondary to pyelonephritis and 285 cases with other benign conditions). 76% were performed laparoscopically. Blood loss greater than 500ml was noted in 74 cases with a 4.8% blood transfusion rate. The intra‐ and post‐operative complication rates were 5.2% and 11.9% respectively. Of the 847 minimal invasive surgery procedures, conversion rate was 5.9%. Patients with stone disease have the highest intra‐ and post‐operative complications (9.9% and 23.9% respectively) compared to other benign pathologies. The total number of T1 RN cases was 1095 cases. In comparison to T1 RN, SN carries an increased risk of conversion to an open procedure (1.8 times), a higher rate of blood transfusion (4.8% vs 2.8%), and a higher risk of intra and postoperative complications (5.2% vs 3.7% and 11.9% vs 10%) respectively. Conclusion This study reports the largest series of nephrectomy performed for benign disease and the resultant data now supports the bespoke pre‐operative counselling of patients.. Furthermore, it confirms the commonly held view that ‘simple’ nephrectomy can be more difficult than its radical counterpart. The authors suggest that the term simple nephrectomy is changed to benign nephrectomy. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-30T10:53:31.084879-05:
      DOI: 10.1111/bju.13141
  • %[‐2]proPSA and “prostate health index” (PHI) improve
           the diagnostic accuracy for clinically relevant prostate cancer at initial
           and repeat biopsy compared to t‐PSA and %f‐PSA in men ≤
           65 years old
    • Authors: Martin Boegemann; Carsten Stephan, Henning Cammann, Sébastien Vincendeau, Alain Houlgatte, Klaus Jung, Jean‐Sebastien Blanchet, Axel Semjonow
      Abstract: Aim %[‐2]proPSA and “prostate health index” (PHI) improve the diagnostic accuracy for clinically relevant prostate cancer at initial and repeat biopsy compared to t‐PSA and %f‐PSA in men ≤ 65 years old Objectives To prospectively test the diagnostic accuracy of %[–2]proPSA and PHI and to determine its role for discrimination between significant and insignificant prostate cancer (PCa) at initial and repeat prostate biopsy in men ≤ 65 years. Patients and Methods The diagnostic performance of %[‐2]proPSA and PHI were evaluated in a multicenter study. A total of 769 men ≤ 65 years old scheduled for initial or repeat prostate biopsy were recruited in four sites based on t‐PSA level 1.6‐8.0 ng/ml WHO‐calibrated (2‐10 ng/ml Hybritech‐calibrated). Serum samples were measured for the concentration of t‐PSA, f‐PSA and [‐2]proPSA with Beckman Coulter immunoassays on Access‐2‐ or DxI800‐instruments. PHI was calculated as ([–2]proPSA/f‐PSA) x √t‐PSA). Uni‐ and multivariable logistic regression models and an artificial neural network (ANN) were complemented by decision curve analysis (DCA). Results In univariate analysis %[‐2]proPSA and PHI were best predictors of PCa detection in all patients (AUC: 0.72 and 0.73), at initial (AUC: 0.67 and 0.69) and repeat biopsy (AUC: 0.74 and 0.74). t‐PSA and %f‐PSA performed less accurate for all patients (AUC: 0.54 and 0.62). For detection of significant PCa (based on PRIAS‐criteria) %[‐2]proPSA and PHI equally demonstrated best performance (AUC: 0.70 and 0.73) compared with t‐PSA and %f‐PSA (AUC: 0.54 and 0.59). In multivariate analysis PHI added to a base model of age, prostate volume, DRE, t‐PSA and %f‐PSA. PHI was strongest in predicting PCa in all patients, at initial and repeat biopsy and for significant PCa (AUC: 0.73, 0.68, 0.78 and 0.72, respectively). In DCA for all patients the artificial neural network (ANN) showed the broadest threshold probability and best net benefit. PHI as single parameter and the base model + PHI were equivalent with threshold probability and net benefit nearing those of the ANN. For significant cancers the ANN was the strongest parameter in DCA. Conclusion This multicenter study showed that %[‐2]proPSA and PHI have a superior diagnostic performance for detecting PCa in PSA range of 1.6‐8.0 ng/ml compared with t‐PSA and %f‐PSA at initial and repeat biopsy and for predicting significant PCa in men ≤ 65 years old. They are equally superior for counceling patients prior to biopsy. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-28T09:56:18.800712-05:
      DOI: 10.1111/bju.13139
  • Symptoms, unmet needs, psychological well‐being and health status in
           prostate cancer survivors: implications for redesigning follow‐up
    • Authors: Eila Watson; Bethany Shinkins, Emma Frith, David Neal, Freddie Hamdy, Fiona Walter, David Weller, Clare Wilkinson, Sara Faithfull, Jane Wolstenholme, Prasanna Sooriakumaran, Christof Kastner, Christine Campbell, Richard Neal, Hugh Butcher, Mike Matthews, Rafael Perera, Peter Rose
      Abstract: Objective To explore ongoing symptoms, unmet needs, psychological wellbeing, self‐efficacy and overall health status in prostate cancer survivors. Subjects/patients and Methods An invitation to participate in a postal questionnaire survey was sent to 546 men, diagnosed with prostate cancer 9 – 24 months previously at two UK cancer centres. The study group comprised men who had been subject to a range of treatments: surgery, radiotherapy, hormone therapy and active surveillance. The questionnaire included measures of prostate‐related quality of life (EPIC‐26); unmet needs (SCNS SF34); anxiety and depression (HADS), self‐efficacy (modified Self‐efficacy Scale), health status (EQ‐5D) and satisfaction with care (questions developed for study). A single reminder was sent to non‐responders after three weeks. Data were analysed by age, co‐morbidities, and treatment group. Results 316 men completed questionnaires (64.1% response rate). Overall satisfaction with follow‐up care was high, but was lower for psychosocial than physical aspects of care. Urinary, bowel, and sexual functioning was reported as a moderate/big problem in the last month for 15.2% (n = 48), 5.1% (n = 16), and 36.5% (n = 105) men, respectively. The most commonly reported moderate/high unmet needs related to changes in sexual feelings/relationships, managing fear of recurrence/uncertainty, and concerns about the worries of significant others. It was found that 17% of men (n = 51/307) reported potentially moderate to severe levels of anxiety and 10.2% reported moderate to severe levels of depression (n = 32/308). The presence of problematic side‐effects was associated with higher psychological morbidity, poorer self‐efficacy, greater unmet needs, and poorer overall health status. Conclusion While some men report relatively few problems following prostate cancer treatment, this study highlights important physical and psycho‐social issues for a significant minority of prostate cancer survivors. Strategies for identifying those men with on‐going problems, alongside new interventions and models of care, tailored to individual needs, are needed to improve quality of life. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-27T10:18:19.8912-05:00
      DOI: 10.1111/bju.13122
  • Enzalutamide: Targeting the androgen signalling pathway in metastatic
           castration‐resistant prostate cancer
    • Authors: Jack Schalken; John M. Fitzpatrick
      Abstract: Context Significant progress has been made in the understanding of the underlying cancer biology of castration‐resistant prostate cancer (CRPC) with the androgen receptor (AR) signalling pathway remaining implicated throughout the prostate cancer disease continuum. Reactivation of the AR signalling pathway is considered to be a key driver of CRPC progression and, as such, the AR is a logical target for therapy in CRPC. Objective To understand the importance of AR signalling in the treatment of patients with metastatic CRPC (mCRPC) and to discuss the clinical benefits associated with inhibition of the AR signalling pathway. Evidence Acquisition A search was conducted to identify articles relating to the role of AR signalling in CRPC and therapies that inhibit the AR signalling pathway. Evidence Synthesis Current understanding of prostate cancer has identified the AR signalling pathway as a logical target for the treatment of CRPC. Available therapies that inhibit the AR signalling pathway include AR blockers, androgen biosynthesis inhibitors and AR signalling inhibitors. Enzalutamide, the first approved AR signalling inhibitor, has a novel mode of action targeting AR signalling at three key stages. The direct mode of action of enzalutamide has been shown to translate into clinical responses in patients with mCRPC. Conclusions The targeting of the AR signalling pathway in patients with mCRPC results in numerous clinical benefits. As the number of treatment options increase, more trials evaluating the sequencing and combination of treatments are required. Patient Summary This review highlights the continued importance of targeting a key driver in the progression of CRPC, AR signalling, and the clinical benefits associated with inhibition of the AR signalling pathway in the treatment of patients with CRPC. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-27T10:08:00.172758-05:
      DOI: 10.1111/bju.13123
  • Analysis of the Clinical Safety of Intralesional Injection of Collagenase
           Clostridium Histolyticum for Adults with Peyronie's Disease
    • Authors: Culley C. Carson; Hossein Sadeghi‐Nejad, James P. Tursi, Ted M. Smith, Gregory J. Kaufman, Kimberly Gilbert, Stanton C. Honig
      Abstract: Objective To examine the safety of intralesional injection of CCH for the treatment of PD, using a pooled safety analysis of subjects who received at least 1 dose of CCH in any of 6 clinical studies. Materials and Methods Subjects from 6 clinical studies, including 3 randomized, double‐blind, placebo‐controlled studies and 3 open‐label safety and efficacy studies, were included if they had received at least 1 dose of 0.58 mg CCH. AEs, including TEAEs, treatment‐related AEs, and SAEs, were characterized. Potential immunogenicity‐related AEs were evaluated through examination of increased anti‐AUX‐I and anti‐AUX‐II antibody levels, AEs, and reported terms possibly associated with immunological or hypersensitivity events. Results Overall, 85.8% of 1044 pooled subjects reported at least 1 treatment‐related AE. The most frequently reported (≥25.0% of subjects) treatment‐related AEs included penile hematoma (82.7% had the verbatim “penile bruising”), penile pain, and penile swelling. Most subjects (75.2%) had mild‐ or moderate‐severity treatment‐related AEs, and 14.2% had no treatment‐related AEs. Nine subjects (0.9%) had treatment‐related SAEs: 5 with penile hematoma and 4 with corporal rupture. No association was found between AEs and anti‐AUX‐I or anti‐AUX‐II antibody levels across treatment cycles, and no systemic hypersensitivity reactions occurred. Conclusions This pooled safety analysis demonstrates that although nonserious and serious treatment‐related AEs can occur following CCH treatment for PD, most were nonserious and the SAEs were manageable. Providers should be prepared to manage possible SAEs. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-27T09:41:11.069143-05:
      DOI: 10.1111/bju.13120
  • Clinical Significance of Peripheral Zone Thickness in Men with Lower
           Urinary Tract Symptom/Benign Prostatic Hyperplasia
    • Authors: Jong Kyou Kwon; Jang Hee Han, Ho Chul Choi, Dong Hyuk Kang, Joo Yong Lee, Jae Heon Kim, Cheol Kyu Oh, Young Deuk Choi, Kang Su Cho
      Abstract: Objective To evaluate the clinical impact of peripheral zone thickness (PZT), based on presumed circle area ratio (PCAR) theory, on urinary symptoms in men with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) as a novel prostate parameter. Patients And Methods Medical records were obtained from a prospective database of first‐visit men with LUTS/BPH. Age, international prostate symptom score (IPSS), overactive bladder symptom score (OABSS), maximum flow rate (Qmax), and post‐void residual (PVR) were assessed. Total prostate volume (TPV), transition zone volume (TZV), and transition zone index (TZI), and PZT were measured from transrectal ultrasonography. Reliability analysis was also performed. Results A total of 1009 patients were enrolled for the analysis. Mean PZT was 11.10 ± 2.50 mm, and patients were classified into 3 groups; PZT < 9.5 mm, 9.5 mm ≤ PZT
      PubDate: 2015-03-23T07:45:37.655271-05:
      DOI: 10.1111/bju.13130
  • Characterisation of the contractile dynamics of the resting ex vivo
           urinary bladder of the pig
    • Authors: R G Lentle; G W Reynolds, P W M Janssen, C M Hulls, Q M King, J P Chambers
      Abstract: Objectives To characterise the area and movements of ongoing spontaneous localised contractions in the resting porcine urinary bladder and relate these to ambient intravesical pressure (pves) in order to further our understanding of their genesis and role in accommodating incoming urine Materials and methods We used image analysis to quantify the areas and movements of discrete propagating patches of contraction (PPCs) on the anterior, anterolateral and posterior surfaces of the urinary bladders of 6 pigs maintained ex vivo with small incremental increases in volume. We then correlated the magnitude of pves and cyclic changes in pves with parameters derived from spatiotemporal maps. Results Contractile movements in the resting bladder consisted only of PPCs that covered around 1/5th of the surface of the bladder, commenced at various sites and were of around 6 s duration. They propagated at around 6 mm/s mainly across the anterior and lateral surface of the bladder by various, sometimes circular, routes in a quasi‐stable rhythm, and did not traverse the trigone. The frequencies of these rhythms were low (3.15 cpm) and broadly similar to those of cyclic changes in pves (3.55 cpm). Each PPC was associated with a region of stretching (positive strain rate) and these events occurred in a background of more constant strain. The amplitudes of cycles in pves and the areas undergoing PPCs increased following a sudden increase in pves but the frequency of cycles of pves and of origin of PPCs did not change. Peaks in pves cycles occurred when PPCs were traversing the upper half of the bladder, which was more compliant. The velocity of propagation of PPCs was similar to that of transverse propagation of action potentials in bladder myocytes and significantly greater than that reported in interstitial cells. The size of PPCs, their frequency and their rate of propagation were not affected by intra‐arterial dosage with tetrodotoxin or lidocaine. Conclusions The origin and duration of PPCs influence both pves and cyclic variation in pves. Hence, propagating rather than stationary areas of contraction may contribute to overall tone and to variation in pves. Spatiotemporal mapping of PPCs may contribute to our understanding of the generation of tone and the basis of clinical entities such as overactive bladder, painful bladder syndrome and detrusor overactivity. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-23T07:45:30.620902-05:
      DOI: 10.1111/bju.13132
  • Radical treatment of localised prostate cancer in the elderly
    • Authors: Wouter Everaerts; Simon Van Rij, Fairleigh Reeves, Anthony Costello
      Abstract: Elderly men are more likely to be diagnosed with aggressive cancer, but are often inappropriately denied curative treatment. Biological rather than chronological age should be used to decide if a patient will profit from radical treatment. Therefore, every man above 70 should undergo a health assessment using a validated tool prior to making treatment decisions. Fit elderly males with intermediate or high‐risk disease should be offered standard curative local treatment in keeping with guidelines for younger men. Vulnerable and frail elderly men warrant geriatric intervention prior to treatment. In the case of vulnerable patients, this intervention may render them suitable for standard care. When considering radical prostatectomy outcomes a ‘bifecta’ of oncological control and continence is appropriate as erectile dysfunction (although prevalent) has a much smaller impact on quality of life than in younger patients. Radiotherapy is an alternative to radical prostatectomy in men with a life expectancy of less than ten years. Primary ADT is not associated with improved survival in localised prostate cancer and should only be used for symptom palliation. Further elderly‐specific research is needed to guide prostate cancer care. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-23T07:35:23.801485-05:
      DOI: 10.1111/bju.13128
  • Envisioning an IDEAL Future for Urological Innovation
    • Authors: Philipp Dahm
      Abstract: Urologists take pride in standing at the forefront of cutting‐edge innovation and being among the first to embrace new procedures and technologies. In fact, when talking to urology residency applicants, access to advanced technology is among the most frequently cited motivating factors for their career choice. This innovative spirit has allowed urologists to harness acoustic waves to treat nephrolithiasis, made us leaders in the use of miniaturized endoscopic equipment and pioneers in the application of robotic‐assisted, laparoscopic surgery. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-23T06:59:58.911988-05:
      DOI: 10.1111/bju.13129
  • Novel anticoagulants and antiplatelet agents; a guide for the urologist
    • Authors: G Ellis; A J Camm, S N Datta
      Abstract: Novel Oral Anti‐Coagulants (NOACs) are increasingly being used in clinical practice and are set to almost entirely replace the Vitamin K agonists, such as warfarin, in the near future. Similarly, new antiplatelet agents are now regularly used in place of older agents such as aspirin and clopidogrel. In an aging population, with an increasing burden of complex comorbidities, urologists will frequently encounter patients who will be using such agents. Some background knowledge, and an understanding, of these drugs and the issues that surround their usage is essential. This article will provide readers with an understanding of these new drugs, including their mechanisms of action, the up‐to‐date evidence justifying their recent introduction into clinical practice and the appropriate interval for stopping them prior to surgery. It will also consider the risks of peri‐operative bleeding with regard to patients taking these drugs and the risks of venous thromboembolism in those in whom they are stopped. Strategies to manage anticoagulant‐associated bleeding are discussed. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-23T06:57:56.040672-05:
      DOI: 10.1111/bju.13131
  • DaPeCa‐1: Diagnostic Accuracy of Sentinel Node Biopsy in 222 Penile
           Cancer Patients at four Tertiary Referral Centres – a National Study
           from Denmark
    • Authors: Jakob Kristian Jakobsen; Kim Predbjørn Krarup, Peter Sommer, Henrik Nerstrøm, Vivi Bakholdt, Jens Ahm Sørensen, Kasper Ørding Olsen, Bjarne Kromann‐Andersen, Birgitte Grønkær Toft, Søren Høyer, Kirsten Bouchelouche, Jørgen Bjerggaard Jensen
      Abstract: Objectives To estimate the diagnostic accuracy of sentinel node biopsy (SNB) in penile cancer patients and assess SNB complications in a national multicentre setting. Patients and methods Retrospectively data were collected from records in four university centres by one medical doctor covering all SNBs performed in Denmark 2000‐2010. Patients had either nonpalpable nodes in one or both groins or had a palpable inguinal mass from which aspiration cytology failed to reveal malignancy. Patients were injected with nanocolloid technetium and had a scintigram recorded before the SNB. Primary end point was nodal recurrence on follow‐up. Secondary endpoint was complications after SNB. Diagnostic accuracy was computed. Results 409 groins in 222 patients were examined by SNB. Median follow‐up of patients who survived was 6.6 (IQR: 5‐10) years. Of 343 negative groins eight disclosed false negative. Sensitivity was 89.2% (95% CI, 79.8‐95.2%) per groin. Interestingly four of 67 T1G1 patients had a positive SNB. Twenty‐eight of 222 (13%) patients had complications of Clavien‐Dindo grade I‐IIIa. Conclusion Penile cancer sentinel node biopsy with a close follow‐up stages lymph node involvement reliably and has few complications in a national multicentre setting. Inguinal lymph node dissection was avoided in 76% of patients. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-21T09:08:44.140524-05:
      DOI: 10.1111/bju.13127
  • Multicenter prospective evaluation of the learning curve of the holmium
           laser enucleation of the prostate (HoLEP)
    • Authors: Grégoire Robert; Jean‐Nicolas Cornu, Marc Fourmarier, Saussine Christian, Aurélien Descazeaud, Abdel Rahmène Azzouzi, Eric Vicaut, Bertrand Lukacs
      Abstract: Objectives To describe the step‐by‐step learning curve of Holmium Laser Enucleation (HoLEP) surgical technique. Patients and methods A prospective, multicentrer observational study was conducted, involving surgeons experienced in transurethral resection of the prostate and open prostatectomy, never having performed HoLEP were included. The main judgment criterion was the ability of the surgeon to perform four consecutive successful procedures, defined by the following: complete enucleation and morcellation, within less than 90 minutes, without any conversion to standard TURP, with acceptable stress, and with acceptable difficulty (evaluated by Likert scales). Each surgeon included 20 consecutive cases. Results Of nine centers, three abandoned the procedure before the end of the study due to complications, and one was excluded for treating patients off protocol. Only one centre achieved the main judgment criterion of four consecutive successful procedures. Overall, the procedures were successfully performed in 43.6% of cases. Reasons for unsuccessful procedures were mainly operative time longer than 90 minutes (n=51), followed by conversion to TURP (n=14), incomplete morcellation (n=8), significant stress (n=9), or difficulty (n=14) during procedure. Ignoring operating time, 64% of procedures were successful and four out of five centers did 4 consecutive successful cases. Of the five centers who completed the study, four chose to continue HoLEP. Conclusion Even in a prospective training structure, HoLEP has a steep learning curve exceeding 20 cases, with almost half of our centres choosing to abandon or not to continue with the technique. Operating time and difficulty of the enucleation seem the most important problems for a beginner. A more intensely mentored and structured mentorship programme might allow safer adoption of the operation. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-17T08:22:57.144723-05:
      DOI: 10.1111/bju.13124
  • Impact of stage migration and practice changes on high risk prostate
           cancer: results from patients treated with radical prostatectomy over the
           last two decades
    • Authors: N. Fossati; N. M. Passoni, M. Moschini, G. Gandaglia, A. Larcher, M. Freschi, G. Guazzoni, D. D. Sjoberg, A. J. Vickers, F. Montorsi, A. Briganti
      Abstract: Background Phenotype of prostate cancer at diagnosis has changed through the years. We aim to evaluate the impact of year of surgery on clinical, pathologic and oncologic outcomes of high‐risk prostate cancer patients. Patients and methods We evaluated 1,033 clinically high‐risk patients, defined as the presence of at least one of the following risk factors: pre‐operative prostate specific antigen (PSA) level >20 ng/ml, and/or clinical stage ≥T3, and/or biopsy Gleason score ≥8. Patients were treated between 1990 and 2013 at a single Institution. Year‐per‐year trends of clinical and pathologic characteristics were examined. Multivariable Cox regression analysis was used to test the relationship between year of surgery and oncologic outcomes. Results We observed a decrease over time in the proportion of high‐risk patients with a pre‐operative PSA level >20 ng/ml or clinical stage cT3. An opposite trend was seen for biopsy Gleason score ≥8. We observed a considerable increase in the median number of lymph nodes removed that was associated with an increased rate of LNI. At multivariable Cox regression analysis, year of surgery was associated with a reduced risk of biochemical recurrence (HR per 5‐year: 0.90; 95% CI: 0.84–0.96; p=0.01) and distant metastasis (HR per 5‐year: 0.91; 95% CI: 0.83–0.99; p=0.039), after adjusting for age, pre‐operative PSA, pathologic stage, lymph node invasion, surgical margin status, and pathological Gleason score. Conclusions In this single center study, an increased diagnosis of localized and less extensive high‐grade prostate cancer was observed over the last two decades. High‐risk patients selected for radical prostatectomy showed better cancer control over time. Better definitions of what constitutes high‐risk prostate cancer among contemporary patients are needed. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-17T08:22:50.622373-05:
      DOI: 10.1111/bju.13125
  • A Comparative Analysis of Robotic versus Laparoscopic Retroperitoneal
           Lymph Node Dissection for Testicular Cancer
    • Authors: Kelly T. Harris; Michael A. Gorin, Mark W. Ball, Phillip M. Pierorazio, Mohamad E. Allaf
      Abstract: Objective To compare the safety and perioperative outcomes of robotic versus laparoscopic retroperitoneal lymph node dissection (RPLND). Patients and Methods Our institutional review board approved retrospective testicular cancer registry was queried for patients who underwent a primary unilateral robotic (R‐RPLND) or laparoscopic (L‐RPLND) RPLND by a single surgeon for a stage I testicular nonseminomatous germ cell tumor. Groups were compared for differences in baseline and outcomes variables. Results Between July 2006 and July 2014, a total of 16 R‐RPLND and 21 L‐RPLND cases were performed by a single surgeon. Intra‐ and perioperative outcomes including operative time, estimated blood loss, lymph node yield, complicate rate and ejaculatory status were similar between groups (all p > 0.1). Conclusions As an early checkpoint, R‐RPLND appears comparable to the laparoscopic approach in terms of safety and perioperative outcomes. It remains unclear if R‐RPLND offers any tangible benefits over standard laparoscopy. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-17T08:06:48.805506-05:
      DOI: 10.1111/bju.13121
  • Contrast Enhanced Ultrasound Parametric Imaging for the detection of
           Prostate Cancer
    • Authors: AW Postema; PJA Frinking, M Smeenge, TM De Reijke, JJMCH De la Rosette, F Tranquart, H Wijkstra
      Abstract: Objective To investigate the value of Dynamic Contrast Enhanced‐Ultrasound (DCE‐US) and software‐generated parametric maps in predicting biopsy outcome and their potential to reduce the amount of negative biopsy cores. Patients and methods For 651 prostate biopsy locations (82 consecutive patients) we correlated the interpretation of DCE‐US recordings with and without parametric maps with biopsy results. The parametric maps were generated by software that extracts perfusion parameters that differentiate benign from malignant tissue form DCE‐US recordings. We performed a stringent analysis (all tumours) and a clinical analysis (clinically significant tumours). We calculated the potential reduction in biopsies (benign on imaging) and the resultant missed positive biopsies (false negatives). Additionally, we evaluated the performance in terms of sensitivity, specificity NPV, and PPV on the per‐prostate level. Results Based on DCE‐US, 470/651 (72.2%) of biopsy locations appeared benign resulting in 40 false negatives (8.5%) regarding clinically significant tumour only. Including parametric maps, 411/651 (63.1%) of the biopsy locations appeared benign, resulting in 23 false negatives (5.6%). In the per‐prostate clinical analysis, DCE‐US classified 38/82 prostates as benign, missing 8 diagnoses. Including parametric maps, 31/82 prostates appeared benign, missing 3 diagnoses. Sensitivity, specificity, PPV and NPV were 73%, 58%, 50% and 79% for DCE‐US alone and 91%, 56%, 57% and 90% with parametric maps, respectively. Conclusion DCE‐US interpretation with parametric maps allows good prediction of biopsy outcome. A two‐thirds reduction in biopsy cores seems feasible with only a modest decrease in cancer diagnosis. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-06T09:46:50.891522-05:
      DOI: 10.1111/bju.13116
  • Observations on transatlantic renal cell cancer surgery outcomes
    • Authors: Grant D Stewart; Alexander Laird, S Alan McNeill, Bradley C Leibovich
      Abstract: Kidney cancer surgeons from North America have provided technological innovation and demonstrated excellent clinical outcomes from high‐volume centres. The results presented by high‐volume US centres provide a benchmark standard for those practicing in other settings. However, the aim of this comment is to make observations regarding the care that the majority of patients undergoing renal cancer surgery receive in USA and contrast these with outcomes following nephrectomy in the UK. Observations are made using large published US database series and the British Association of Urological Surgeons (BAUS) nephrectomy data, which has become the first set of individual British urologist level data to be made publically available This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-06T09:08:15.88443-05:0
      DOI: 10.1111/bju.13117
  • Partial versus Radical Nephrectomy for T1 renal tumours:An analysis from
           the British Association of Urological Surgeons Nephrectomy Audit
    • Authors: Marios Hadjipavlou; Fahd Khan, Sarah Fowler, Adrian Joyce, Francis X. Keeley, Seshadri Sriprasad,
      Abstract: Introduction and objectives The increasing incidence of small localised renal tumours has changed practice towards nephron‐sparing and minimally invasive techniques. This has prompted assessment of current practice. The objective was to analyse and compare data from The British Association of Urological Surgeons Nephrectomy Audit for outcomes of partial and radical nephrectomy for T1 renal tumours. Materials and Methods UK consultants were invited to submit data on all patients undergoing nephrectomy between 1st January and 31st December 2012 to a nationally established database using a standard proforma. Analysis was made on patient demographics, operative technique and perioperative data/outcome between partial and radical nephrectomy for T1 tumours. Results Overall, data from 6,042 nephrectomies were reported of which 1,768 were performed for T1 renal tumours. Of these, 1,082 (61.2%) were radical nephrectomies (RN) and 686 (38.8%) were partial nephrectomies (PN). The mean age of patients undergoing PN was lower (PN 59 vs RN 64; p
      PubDate: 2015-03-06T09:07:55.709667-05:
      DOI: 10.1111/bju.13114
  • Biodistribution of Evans blue in an orthotopic AY‐27 rat bladder
           urothelial cell carcinoma model: implication for the improved diagnosis of
           non‐muscle‐invasive bladder cancer (NMIBC) using
           dye‐guided white‐light cystoscopy
    • Authors: S Elsen; E Lerut, B Van Cleynenbreugel, F Aa, H Van Poppel, P.A Witte
      Abstract: Objectives To investigate the possibility of using Evans blue (EB) as a novel diagnostic tool to detect bladder tumors with white‐light (WL) cystoscopy, in this preclinical study we examined the biodistribution of the compound in the different layers (urothelium, submucosa, muscle) of a normal rat bladder and a rat bladder bearing a malignant urothelium composed of syngeneic AY‐27 tumor cells. Materials and methods EB was instilled into both normal as well as tumor‐bearing rat bladders. Following instillation, bladders were removed and snap frozen in liquid nitrogen. The distribution of EB in the different layers was quantified using fluorescence microscopy. To gain more insight into the mechanism underlying the selective accumulation of EB in tumor tissue, bladder sections were prepared for ultrastructural investigations by means of transmission electron microscopy (TEM). Besides, we also examined the expression of E‐cadherin, claudin‐1 and desmoglein‐1 by immunohistochemistry to study the integrity of the bladder wall as these molecules are key constituents of adherens junctions, tight junctions and desmosomes, respectively. Results In most cases the accumulation of EB in malignant bladders was substantially higher than in healthy bladders, at least when 1 mM EB instillations were used. In case of a 1 mM EB instillation for 2 hrs, the EB‐associated fluorescence in malignant urothelial tissue was 55 times higher as compared to the fluorescence found in normal urothelium. Ultrastructurally, malignant tissue displayed wider intercellular spaces and a decreased number of cell junction components as compared to normal tissue, pointing to defects in the urothelial barrier. No differences in expression of E‐cadherin were found, whereas desmoglein‐1 staining was stronger in the membranes of healthy bladder urothelium compared to tumor tissue. Claudin‐1 expression was negative in all samples tested. Conclusion EB is selectively taken up by tumor tissue after intravesical instillations in rats bearing bladder tumors. The lower expression of desmoglein‐1 in tumor samples, together with the decreased presence of desmosomes observed with TEM, likely imply that desmosomes play an important role in the ultrastructural differences between healthy rat urothelium and tumor tissue, and secondary to that, to the differential uptake of EB in both tissues. We believe that our findings can be useful for future clinical developments in the field of diagnostics for bladder cancer. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-06T09:06:03.625905-05:
      DOI: 10.1111/bju.13113
  • The Diminishing Returns of Robotic Diffusion: Complications Following
           Robot‐Assisted Radical Prostatectomy
    • Authors: Jesse D. Sammon; Firas Abdollah, Dane E. Klett, Daniel Pucheril, Akshay Sood, Quoc‐Dien Trinh, Mani Menon
      Abstract: In the United States, robot‐assisted radical prostatectomy (RARP) is the most common approach for the operative management of prostate cancer (PCa). Patients pursue robotic surgery based on perceived benefit, but fail to take into account the importance of institution and surgeon volume on outcomes. Therefore, we examined the Nationwide Inpatient Sample (NIS) to elucidate the extent of robotic diffusion for PCa surgery, and to explore the effects of wider robotic adoption on prostatectomy complication rates. NIS patients who underwent RARP between 2009 and 2011 were included. Hospital volume was calculated and complications were recorded. The effect of hospital volume quintile was assessed with ordinal logistic regression fitted with generalized estimating equations to control for hospital clustering and was adjusted for various confounders. Results show median hospital volume fell sharply after 2009. Overall postoperative complication rates at very‐low volume institutions (14.7%) versus very‐high volume institutions (5.7%) were significant, and patients treated at very‐high volume hospitals were less than half as likely to experience a complication (OR: 0.40; 95% CI: 0.29‐0.54). In conclusion, migration of patients away from very‐high volume institutions is likely jeopardizing patient care, and a renewed focus on the benefits of centralization of care is warranted. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-06T09:04:26.596376-05:
      DOI: 10.1111/bju.13111
  • Sampling of the anterior apical region results in increased cancer
           detection and upgrading in transrectal repeat saturation biopsy of the
    • Authors: Maximilian Seles; Thomas Gutschi, Kathrin Mayrhofer, Katja Fischereder, Georg Ehrlich, Guenter Gallé, Stefan Gutschi, Oliver Pachernegg, Karl Pummer, Herbert Augustin
      Abstract: Detection of clinically suspected prostate cancer using ultrasound‐guided transrectal biopsy is standard of care [1]. The relatively high probability of missing clinically significant cancers during initial sextant biopsies led to the introduction of extended 10‐12 core biopsy and subsequently to 20+ core saturation biopsy strategies [1–9]. Nevertheless, underdiagnosis of high risk prostate cancer even in patients with low PSA levels still occurs in 25‐30% [10,11].Anteriorly located prostate cancer contributes to these high rates and data from magnetic resonance imaging (MRI) studies underlines these considerations [12–14]. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-26T02:24:36.483739-05:
      DOI: 10.1111/bju.13108
  • Continence outcomes of robot assisted radical prostatectomy in patients
           with adverse urinary continence risk factors
    • Authors: Anup Kumar; Srinivas Samavedi, Anthony S Bates, Rafael Coelho, Bernardo Rocco, Kenneth Palmer, Vipul R Patel
      Abstract: Objective To analyze the continence outcomes of robot assisted radical prostatectomy (RARP) in suboptimal patients that have challenging continence recovery factors: enlarged prostates, elderly patients, higher Body Mass Index (BMI), salvage prostatectomy and bladder neck procedures prior to RARP Material & Methods From January 2008 through November 2012, 4023 patients underwent RARP by a single surgeon at our institution. Retrospective analysis of prospectively collected data identified 3362 men who had minimum of one year of follow‐up. This cohort of patients was stratified into six groups: Group I, age 70 and over (n=451); Group II, BMI 35 and over (n=197); Group III, prior bladder neck procedures (n=103); Group IV, prostate weight 80 g and over (n=280); and Group V, salvage prostatectomy patients (n=41). Group VI consisted of patients (n=2447) with none of these risk factors. Continence outcomes at follow‐up were analyzed for all groups. Results The continence rate at 1 year and mean time to continence in different groups were for patients ≥70 years 85.6% and 3.2 ± 4.5 months; BMI ≥35 years 87.8% and 3.1 ± 4.5 months; prior bladder neck treatment 82.4% and 3.4 ± 4.7 months; prostate weight ≥80 g 85.8% and 3.3 ± 4.4 months; salvage procedures 51.3% and 6.6 ± 8.3 months and in Group VI, 95.1% and 2.4 ± 3.2 months. The continence rate was significantly higher in group VI in comparison to salvage group at different time intervals (p
      PubDate: 2015-02-26T02:11:06.639871-05:
      DOI: 10.1111/bju.13106
  • Pharmacological characterization of the relaxation induced by the soluble
           guanylate cyclase activator, BAY 60‐2770 in rabbit corpus cavernosum
    • Authors: Camila Stefani Estancial; Renata Lopes Rodrigues, Gilberto De Nucci, Edson Antunes, Fabiola Zakia Mónica
      Abstract: Objective To characterize the relaxation induced by the soluble guanylate cyclase (sGC) activator, BAY 60‐2770 in rabbit corpus cavernosum. Material and Methods Penis from male New Zealand rabbits were removed and fours strips of corpus cavernosum (CC) were obtained. Concentration‐response curves to BAY 60‐2770 were carried out in the absence and presence of inhibitors of nitric oxide synthase, L‐NAME (100 μM), sGC, ODQ (10 μM) and phosphodiestarase type 5, tadalafil (0.1 μM). The potency (pEC50) and maximal response (Emax) values were determined. Second, electrical‐field stimulation (EFS)‐induced contraction or relaxation was realized in the absence and presence of BAY 60‐2770 (0.1 or 1 μM) alone or in combination of ODQ (10 μM). In the case of EFS‐induced relaxation two protocols were realized: 1) ODQ (10 μM) was first incubated for 20 min and then BAY 60‐2770 (1 μM) was added for another 20 min (ODQ + BAY 60‐2770). In different CC strips, BAY 60‐2770 was incubated for 20 min followed by another 20 min with ODQ (BAY 60‐2770 + ODQ). The intracellular levels of cyclic guanosine monophosphate (cGMP) were also determined. Results BAY 60‐2770 potently relaxed rabbit CC with pEC50 and Emax values of 7.58 ± 0.19 and 81 ± 4%, respectively. The inhibitors ODQ (n=7) or tadalafil (n=7) produced 4.2‐ and 6.3‐leftward shifts, respectively in BAY 60‐2770‐induced relaxation without interfering on the Emax values. The intracellular levels of cGMP were augmented after stimulation with BAY 60‐2770 (1 μM) alone, whereas its co‐incubation with ODQ produced even higher levels of cGMP. The EFS‐induced contraction was reduced in the presence of BAY 60‐2770 (1 μM) and this inhibition was even greater when BAY 60‐2770 was co‐incubated with ODQ. The nitrergic stimulation induced CC relaxation, which was abolished in the presence of ODQ. BAY 60‐2770 alone increased the amplitude of relaxation. Co‐incubation of ODQ and BAY 60‐2770 did not alter the relaxation in comparison with ODQ alone. Interestingly, when BAY 60‐2770 was incubated prior to ODQ, EFS‐induced relaxation was partly restored in comparison with ODQ alone or ODQ + BAY 60‐2770. Conclusions Considering that the relaxation induced by the sGC activator, BAY 60‐2770 was increased after sGC oxidation and unaltered in the absence of nitric oxide, these class of substances are advantageous over sGC stimulators or PDE5 inhibitors for the treatment in those patients with erectile dysfunction and high endothelial damage. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-26T01:31:46.85697-05:0
      DOI: 10.1111/bju.13105
  • Guideline of Guidelines: Prostate Cancer Imaging
    • Authors: Daniel A Wollin; Danil V Makarov
      Abstract: In the era before the widespread adoption of PSA screening for prostate cancer, most incident cases were already advanced stage. Because treatment options such as surgery or radiation are thought mainly to benefit patients with localized disease, prostate cancer imaging was necessary prior to treatment of almost all patients. In the PSA era, however, over 90% of incident cases are localized, making the need for routine imaging with CT, MRI, or bone scan obsolete [1]. Numerous studies show a relatively low rate of positive staging imaging in low‐ and intermediate‐ risk patients. Recognizing these trends, several professional societies issued prostate cancer imaging guidelines in the mid‐1990s in an effort to curb the overuse of imaging. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-26T01:25:53.933476-05:
      DOI: 10.1111/bju.13104
  • Salvage Radical Prostatectomy for recurrent Prostate Cancer: Verification
           of EAU guideline criteria
    • Authors: Philipp Mandel; Thomas Steuber, Sascha Ahyai, Maximilian Kriegmair, Jonas Schiffmann, Katharina Boehm, Hans Heinzer, Uwe Michl, Thorsten Schlomm, Alexander Haese, Hartwig Huland, Markus Graefen, Derya Tilki
      Abstract: Objective To analyze oncological and functional outcomes of salvage radical prostatectomy (SRP) in patients with recurrent prostate cancer (PCa) and to compare outcomes of patients within and outside the EAU guideline criteria (organ‐confined PCa ≤ T2b, Gleason score ≤ 7 and preoperative PSA < 10 ng/mL) for SRP. Patients and Methods A total of 55 patients who underwent SRP from January 2007 to December 2012 were retrospectively analyzed. Kaplan‐Meier curves assessed time to biochemical recurrence (BCR), metastasis‐free survival (MFS) and cancer specific survival (CSS). Cox regressions addressed factors influencing BCR and MFS. BCR was defined as PSA>0.2 ng/ml and rising, continence as the use of 0‐1 safety pad per day and potency as an IIEF‐5 score ≥18. Results Median follow‐up was 36 months. Following SRP 42.0% of the patients experienced BCR, 15.9% developed metastasis and 5.5% died from PCa. Patients fulfilling EAU guideline criteria were less likely to have positive lymph nodes and had significantly better BCR‐free survival (5‐year BCR‐free survival 73.9% vs. 11.6% (p=0.001), respectively). In multivariate analysis, LDR‐brachytherapy as primary treatment (p=0.03) and presence of positive lymph nodes at SRP (p=0.02) were significantly associated with worse BCR‐free survival. The presence of positive lymph nodes or Gleason score > 7 at SRP were independently associated with metastasis. Urinary continence‐rate 1 year after SRP was 74%. Seven patients (12.7%) experienced complications ≥III (Clavien grade). Conclusion Salvage radical prostatectomy is a safe procedure providing good cancer control and reasonable urinary continence. Oncologic outcomes are significantly better in patients who met EAU guideline recommendations. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-24T11:31:46.312222-05:
      DOI: 10.1111/bju.13103
  • Significance of time interval between first and second transurethral
           resection on recurrence and progression rates in patients with high risk
           non muscle invasive bladder cancer treated with maintenance intravesical
           Bacillus Calmette‐Guerin
    • Authors: Sümer Baltacı; Murat Bozlu, Asif Yildirim, Mehmet İlker Gökce, Llker Tinay, Guven Aslan, Cavit Can, Levent Türkeri, Uğur Kuyumcuoğlu, Aydin Mungan
      Abstract: Objectives To evaluate the effect of time lapse between the initial and second transurethral resection (TUR) on the outcome of patients with high risk nonmuscle invasive bladder cancer (NMIBC) treated with maintenance intravesical Bacillus Calmette‐Guerin (BCG) therapy. Materials and Methods We reviewed the data of patients from ten centers treated for high risk NMIBCbetween 2005 and 2012.Patients without a diagnosis of muscle invasive cancer on second TUR performed within 90 days after a complete first TUR, and received at least one year of maintenance BCG were included in this study.Time interval between first and second TUR in addition to other parameters were recorded.Multivariate logistic regression analysis was performed to identify predictors of recurrence and progression. Results A total of 242 patients were included in this study. The mean follow‐up period was 29.4±22.2 months (range 12‐96).The 3‐year recurrenceand progression free survival rates of patients who underwent second TUR between 14‐42 days and 43‐90 days were 73.6% vs. 46.2%(p=0.0001) and 89.1% vs. 79.1%(p=0.006), respectively. On multivariate analysis, time lapse to second TUR was found to be a predictor of both recurrence (OR 3.598, 95% CI 1.885–8.137, p =0.001) and progression (OR 2.144, 95% CI 1.447–5.137, p=0.003). Conclusions The time interval between first and second TUR should be≤ 42 days in order to obtain lower recurrence and progression rates. To our knowledge, this is the first study demonstrating the effect of time lapse between first and second TUR on patient outcomes. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-24T11:31:24.223057-05:
      DOI: 10.1111/bju.13102
  • Diagnosis and treatment of chronic bacterial prostatitis and chronic
           prostatitis/chronic pelvic pain syndrome: a consensus guideline
    • Authors: Jon Rees; Mark Abrahams, Andrew Doble, Alison Cooper,
      Abstract: Objectives To improve awareness and recognition of these conditions among non‐specialists and patients. To provide guidance to healthcare professionals treating patients with CBP and CP/CPPS, in both non‐specialist and specialist settings. To promote efficient referral of care between non‐specialists and specialists and the involvement of the multidisciplinary team (MDT). Patients and Methods The guideline population were men with CBP or CP/CPPS (persistent or recurrent symptoms and no other urogenital pathology for ≥3 of the previous 6 months). Consensus recommendations for the guidelines were based on a search to identify literature on the diagnosis and management of CBP and CP/CPPS (published between 1999 and February 2014). A Delphi panel process was used where high‐quality, published evidence was lacking. Results CBP and CP/CPPS can present with a wide range of clinical manifestations. The 4 main symptom domains are urogenital pain, lower urinary tract symptoms (LUTS ‐ voiding or storage symptoms), psychological issues and sexual dysfunction. Patients should be managed according to their individual symptom pattern. Options for first‐line treatment include antibiotics, alpha‐adrenergic antagonists (if voiding LUTS are present) and simple analgesics. Repeated use of antibiotics such as quinolones should be avoided if there is no obvious symptomatic benefit from infection control or cultures do not support an infectious cause. Early use of treatments targeting neuropathic pain and/or referral to specialist services should be considered for patients who do not respond to initial measures. An MDT approach (urologists, pain specialists, nurse specialists, specialist physiotherapists, GPs, cognitive behavioural therapists/psychologists, sexual health specialists) is recommended. Patients should be fully informed about the possible underlying causes and treatment options, including an explanation of the chronic pain cycle. Conclusion Chronic prostatitis can present with a wide variety of signs and symptoms. Identification of individual symptom patterns and a symptom‐based treatment approach are recommended. Further research is required to evaluate management options for CBP and CP/CPPS. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-24T09:43:14.900182-05:
      DOI: 10.1111/bju.13101
  • Clinical Efficacy of Collagenase Clostridium Histolyticum in the Treatment
           of Peyronie's Disease by Subgroups: Results From Two Large,
    • Authors: Larry I. Lipshultz; Irwin Goldstein, Allen D. Seftel, Gregory J. Kaufman, Ted M. Smith, James P. Tursi, Arthur L. Burnett
      Abstract: Objectives To examine the efficacy of intralesional collagenase clostridium histolyticum (CCH) in defined subgroups of subjects with Peyronie's disease (PD). Subjects and Methods The efficacy of CCH compared with placebo from baseline to week 52 was examined in subgroups of subjects from the Investigation for Maximal Peyronie's Reduction Efficacy and Safety Studies (IMPRESS) I and II, defined by: severity of penile curvature deformity at baseline (30°‐60° [n=492] and 61°‐90° [n=120]); PD duration (1 to ≤2 [n=201], >2 to ≤4 [n=212], and >4 years [n=199]); degree of plaque calcification (no calcification [n=447], noncontiguous stippling [n=103], and contiguous calcification that did not interfere with the injection [n=62]); and baseline erectile function (International Index of Erectile Function [IIEF] 1‐5 [n=22], 6‐16 [n=106], and ≥17 [n=480]). Results Reductions in penile curvature deformity and PD symptom bother were observed in all subgroups. Penile curvature deformity reductions were significantly greater for CCH vs placebo for: baseline penile curvature 30°‐60° and 61°‐90°; disease duration >2 to ≤4 years and >4 years; no calcification; and IIEF ≥17 (high IIEF erectile function) (P < .05 for all). PD symptom bother reductions were significantly greater in the CCH group for: penile curvature 30°‐60°; disease duration >4 years; no calcification; and IIEF 1‐5 (no sexual activity) and ≥17 (P < .05 for all). Conclusions In this analysis, the clinical efficacy of CCH treatment for reducing penile curvature deformity and PD symptom bother was demonstrated across subgroups. In the IMPRESS I and II studies overall, AEs were typically mild or moderate, although treatment‐related serious AEs, including corporal rupture or penile hematoma, occurred. Future studies could be considered to directly assess the efficacy and safety of CCH treatment in defined subgroups of PD patients, with the goal of identifying predictors of optimal treatment success. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-24T09:17:53.228323-05:
      DOI: 10.1111/bju.13096
  • Internet‐based treatment of stress urinary incontinence: 1‐
           and 2 years results of a randomised controlled trial with focus on pelvic
           floor muscle training
    • Authors: M Sjöström; G Umefjord, H Stenlund, P Carlbring, G Andersson, E Samuelsson
      Abstract: Objectives To evaluate the long‐term effects of two non‐face‐to‐face treatment programmes for stress urinary incontinence (SUI) based on pelvic floor muscle training (PFMT). Subjects and Methods Randomised controlled trial with online recruitment of 250 community‐dwelling women aged 18‐70 years with SUI ≥1/week. Diagnosis based on validated self‐assessed questionnaires, 2‐day bladder diary, and telephone interview with a urotherapist. Consecutive computer‐generated block‐randomisation with allocation by an independent administrator to 3 months of treatment with either an Internet‐based treatment programme (n=124) or a programme sent by post (n=126). Both interventions focused mainly on PFMT; the Internet group received continuous e‐mail support from a urotherapist, whereas the postal group trained on their own. Follow‐up was performed after 1 and 2 years via self‐assessed postal questionnaires. The primary outcomes were symptom severity (International Consultation on Incontinence Questionnaire Short Form, ICIQ‐UI SF) and condition‐specific quality of life (ICIQ‐Lower Urinary Tract Symptoms Quality of Life, ICIQ‐LUTSqol). Secondary outcomes were the Patient's Global Impression of Improvement, health‐specific quality of life (EQ‐Visual Analogue Scale), use of incontinence aids, and satisfaction with treatment. There was no face‐to‐face contact with the participants at any time. Analysis was based on intention‐to‐treat. Results We lost 32.4% (81/250) of participants to follow‐up after 1 year and 38.0% (95/250) after 2 years. With both interventions, we observed highly significant (p0.8) for symptoms and condition‐specific quality of life after 1 and 2 years, respectively. No significant differences were found between the groups. The mean changes (SD) in symptom score were 3.7 (3.3) for Internet and 3.2 (3.4) for postal (p=0.47) after 1 year, and 3.6 (3.5) for Internet and 3.4 (3.3) for postal (p=0.79) after 2 years. The mean changes (SD) of condition‐specific quality of life were 5.5 (6.5) for Internet and 4.7 for postal (6.5) (p=0.55) after 1 year, and 6.4 (6.0) for Internet and 4.8 (7.6) for postal (p=0.28) after 2 years. The proportions of participants perceiving they were much or very much improved were similar in both intervention groups after 1 year (Internet 31.9% (28/88), postal 33.8% (27/80) p=0.82), but after 2 years significantly more participants in the Internet group reported this level of improvement (39.2% (29/74) vs. 23.8% (19/80), p=0.03). Health‐specific quality of life improved significantly in the Internet group after 2 years (mean change EQ‐VAS 3.8 (11.4), p=0.005). We found no other significant improvements in this measure. One year after treatment, 69.8% (60/86) of participants in the Internet group and 60.5% (46/76) of participants in the postal group reported that they were still satisfied with the treatment result. After 2 years, the proportions were 64.9% (48/74) and 58.2% (46/79), respectively. Conclusion Non‐face‐to‐face treatment of SUI with PFMT provides significant and clinically relevant improvements in symptoms and condition‐specific quality of life 1 and 2 years after treatment. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-14T02:47:40.598066-05:
      DOI: 10.1111/bju.13091
  • Combination of multi‐parametric magnetic resonance imaging
           (mp‐MRI) and transperineal template‐guided mapping biopsy
           (TTMB) of the prostate to identify candidates for hemi‐ablative
           focal therapy
    • Authors: Minh Tran; James Thompson, Maret Böhm, Marley Pulbrook, Daniel Moses, Ron Shnier, Phillip Brenner, Warick Delprado, Anne‐Maree Haynes, Richard Savdie, Phillip D Stricker
      Abstract: Objective To evaluate the accuracy of combined multi‐parametric magnetic resonance imaging (mp‐MRI) and transperineal template‐guided mapping biopsy (TTMB) for identifying lobes with significant prostate cancer (PCa) for the application of hemi‐ablative focal therapy (FT). Patients and Methods From January 2012–January 2014, 89 consecutive patients aged ≥40 with PSA ≤15 underwent in sequential order: mp‐MRI, TTMB and radical prostatectomy (RP) at a single centre. Analysis was performed on 50 patients that met consensus guidelines for FT. Lobes were stratified into lobes with significant cancer (LSC), insignificant cancer (LIC) and no cancer (LNC). Using histopathology at RP, the predictive performance of combined mp‐MRI+TTMB in identifying LSC was evaluated. Results The sensitivity, specificity and positive predictive value (PPV) for mp‐MRI+TTMB for LSC was 97%, 61% and 83% respectively. The negative predictive value (NPV), the primary parameter of interest, for mp‐MRI+TTMB for LSC was 91%. Of the 50 patients, 21 had significant unilateral disease on mp‐MRI+TTMB. Two of these 21 patients had significant bilateral disease on RP not identified on mp‐MRI+TTMB. Conclusions In candidates for FT, mp‐MRI and TTMB provides a high NPV in the detection of lobes with significant cancer. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-14T02:47:32.861001-05:
      DOI: 10.1111/bju.13090
  • Telemetric monitoring of bladder function in female Göttingen
    • Authors: Nadine D Huppertz; Ruth Kirschner‐Hermanns, Rene H Tolba, Joachim O Grosse
      Abstract: Objectives To generate real‐time radio‐telemetric urodynamic reference data of maximum detrusor pressure (Pdet max), maximum flowrate (Qmax) and estimated grade of infravesical obstruction as well as for duration of detrusor contraction (DOC), in female Göttingen minipigs and to describe translational aspects of the use of Göttingen minipigs for urological research. Material and Methods In five female Göttingen minipigs, a telemetric transmitter was implanted and 24 h measurements in metabolic cages were performed. Through operator based analysis, synchronized real‐time radio‐telemetric cystometric data with flowmetric data and video sequences were used to determine voiding detrusor contractions (VC) and non‐voiding detrusor contractions (NVC). Furthermore data from telemetric natural filling cystometry from free‐moving and restricted maintenance were compared for potential difference. Results Median maximum detrusor pressure (Pdet max) of VC's was 120.6 cm H2O (21.0‐ 370.0 cm H2O) (median [range]) and, therefore, significantly different from Pdet max of NVC's (64.60 cm H2O [20.4 to 280.6 cmH2O]). Intra‐individual comparison of minipig data revealed great differences in voiding contractions. Effects of limited moving on VC's were analyzed and showed significantly higher Pdet max and lower DOC than in free‐moving maintenance. Conclusion The presented data can be used for the development of telecystometric implanted minipig models ‐ to investigate changes of detrusor function like under‐ or overactivity and might serve as model for bladder changes occurring with iatrogenic bladder outlet obstruction (BOO) or different therapeutical options for overactive bladder (OAB). Radio‐telemetric real‐time natural filling and voiding cystometries are feasible, reproducible in not anesthetized minipigs of free or limited moving and can give new insights in understanding circadian behaviour, physiological and pathological bladder function. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-13T22:44:32.04063-05:0
      DOI: 10.1111/bju.13089
  • Intravesical Gemcitabine in combination with Mitomycin C as salvage
           treatment in recurrent non‐muscle invasive bladder cancer
    • Authors: Patrick A. Cockerill; John J. Knoedler, Igor Frank, Robert Tarrell, R. Jeffrey Karnes
      Abstract: Objectives To evaluate oncologic outcomes after combination intravesical therapy with Gemcitabine (GC) and Mitomycin C (MMC), in the setting of recurrent non‐muscle invasive bladder cancer (NMIBC), after failure of prior intravesical therapy. Patients and Methods We retrospectively identified patients with recurrent NMIBC after prior intravesical therapy, who refused or were not candidates for cystectomy, between 2005 and 2011. GC and MMC were sequentially instilled weekly for six to eight weeks. Data was collected regarding patient demographics, bladder cancer history, and number and type of intravesical therapies prior to GC/MMC, Outcomes evaluated included time to recurrence and/or progression after GC/MMC. Recurrence free outcomes were estimated using the Kaplan Meier method, and cox proportional hazard regression models were used to test the association of clinicopathologic features with outcomes. Results 27 patients were identified, 23 with high risk (high grade or CIS) and four with intermediate risk (multifocal or recurrent low grade) disease. All patients received prior intravesical therapy, and 17 patients (63%) received multiple courses. Twenty four patients were treated with BCG. Median disease free survival of all patients was 15.2 months (1.7 months‐39.3 months). Seventeen patients (63%) developed recurrent bladder cancer, a median of 15.2 months after therapy. One patient progressed to muscle invasive disease five months after treatment, and one patient developed metastatic disease 22 months after treatment. Three patients went on to cystectomy. Ten patients (37%) had no evidence of disease at last follow up, with a median follow up of 22.1 months. Conclusion The combination of intravesical GC and MMC may offer durable recurrence free survival to some patients with recurrent NMIBC who are not candidates for, or refuse, cystectomy. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-13T22:44:19.687063-05:
      DOI: 10.1111/bju.13088
  • Does the Addition of Targeted Prostate Biopsies to Standard Systemic
           Biopsies Impact Treatment Management for Radiation Oncologists'
    • Authors: Mitchell Kamrava; John V. Hegde, Narine Abgaryan, Edward Chang, Jesse D. Le, Jason Wang, Patrick Kupelian, Leonard S. Marks
      Abstract: Objectives To study the management impact that MRI‐guided targeted prostate biopsies could provide relative to using only non‐targeted systematic biopsies in men with clinically‐localized prostate cancer (CaP). Subjects/Patients and Methods A consecutive series of untreated men undergoing Artemis (MRI‐ultrasound fusion) biopsies between March 2010 and June 2013 was evaluated in this retrospective, IRB‐approved study. Fusion biopsy included MRI targeted and systematic sampling at the same session. 3‐Tesla multiparametric MRI was performed at a median of 2 weeks prior to biopsy. Patients were included if > 1 systematic core revealed CaP. The impact of the information obtained from targeted versus systematic biopsies was studied on the following: Gleason Score (GS), NCCN risk reclassification, cancer core length, percent of core positive for tumor involvement, and percent positive biopsy cores. Results The study sample included 215 men (mean age=66 +/‐8 years). Median PSA was 6.0 (range = 0.7‐181 ng/ml). The mean number of total biopsy samples was 18 (12 systematic and 6 targeted samples). 34/215 men (16%) had a higher GS on targeted vs. systematic biopsy. 21/183 men (12%) were stratified into a higher NCCN risk group when incorporating targeted biopsy GS results. 18/101 men (18%) were upgraded to intermediate‐ or high‐risk from the low‐risk group. Among the 34 men whose cancer severity was upgraded, increases in cancer core length, percent involvement, and percent of cores involved were all statistically significant (p < 0.01). Conclusion Targeted prostate biopsy provided information about GS, NCCN risk, and tumor volume beyond that obtained in systematic biopsies, specifically increasing the proportions of intermediate‐ and high‐risk men. Such patients may be recommended for additional treatments (pelvic nodal irradiation or hormonal therapy). The appropriateness of changing treatment because of targeted biopsy results is still unclear. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-13T22:41:34.616952-05:
      DOI: 10.1111/bju.13082
  • The serum luteinizing hormone level is significantly associated with
           recovery of urinary function after radical prostatectomy
    • Authors: Shunichi Namiki; Koji Mitsuzuka, Yasuhiro Kaiho, Shigeyuki Yamada, Hisanobu Adachi, Shinichi Yamashita, Hideo Saito, Akihiro Ito, Haruo Nakagawa, Misa Takegami, Yoichi Arai
      Abstract: Objective To perform a longitudinal investigation of the correlation between functional recovery and sex hormone levels after radical prostatectomy (RP). Patients and methods A total of 72 consecutive men undergoing RP between January 2012 and June 2013were prospectively included and serially followed postoperatively for comparative analysis. They underwent measurements of luteinizing hormone (LH) and total testosterone (TT) levels prior to surgery and 3 and 12 months postoperatively. They filled out a health‐related quality of life questionnaire before and at 1, 3, 6, and 12 months after surgery. Results The mean LH level increased from 4.28 U/L at baseline to 5.53 U/L at 3 months and remained high at 12 months after RP (both p
      PubDate: 2015-02-13T22:41:24.308737-05:
      DOI: 10.1111/bju.13083
  • Outcomes of Robotic‐Assisted Laparoscopic Upper Urinary Tract
           Reconstruction: 250 Consecutive Patients
    • Authors: Tracy Marien; Marc Bjurlin, Blake Wynia, Matthew Bilbily, Gaurav Rao, Lee C. Zhao, Ojas Shah, Michael D. Stifelman
      Abstract: Objective To evaluate our long‐term outcomes of robotic assisted laparoscopic (RAL) upper urinary tract (UUT) reconstruction. Materials and Methods Data from 250 consecutive patients undergoing RAL UUT reconstruction including pyeloplasty with or without stone extraction, ureterolysis, ureteroureterostomy, ureterocalicostomy, ureteropyelostomy, ureteral reimplantation and buccal mucosa graft ureteroplasty was collected at a tertiary referral center between March 2003 and December 2013. The primary outcomes were symptomatic and radiographic improvement of obstruction and complication rate. The mean follow‐up was 17.1 months. Results Radiographic and symptomatic success rates ranged from 85% to 100% for each procedure with a 98% radiographic success rate and 97% symptomatic success rate for the entire series. There were a total of 34 complications; none greater than Clavien grade 3. Conclusion RAL UUT can be performed with few complications, with durable long‐term success, and is a reasonable alternative to the open procedure in experienced robotic surgeons. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-13T22:41:13.170724-05:
      DOI: 10.1111/bju.13086
  • A review of detrusor overactivity and the overactive bladder after radical
           prostate cancer treatment
    • Authors: N Thiruchelvam; F Cruz, M Kirby, A Tubaro, C Chapple, K D Sievert
      Abstract: There are various forms of treatment for prostate cancer. In addition to oncologic outcomes, physicians and increasingly patients are focusing on functional and adverse outcomes. Symptoms of overactive bladder (OAB), including urinary frequency, urgency, and incontinence, can occur regardless of treatment modality. This article examines the prevalence, pathophysiology, and options for treatment of OAB after radical prostate cancer treatment. OAB seems to be more common and severe after radiation therapy than surgical therapy and even persisted longer with complications, suggesting an advantage for surgery over radiotherapy. Because OAB that occurs after radical prostate surgery or radiotherapy can be difficult to treat, it is important that patients are made aware of the potential development of OAB during counselling before decisions regarding treatment choice are made. To ensure a successful outcome of both treatments, it is imperative that clinicians and non‐specialists enquire about and document pre‐treatment urinary symptoms and carefully evaluate post‐treatment symptoms. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-13T10:16:11.054799-05:
      DOI: 10.1111/bju.13078
  • Final Quality of Life and Safety Data for patients with mCRPC treated with
           Cabazitaxel in the UK Early Access Programme (NCT01254279)
    • Authors: A Bahl; S Masson, Z Malik, AJ Birtle, S Sundar, RJ Jones, ND James, MD Mason, S Kumar, D Bottomley, A Lydon, S Chowdhury, J Wylie, JS Bono
      Abstract: Background Cabazitaxel is a novel taxoid developed to overcome resistance to other taxanes. The 2010 TROPIC trial demonstrated improved survival for cabazitaxel compared with mitoxantrone in metastatic castration resistant prostate cancer (mCRPC) after previous docetaxel chemotherapy. However, concerns regarding safety (particularly neutropenic and cardiac complications) remained and quality of life (QOL) was not assessed. Objective The UK Early Access Programme (EAP) was part of an international phase IIIb/IV trial set up to facilitate access to cabazitaxel and to record detailed safety data. In the UK a specific amendment enabled formal QOL evaluation. Design, Setting and Participants 112 patients participated at 12 UK Cancer Centres. All had mCRPC with disease progression during or after docetaxel. Intervention Patients received cabazitaxel 25mg/m2 every 3 weeks with prednisolone 10mg daily for up to 10 cycles. Safety assessments were performed prior to each cycle and QOL recorded at alternate cycles using the EQ5D‐3L questionnaire and visual analogue scale (VAS). Outcome measures and statistical analysis Safety profile was compiled following completion of the EAP and QOL measures analysed to record trends. No formal statistical analysis was carried out. Results and Limitations The incidences of neutropenic sepsis (6.3%), grade 3 and 4 diarrhoea (4.5%) and grade 3 and 4 cardiac toxicity (0%) were low. Neutropenic sepsis episodes though low occurred only in patients who did not receive prophylactic G‐CSF. There were trends to improved VAS and EQ5D‐3L pain scores during treatment. Conclusions The UK EAP experience indicates that cabazitaxel may improve QOL in mCRPC and represents an advance and useful addition to the armamentarium of treatment for patients whose disease has progressed during or after docetaxel. In view of the potential toxicity, careful patient selection is important. Patient Summary We recorded detailed information about side effects and quality of life in 112 patients with advanced prostate cancer receiving cabazitaxel chemotherapy. We found that side effects were less severe than expected and, importantly, many patients’ quality of life and pain symptoms improved during treatment.
      PubDate: 2015-01-30T03:59:19.676623-05:
      DOI: 10.1111/bju.13069
  • Penile lengthening and widening without grafting according to a modified
           sliding technique
    • Authors: Paulo H. Egydio; Franklin E. Kuehhas
      Abstract: To present the feasibility and safety of penile length and girth restoration based on a modified “sliding technique” for patients suffering from severe ED, significant penile shortening with or without Peyronie's disease. Materials and Methods Between January 2013 and January 2014, 143 patients underwent our modified “sliding technique” for penile length and girth restoration and concomitant penile prosthesis implantation. It is based on three key elements: 1) the sliding maneuver for penile length restoration, 2) potential complementary longitudinal ventral and/or dorsal tunical incisions for girth restoration, and 3) closure of the newly created rectangular bow‐shaped tunical defects with Buck's fascia only. Results 143 patients underwent the procedure. The etiologies of penile shortening and narrowing were PD in 53.8%, severe ED with unsuccessful intracavernosal injection therapy in 21%, post‐radical prostatectomy 14.7%, androgen deprivation therapy, with or without brachytherapy or external radiotherapy, for prostate cancer in 7%, post‐penile fracture in 2.1%, post‐redo‐hypospadias repair 0.7%, and post‐priapism in 0.7%. In cases of ED and PD, the mean deviation of the penile axis was 45° (range, 0‐100°). The mean subjective penile shortening reported by patients was 3.4 cm (range, 1‐7 cm), and shaft constriction was present in 53.8%. Malleable penile prostheses were used in 133 patients and inflatable penile prostheses were inserted in 10 patients. The median follow‐up was 9.7 months (range, 6‐18 months). The mean penile length gain was 3.1 cm (range, 2‐7 cm). No penile prosthesis infection caused device explantation. The average IIEF score increased from 24 points at baseline to 60 points at the six‐month follow‐up. Conclusion Penile length and girth restoration based on our modified “sliding technique” is a safe and effective procedure. The elimination of grafting saves operative time and consequently, decreases infection risk and costs associated with surgery.
      PubDate: 2015-01-28T04:34:11.619848-05:
      DOI: 10.1111/bju.13065
  • A lot of questions (and a few answers…) in retroperitoneal fibrosis
    • Authors: Archie Fernando; James Pattison, Catherine Horsfield, Matthew Bultitude, David D'Cruz, Tim O'Brien
      PubDate: 2015-01-23T01:25:45.61947-05:0
      DOI: 10.1111/bju.13061
  • Causes of death in men with localised prostate cancer: a nationwide,
           population‐based study
    • Authors: Mieke Van Hemelrijck; Yasin Folkvaljon, Jan Adolfsson, Olof Akre, Lars Holmberg, Hans Garmo, Pär Stattin
      Abstract: Objective To detail the distribution of causes of death for localised prostate cancer (PCa). Patients and Methods PCBase Sweden links the Swedish National Prostate Cancer Register (NPCR) with other nation‐wide population‐based healthcare registers. We selected all 57,187 men diagnosed with localised PCa between 1997‐2009 and their 114,374 age‐ and county‐matched PCa‐free control men. Mortality was calculated using competing risk regression analyses, taking into account PCa risk category, age, and Charlson comorbidity index (CCI). Results In men with low risk PCa, all‐cause mortality was lower compared to corresponding PCa‐free men: 10‐year all‐cause mortality was 18% for men diagnosed at age 70 with CCI=0 and 21% among corresponding controls. 31% of these cases died of CVD compared to 37% of their controls. For men with low‐risk PCa, 10‐year PCa‐mortality was 0.4%, 1%, and 3% when diagnosed at age 50, 60, and 70, respectively. PCa was the third most common cause of death (18%), after CVD (31%) and other cancers (30%). In contrast, PCa was the most common cause of death in men with intermediate and high‐risk localised PCa. Conclusions Men with low‐risk PCa had lower all‐cause mortality than PCa‐free men due to lower cardiovascular mortality, driven by early detection selection. However, for men with intermediate or high‐risk disease, PCa death was substantial, irrespective of CCI, and this was even more pronounced for those diagnosed at age 50 or 60.
      PubDate: 2015-01-21T05:43:30.078348-05:
      DOI: 10.1111/bju.13059
  • Intermediate Analysis of A Phase Ii Trial Assessing Gemcitabine and
           Cisplatin in Locoregional or Metastatic Penile Squamous Cell Carcinoma
    • Authors: N. Houédé; L. Dupuy, A. Fléchon, P. Beuzeboc, G. Gravis, B. Laguerre, C. Théodore, S. Culine, T. Filleron, C. Chevreau
      Abstract: Objective Patients with squamous cell carcinoma of the penis and unresected loco‐regional lymph nodes and/or distant metastases have a poor prognostic with no standard of chemotherapy. We performed a phase II study evaluating the association of gemcitabine and cisplatin in this population. Patients and method Eligible patients had histological confirmed squamous cell carcinoma of the penis with unresected locoregional lymph nodes and/or distant metastases at initial diagnosis or at relapse, and measurable disease as defined by RECIST criteria. Patients were treated with the association of gemcitabine 1250 mg/m2 on day 1 over 30 minutes and cisplatin 50 mg/m2 on day 1 over 1 hour, every two weeks. Primary endpoint was the objective response rate; secondary endpoints were time to progression (TTP) and overall survival (OS). Results Twenty five patients were included in the first step of the study between February 2004 and January 2010 and received a median of 5 cycles. For ITT population, 2 patients (95%CI = [0.98 ;26.0]) presented an objective response. Thirteen patients had stable disease (52% 95%CI = [35.5‐76.8]). Median TTP is estimated at 5.48 months (95%CI = [2.40 ;11.73]). After a median follow up of 26.97 months (95%CI = [17.77 ; Not reached]), nine patients were still alive. OS median and 2 years OS rates are respectively estimated at 14.98 months (95%CI = [ 9.76 ;32.9]) and 39.32% (95%CI = [19.15 ; 59.03]). Eleven patients had a SAE (44%) within 24% were relied to chemotherapy. Conclusion The every two weeks administration of the combination of gemcitabine and cisplatin showed non‐significant responses in patients with unresected loco‐regional or metastatic penile squamous cell carcinoma. Despite manageable side effects, this combination cannot be recommended as a standard of care due to disappointing response rates observed in this negative study. Further regimens should be explored to improve the overall survival of these patients with poor prognosis.
      PubDate: 2015-01-20T02:13:49.107331-05:
      DOI: 10.1111/bju.13054
  • Post‐operative Radiation Therapy for Patients at High‐risk of
           Recurrence after Radical Prostatectomy: Does Timing Matter'
    • Authors: Charles C. Hsu; Alan T. Paciorek, Matthew R. Cooperberg, Mack Roach, I‐Chow J. Hsu, Peter R. Carroll
      Abstract: Objective To evaluate among prostatectomy patients at high‐risk of recurrence whether the timing of post‐operative radiation therapy (adjuvant, early salvage with detectable post‐prostatectomy PSA, or “late” salvage with PSA>1.0) significantly is associated with overall, prostate‐cancer specific or metastasis‐free survival, in a longitudinal cohort. Patients and Methods Of 6176 prostatectomy patients in the Cancer of the Prostate Strategic Urologic Research Endeavor(CaPSURE), 305 patients with high‐risk pathologic features(margin positivity, Gleason Score(pGS) 8‐10, or pT3‐T4) who underwent post‐operative radiation were examined, either in the adjuvant(≤6 months from surgery with undetectable PSA, N=76) or salvage setting(>6 months after surgery or pre‐radiation PSA>0.1, N=229). Early (PSA≤1.0, N=180) or late salvage radiation(PSA>1.0, N=49) was based on post‐prostatectomy, pre‐radiation PSA. Multivariable Cox regression examined associations with all‐cause mortality and prostate cancer‐specific mortality or metastases(PCSMM). Results After a median of 74 months from prostatectomy, 65 men died(with 37 events of PCSMM). Adjuvant and salvage radiation patients had comparable high‐risk features. Compared to adjuvant, salvage radiation(early or late) had an increased association with all‐cause mortality(hazard ratio[HR] 2.7, p=0.018) and with PCSM(HR 4.0, p=0.015). PCSM‐free survival differed by further stratification of timing, with 10‐year estimates of 88%, 84%, and 71% for adjuvant, early salvage, and late salvage radiation, respectively(P=0.026). For PCSM‐ and overall‐survival, compared to adjuvant RT, late salvage RT had statistically significantly increased risk, however early salvage RT did not. Conclusion This analysis suggests that patients who underwent early salvage radiation with PSA1.0 is associated with worse clinical outcomes.
      PubDate: 2015-01-20T02:13:04.133915-05:
      DOI: 10.1111/bju.13043
  • External urethral sphincter electromyography in asymptomatic women and the
           influence of the menstrual cycle
    • Authors: C. Tawadros; K. Burnett, L.F. Derbyshire, T. Tawadros, N. W. Clarke, C.D. Betts
      Abstract: Objective To investigate by electromyography (EMG), the presence of complex repetitive discharges (CRDs) and decelerating bursts (DBs) in the striated external urethral sphincter during the menstrual cycle in female volunteers with no urinary symptoms and complete bladder emptying. Subjects and methods Healthy female volunteers aged 20‐40 years, with regular menstrual cycles and no urinary symptoms were recruited. Volunteers completed a menstruation chart, urinary symptom questionnaire, pregnancy test, urine dipstick, urinary free flow and post void ultrasound bladder scan. Exclusion criteria included current pregnancy, use of hormonal medication or contraception, body mass index greater than 35, incomplete voiding and a history of pelvic surgery. Eligible participants underwent an external urethral sphincter EMG, using a needle electrode, in the early follicular phase and the mid‐luteal phase of their menstrual cycles. Serum oestradiol and progesterone were measured at each EMG test. Results One hundred and nineteen women enquired about the research and following screening, 18 females were eligible to enter the study phase. Complete results were obtained in 15 women. Thirty EMG tests were undertaken in the 15 asymptomatic women. Sphincter EMG was positive for CRDs and DBs at one or both phases of the menstrual cycle in 8 (53%) of the female volunteers. Three had CRDs and DBs in both early follicular and midluteal phases. Five had normal EMG activity in the early follicular phase and CRDs and DBs in the midluteal phase. No woman had abnormal EMG activity in the early follicular phase and normal activity in the luteal phase. There was no relationship between EMG activity and age, parity or serum levels of oestradiol and progesterone. Conclusions CRDs and DB activity in the external striated urethral sphincter is present in a high proportion of asymptomatic young women. This abnormal EMG activity has been shown for the first time to change during the menstrual cycle in individual women. CRDs and DBs are more commonly found in the luteal phase of the menstrual cycle. The importance of CRDs and DBs in the aetiology of urinary retention in young women remains uncertain. The distribution and or quantity of abnormal EMG activity in the external urethral sphincter may be important. In a woman with urinary retention the finding of CRDs and DBs by needle EMG does not automatically establish Fowler's syndrome as the explanation for the bladder dysfunction. Urethral pressure profilometry may be helpful in establishing a diagnosis. Opiate use and psychological stress should be considered in young women with urinary retention.
      PubDate: 2015-01-20T02:12:55.634599-05:
      DOI: 10.1111/bju.13042
  • The accuracy of Magnetic Resonance Imaging (MRI) in predicting the
           invasion of the tunica albuginea and the urethra during the primary
           staging of Penile Cancer
    • Authors: Vishwanath Hanchanale; Lehana Yeo, Nawraj Subedi, Jonathan Smith, Tze Wah, Patricia Harnden, Selina Bhattarai, Sameer Chilka, Ian Eardley
      Abstract: Objectives Penile preserving surgery is increasingly offered to men with localised penile cancer and surgical margins of less than 10 mm appear to offer excellent oncological control. Invasion of the tunica albuginea (TA) and the urethra are important factors in determining the feasibility of such surgery. We assessed the accuracy of magnetic resonance imaging (MRI) in predicting the invasion of the tunica albuginea and the urethra during the primary staging of penile Cancer. Methods One hundred and four consecutive patients with clinical T1‐T3 penile cancer had a penile MRI as a part of local staging protocol. An artificial erection was induced by injecting alprostadil (prostaglandin E1). Four men with poor quality MRI images were excluded from the study. The preoperative MRI was compared to final histology to assess its accuracy in predicting the invasion of the tunica albuginea and urethral invasion. Results Data of one hunded patients who underwent penile MRI prior to definitive surgery for invasive penile carcinoma was available for analysis. The mean age was 65 years and number of patients with pathological stage T1, T2 and T3 were 32, 52 and 16 respectively. The sensitivity and specificity of MRI in predicting the invasion of tunica albuginea and urethra were 82.1%, 73.6% and 62.5%, 82.1% respectively. There were no MRI related complications. Conclusions This study shows that penile MRI is an accurate imaging modality in assessing the tunica albuginea invasion but is less sensitive in assessing urethral invasion. These results support the use of MRI in the local staging of penile cancer.
      PubDate: 2015-01-20T02:12:46.112717-05:
      DOI: 10.1111/bju.13041
  • Guideline of guidelines: A Review of Urologic Trauma Guidelines
    • Authors: Darren J. Bryk; Lee C. Zhao
      Abstract: Objective To review the guidelines released in the last decade by several organizations regarding the optimal evaluation and management of genitourinary injuries (renal, ureteral, bladder, urethral and genital). Materials and Methods This is a review of the genitourinary trauma guidelines from the European Association of Urology (EAU) and the American Urological Association (AUA) and renal trauma guidelines from the Societe Internationale D'Urologie (SIU). Results Most recommendations are guided by the American Association for the Surgery of Trauma (AAST) organ injury severity system. Grade A evidence is very rare in genitourinary trauma, and most recommendations are based on Grade C evidence. The findings of the most recent urologic trauma guidelines are summarized. All guidelines recommend conservative management for low‐grade injuries. The major difference is for high‐grade renal trauma, where the SIU and EAU recommended exploratory laparotomy for Grade 5 renal injuries, while the more recent AUA guideline recommends initial conservative management in hemodynamically stable patients. Conclusion There is generally consensus among the three guidelines. Recommendations are based on observational or retrospective studies as well as clinical principles and expert opinions. Large‐scale prospective studies can improve the quality of evidence, and direct more effective evaluation and management of urologic trauma.
      PubDate: 2015-01-20T02:12:38.105022-05:
      DOI: 10.1111/bju.13040
  • Patient reported “ever had” and “current” long
           term physical symptoms following prostate cancer treatments
    • Authors: Anna T Gavin; Frances J Drummond, Conan Donnelly, Eamonn O'Leary, Linda Sharp, Heather R Kinnear
      Abstract: Objective To document prostate cancer patient reported ‘ever experienced’ and ‘current’ prevalence of disease specific physical symptoms stratified by primary treatment received. Patients 3,348 prostate cancer survivors 2‐15 years post diagnosis. Methods Cross‐sectional, postal survey of 6,559 survivors diagnosed 2‐15 years ago with primary, invasive PCa (ICD10‐C61) identified via national, population based cancer registries in Northern Ireland and Republic of Ireland. Questions included symptoms at diagnosis, primary treatments and physical symptoms (impotence/urinary incontinence/bowel problems/breast changes/loss of libido/hot flashes/fatigue) experienced ‘ever’ and at questionnaire completion (“current”). Symptom proportions were weighted by age, country and time since diagnosis. Bonferroni corrections were applied for multiple comparisons. Results Adjusted response rate 54%; 75% reported at least one ‘current’ physical symptom (‘ever’:90%), with 29% reporting at least three. Prevalence varied by treatment; overall 57% reported current impotence; this was highest following radical prostatectomy (RP)76% followed by external beam radiotherapy with concurrent hormone therapy (HT); 64%. Urinary incontinence (overall ‘current’ 16%) was highest following RP (‘current'28%, ‘ever'70%). While 42% of brachytherapy patients reported no ‘current’ symptoms; 43% reported ‘current’ impotence and 8% ‘current’ incontinence. ‘Current’ hot flashes (41%), breast changes (18%) and fatigue (28%) were reported more often by patients on HT. Conclusion Symptoms following prostate cancer are common, often multiple, persist long‐term and vary by treatment. They represent a significant health burden. An estimated 1.6% of men over 45 is a prostate cancer survivor currently experiencing an adverse physical symptom. Recognition and treatment of physical symptoms should be prioritised in patient follow‐up. This information should facilitate men and clinicians when deciding about treatment as differences in survival between radical treatments is minimal.
      PubDate: 2015-01-18T23:02:52.137378-05:
      DOI: 10.1111/bju.13036
  • 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
  • Utilization of pre‐operative imaging for muscle‐invasive
           bladder cancer: a population‐based study
    • Authors: Matthew DF McInnes; D. Robert Siemens, William J. Mackillop, Yingwei Peng, Shelly Wei, Nicola Schieda, Christopher M. Booth
      Abstract: Objective To test the hypotheses that: a) use of pre‐operative imaging for muscle‐invasive bladder cancer (MIBC) conforms to practice guidelines; b) pre‐operative imaging, through more accurate staging is associated with improved outcomes. Materials & Methods In this population‐based cohort study, records of treatment were linked to the Ontario Cancer Registry to identify all patients with MIBC treated with cystectomy from 1994‐2008. Utilization of chest, abdomen‐pelvis and bone imaging were evaluated. Trends were evaluated over time. Logistic regression was used to analyze factors associated with utilization. Cox model analyses were used to explore associations between imaging and survival. Results 2802 patients with MIBC underwent cystectomy during 1994‐2008. Over the three 5‐year study periods, an increase in the proportion of patients having pre‐operative: chest x‐ray(CXR)(55%,64%,63%,p
      PubDate: 2015-01-05T05:55:30.542014-05:
      DOI: 10.1111/bju.13034
  • Transurethral intraprostatic injection of botulinum neurotoxin type A for
           the treatment of chronic prostatitis/chronic pelvic pain syndrome: results
           of a prospective pilot double‐blind and randomized
           placebo‐controlled study
    • Abstract: Objective To evaluate the effect of botulinum neurotoxin type‐A (BoNT‐A) on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) refractory to medical therapy. Materials and Methods Between November 2011 and January 2013, 60 men aged ≥18 years with CP/CPPS, and with National Institutes of Health Chronic Prostatitis Symptom Index (NIH‐CPSI) scores ≥10 and pain subscale scores ≥8, who were refractory to 4–6 weeks' medical therapy, underwent transurethral intraprostatic injection of BoNT‐A or normal saline in a prospective pilot double‐blind randomized study. The patients' NIH‐CPSI total and subscale scores, American Urological Association (AUA)‐symptom score (SS), visual analogue scale (VAS) and quality of life (QoL) scores and frequencies of diurnal and nocturnal urination were evaluated and compared at baseline and at 1, 3 and 6 months after injection and also were compared between the two groups. Results A total of 60 consecutive patients were randomized to a BoNT‐A (treatment) or normal saline (placebo) group. In the treatment group at the 1‐, 3‐ and 6‐month evaluation the NIH‐CPSI total and subscale scores, and the AUA‐SS, VAS and QoL scores, along with frequencies of diurnal and nocturnal urinations, had significantly improved compared with baseline values (P < 0.05). By contrast, in the placebo group, none of these values showed improvement and the values were significantly different from those in the treatment group. Although the differences between the two groups in AUA‐SS and frequencies of nocturnal urination were not significant at 1‐month follow‐up, repeated‐measure analysis showed significant improvement in each of these values over the entire follow‐up period in the treatment group. The most prominent improvement was related to the pain subscale score, which decreased by 64.76, 75.63 and 79.97% at 1, 3 and 6 months after treatment compared with baseline, followed by the VAS score, which decreased by 62.3, 72.4 and 82.1% at each follow‐up, respectively. Only two patients developed mild transient gross haematuria, which was managed conservatively. Conclusions Transurethral intraprostatic BoNT‐A injection maybe an effective therapeutic option in patients with CP/CPPS as it reduces pain and improves QoL.
  • Is it safe to insert a testicular prosthesis at the time of radical
           orchidectomy for testis cancer: an audit of 904 men undergoing radical
    • Abstract: Objective To compare the complication rate associated with synchronous prosthesis insertion at the time of radical orchidectomy with orchidectomy alone. Patient and Methods All men undergoing radical orchidectomy for testis cancer in the North West Region of England between April 1999 to July 2005 and November 2007 to November 2009 were included. Data on postoperative complications, length of stay (LOS), re‐admission rate and return to theatre rate were collected. Results In all, 904 men [median (range) age 35 (14–88) years], underwent a radical orchidectomy during the study period and 413 (46.7%) were offered a prosthesis, of whom 55.2% chose to receive one. Those offered a prosthesis were significantly younger (P < 0.001), with a median age of 33 vs 37 years. There was no significant difference between the groups for LOS (P = 0.387), hospital re‐admission rates (P = 0.539) or return to theatre rate (P = 0.999). In all, 33/885 patients were readmitted ≤30 days of orchidectomy, with one of 236 prosthesis patients requiring prosthesis removal (0.4%). Older age at orchidectomy was associated with an increased risk of 30‐day hospital re‐admission (odds ratio 1.032, P = 0.016). Conclusions Concurrent insertion of a testicular prosthesis does not increase the complication rate of radical orchidectomy as determined by LOS, re‐admission or the need for further surgery. Prosthesis insertion at the time of orchidectomy for testis cancer is safe and concerns about increased complications should not constrain the offer of testicular prosthesis insertion concurrently with primary surgery.
  • A Phase II, Randomized, Double‐blind, Placebo‐Controlled Trial
           of Methylphenidate for Reduction of Fatigue in Prostate Cancer Patients
           Receiving LHRH‐Agonist Therapy
    • Abstract: Objectives To investigate whether methylphenidate could alleviate fatigue, as measured by the Functional Assessment of Cancer Therapy: Fatigue subscale (FACT‐F), in men with PCa treated with an LHRH agonist for a minimum of 6 months. To assess changes in global fatigue and QoL as measured by the Bruera Global Fatigue Severity Scale (BFS) and the Medical Outcomes Study 36‐Item Short‐Form Health Survey (SF‐36), respectively. Materials and Methods We performed a single center, randomized, double‐blind, placebo‐controlled trial with the goal to recruit 128 participants. Men treated with an LHRH agonist for PCa were screened between February 2008 and June 2012 for fatigue at our outpatient clinics using the BFS. Participants were randomized to receive either 10mg daily of methylphenidate or a placebo. Change of fatigue levels and in SF‐36 scores between both groups were compared using linear regression adjusted for baseline scores. Results The study was closed prematurely due to poor accrual. Of the 790 subjects screened, 24 men were randomized to methylphenidate or placebo (12 per group). After 10 weeks, the improvement in fatigue was greater in the methylphenidate arm than in placebo [+7.7(7.7) vs. +1.4(7.6)]; p=0.022). The within‐group analysis demonstrated a significant improvement of fatigue in the methylphenidate arm (p=0.008) but not in the placebo arm (p=0.82). The use of methylphenidate also resulted in a significantly greater improvement in QoL as measured by the physical and mental component score than placebo (p=0.04 for both component scores). Conclusion Our findings support the benefit of methylphenidate on fatigue and QoL among men with LHRH‐induced fatigue. Clinicians should be aware of its benefit and should consider discussing these findings with their fatigued patients.
  • Argument for prostate cancer screening in populations of
           African‐Caribbean origin
    • Abstract: The high prevalence, incidence and mortality rates of prostate cancer in Tobago would appear to strongly indicate that screening of this population would be justified and could positively impact on mortality. We consider our approach to be consonant with the recommendations of the EAU (Heidenreich A et al, 2013) and the findings of Hugosson et al, 2014)
  • Nephroureterectomy surgery in the United Kingdom in 2012: British
           Association of Urological Surgeons (BAUS) Registry data
    • Abstract: Objective Descriptive report of registry data obtained by BAUS in relation to nephroureterectomy (NU) surgery in the UK performed between January 1st and December 31st 2012. Subjects/Patients and methods Registry data entered by each individual surgeon's team (self‐reported) on all 6042 nephrectomy surgeries reported to BAUS during 2012 were analysed to identify all NU surgery. Parameters for analysis included demographics, indication, type of surgery, histopathology and complications (Clavien system) of surgery. Data did not include tumour location or multiplicity, pre‐operative diagnostic evaluation or details of minimally‐invasive surgery (MIS) undertaken. Prior to analysis for this report a central process of “data‐cleansing” was undertaken by a BAUS group in order to address any discrepancy between the listed surgery and the pre‐operative indication. Results In total 863 NU surgeries were included, performed by 220 consultant surgeons in 119 centres, and the median number of NU per surgeon and unit was 3 and 6 respectively (ranges 1‐20 and 1‐29). The most common age group was 71‐80 years (40%), majority were male (64%), and haematuria was the most common presentation (74%). Dominant pathology was upper tract urothelial cancer (89%, 735), with final stage ≥pT2 in 47% (367), and grade was 1, 2 or 3 in 6% (38), 36% (228) and 58% (362) respectively. Operative technique included MIS in 85% (720) and total reported operative complication rate (any Clavien) was 15% (128), of which Clavien ≥3 was reported in 4% (36), and peri‐operative death was reported in 9 patients (1%). Advantages in favour of MIS included reduced length of stay in hospital (median 5 v 8 days), reduced major blood loss (3 v 14%) and reduced transfusion requirement (6 v 24%). Seventy‐six cases (8%) were excluded from analysis based on benign pathology leading to reassignment to “simple nephrectomy” category. Conclusion NU is currently a low‐volume operation (median 3 cases per year) within the remit of the nephrectomy surgeon, but is a safe procedure with a relatively low complication rate. The majority of NU surgery is now performed with laparoscopic assistance, with advantages including reduced major blood loss, reduced transfusion requirement and shorter hospital stay.
  • Number of positive pre‐operative biopsy cores is a predictor of
           positive surgical margins in small prostates after robot‐assisted
           radical prostatectomy
    • Abstract: Objective To determine the impact of prostate size on positive surgical margin (PSM) rates after RARP and the pre‐operative factors associated with PSM. Materials And Methods A total of 1,229 men underwent RARP by a single surgeon, from 2005 to August of 2013. Excluded were patients who had trans‐urethral resection of the prostate, neo‐adjuvant therapy, clinically‐advanced cancer, and the first 200 performed cases, to reduce the effect of learning curve. Included were 815 patients who were then divided into three groups: 45 g (group3). Multivariate analysis determined predictors of PSM and BCR. Results Console time and blood loss increased with increasing prostate size. There were more high‐grade tumors in group one (group1 vs. group2 and group3, 33.9% vs. 25.1 and 25.6%, p=0.003 and p=0.005). PSM were increased in 20 ng/dl, Gleason score >7, T3 tumor, and >3 positive biopsy cores. In group one, pre‐operative stage T3 (OR=3.94, p=0.020) and >3 positive biopsy core (OR=2.52, p=0.043) were predictive of PSM while a PSA >20ng/dl predicted the occurrence of BCR (OR=5.34, p=0.021). No pre‐operative factors predicted PSM or BCR for groups two and three. Conclusion A pre‐operative biopsy with >3 positive cores in men with small prostates predicts PSM after RARP. In small prostates with PSM, a PSA >20 ng/dl is a predictor of BCR. These factors should guide the choice of therapy and indicate the need for closer post‐operative follow‐up.
  • γEpithelial Na+ Channel and the Acid‐Sensing Ion Channel 1
           expression in the urothelium of patients with neurogenic detrusor
    • Abstract: Objective To investigate the expression of two types of cation channels such as the γEpithelial Na+ Channel (γENaC) and the Acid‐Sensing Ion Channel1 (ASIC1) in the urothelium of controls and in patients affected by neurogenic detrusor overactivity (NDO). In parallel, the urodynamic parameters were collected and correlated to the immunohistochemical (IHC) results. Subjects and Methods Four controls and 12 patients with a clinical diagnosis of NDO and suprasacral spinal cord lesion underwent to urodynamic measurements and cystoscopy. Cold cup biopsies were frozen and processed for immunohistochemistry and western blots. Spearman's correlation coefficient between morphological and urodynamic data was applied. One‐way ANOVA followed by Newman–Keuls multiple comparison post‐hoc test was applied for western blot results. Results In the controls, γENaC and ASIC1 were expressed in the urothelium with differences in their cell distribution and intensity. In NDO patients, both markers showed consistent changes either in cell distribution and labeling intensity compared to controls. A significant correlation between the higher intensity of the γENaC expression in urothelium of NDO patients and the lower values of bladder compliance was detected. Conclusion The present findings show important changes in the expression of γENaC and ASIC1 in NDO human urothelium. Of note, while the changes in γENaC might impair the mechanosensory function of urothelium, the increase of the ASIC1 might represent an attempt to compensate excess in local sensitivity.
  • An evaluation of the ‘weekend effect’ in patients admitted
           with metastatic prostate cancer
    • Abstract: Objectives To investigate whether mortality is increased for patients with metastatic prostate cancer (mCaP) admitted over the weekend. Patients and methods Using the Nationwide Inpatient Sample (NIS) between 1998‐2009, admitted patients with a diagnosis of prostate cancer and concomitant metastases were identified. Rates of in‐hospital mortality, complications, utilization of imaging and procedures were assessed. Adjusted logistic regression models examined associations of mortality and complications. Results A weighted sample of 534,011 patients with mCaP was identified, including 81.7% weekday and 18.3% weekend admissions. Of these, 8.6% died following a weekday vs. 10.9% after a weekend admission (p
  • Salvage micro‐dissection testicular sperm extraction; Outcome in men
           with Non obstructive azoospermia with previous failed sperm retrievals
    • Abstract: Objective To assess the outcome of m‐TESEas a salvage treatment in men withnon‐obstructive azoospermia (NOA) in whom no sperm was previously found on single/multiple TESE or TESA. Materials and Methods A total of 58 men with NOA underwent micro‐dissection testicular sperm extraction. All patients had previously undergone either single/multiple TESE or TESA with no sperm found. All patients underwent an m‐TESE using a standard technique. Serum follicle‐stimulating hormone, Testosterone and histopathological diagnosis were examined as predictive factors for sperm recovery. All patients underwent pre‐operative genetic screening.One patient was found to havean AZFc micro‐deletion and 5 werediagnosed with Kleinfelter's syndrome. Results The mean age of patients was39.0 years (range 26‐57).Spermatozoa were successfully retrieved in 27men by m‐TESE (46.5%).The mean FSH level was 19.4 (range 1.6‐ 58.5). There was no correlation in age (retrieved 38.1, not retrieved 39.7 p=0.38) FSH levels (Mean FSH retrieved 21.4, not retrieved 17.7p=0.3) and the ability to find sperm by m‐TESE. However, there was a significant difference with respect to testosterone and sperm retrieval (Mean testosterone retrieved 14.99, not retrieved 11.39 p
  • Sunitinib‐induced hypertension, neutropenia and thrombocytopenia as
           predictors of good prognosis in metastatic renal cell carcinoma patients
    • Abstract: Objectives To evaluate the clinical significance of hypertension, neutropenia and thrombocytopenia as possible new biomarkers of sunitinib efficacy in non‐trial metastatic renal cell carcinoma (mRCC) patients. Materials and methods 181 consecutive mRCC patients were treated with sunitinib. Thirty‐nine (22%) patients received sunitinib 50 mg/day 4 weeks on/ 2 weeks off, 80 patients (44%) 37.5 mg/day continuously and 62 (34%) 25 mg/day continuously as their starting dose. Treatment‐induced adverse events (AE) and their impact on outcome were analysed on multiple sunitinib doses. Results During sunitinib treatment 60 patients (33%) developed ≥grade 2 hypertension, 88 (49%) ≥grade 2 neutropenia and 135 (75%) ≥grade 1 thrombocytopenia. These AEs were associated significantly with longer progression‐free survival (PFS; 15.7 vs. 6.7; 14.6 vs. 6.9; 10.4 vs. 4.2 months, respectively; P
  • Prognostic Factors Influencing Survival from Regionally Advanced Squamous
           Cell Carcinoma of the Penis After Preoperative Chemotherapy
    • Abstract: Objective To describe both clinical and pathologic response rates, survival, and predictors of survival when utilizing contemporary peri‐operative chemotherapy and surgical resection for patients with regionally advanced squamous cell carcinoma of the penis. Materials & Methods Retrospective review of all patients diagnosed with squamous cell carcinoma of the penis and regional lymph node metastases that were treated with chemotherapy with the intent to undergo lymphadenectomy. Clinical and pathologic responses were reported. Recurrence‐free and overall survival was estimated using Kaplan‐Meier analysis. Cox proportional hazards regression was used to assess factors for survival. Results Sixty‐one patients were identified, of which 54 (90%) received chemotherapy with paclitaxel/ifosfamide/cisplatin. Thirty‐nine patients (65%) exhibited either a partial (PR) or complete response (CR) to chemotherapy. Five‐year survival varied significantly (p=0.045‐0.001) among patients achieving a CR/PR (50%), stable disease (25%), and progression (7.7%). Ten patients (16.4%) were rendered pN0 with combined therapy. Twenty patients (33%) were alive and disease free at a median follow‐up of 67 months, while 32 (52%) died of disease. Long‐term survival was associated with response to chemotherapy and favorable pathologic findings post resection. Conclusion Contemporary chemotherapy resulted in clinically significant responses among patients with regionally advanced penile cancer. Approximately 50% of such patients with an objective response to chemotherapy who undergo consolidative lymphadenectomy will remain alive at 5 years.
  • A Systematic Review of Experience of 180W XPS GreenLight Laser
           Vaporization of the Prostate in 1640 men
    • Abstract: Aim To systematically review the literature regarding clinical outcomes of 180W XPS GreenLight laser (GL) vaporization for the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). Methods Recent publications in the field of 180 Watt GreenLight Laser (GL) vaporization for the treatment of LUTS due to BPH were identified by a literature search. It was searched for peer reviewed original articles in English language. Search items were: 180W lithium triborate laser or 180W greenlight laser or 180 watt lithium triborate laser or 180 watt greenlight laser or XPS greenlight laser. 30 papers published between 2012 and 2014 matched this search. Out of this collective 10 papers were identified dealing with consecutive cohorts of patients treated with the 180W XPS GreenLight® laser. Results Ten papers included a total experience of 1640 patients. The only RCT in this field compares 180W XPS with transurethral resection of the Prostate (TURP). Functional outcomes and prostate volume reduction following GL vaporization were similar to TURP. Catheterization time and hospital stay were shorter in patients undergoing 180W XPS GL‐vaporization (41 and 66 hours vs 60 and 97 hours respectively). Four papers compared the 180W XPS system to former GL devices demonstrating increased operation time efficiency and comparable postoperative voiding results and adverse events. One paper defined the learning curve to achieve an expert level according to the speed of the procedure and the effectiveness of volume reduction was met after 120 procedures. Conclusion The 180W XPS GreenLight laser offers shorter operation times than the former devices. In the one randomised controlled trial comparison with TURP, volume reduction and functional results were comparable to those of TURP. Longer term studies are required.
  • HIV‐related stone disease – a potential new paradigm'
  • Renal cell cancer histologic subtype distribution differs by race and sex
    • Abstract: Objectives To examine racial differences in the distribution of histologic subtypes of renal cell carcinoma (RCC) and associations with established RCC risk factors by subtype. Materials and methods Tumors from 1,532 consecutive RCC patients who underwent nephrectomy at Vanderbilt University Medical Center (1998‐2012) were classified as clear cell, papillary, chromophobe, and other subtypes. In pairwise comparisons, we used multivariate logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for the associations between race, sex, age, ESRD and body mass index at diagnosis (BMI, kg/m2) according to histologic subtype. Results The RCC subtype distribution was significantly different among blacks compared with whites (p
  • Radical Cystectomy with Super‐extended Lymphadenectomy: Impact of
           Separate Versus en Bloc Lymph Node Submission on Analysis and Outcomes
    • Abstract: Objective ● At USC, the submission of lymphadenectomy specimens changed from en bloc to 13 separate anatomically defined packets in May 2002. ● We update our previous analysis of the clinical and pathological impact of this change in methodology, and determine whether lymph node (LN) packeting resulted in any change in oncologic outcomes. Patients and Methods ● 846 patients who underwent radical cystectomy (RC) with super‐extended LN dissection (LND) for cTxN0M0 bladder cancer between 01/1996 and 12/2007 were identified, ● Specimens of 376 patients were sent en bloc (group 1), and specimens of 470 patients were sent in 13 separate anatomical packets (group 2). Results ● Pathologic tumor stage distribution and proportion of LN‐positive patients (group 1: 82 (22%) vs. group 2: 99 (21%); p=0.80) were similar: the median number of total LNs identified increased significantly (group 1: 32 (range: 10‐97), group 2: 65 (range: 10‐179); p
  • Applications of Three‐Dimensional Printing Technology in Urologic
    • Abstract: A rapid expansion in the medical applications of three‐dimensional (3D) printing technology has been observed in recent years. This technology is capable of manufacturing low‐cost and customizable surgical devices, 3D models for use in pre‐operative planning and surgical education, and fabricated biomaterials. While several studies have suggested 3D printers may be a useful and cost‐effective tool in urologic practice, few studies are available that clearly demonstrate the clinical benefit of 3D printed materials. Nevertheless, 3D printing technology continues to advance rapidly and promises to play an increasingly larger role in the field of urology. Herein, we review the current urological applications of 3D printing and discuss the potential impact of 3D printing technology on the future of urologic practice. This article is protected by copyright. All rights reserved.
  • Adverse Pathology and Undetectable Ultrasensitive Prostate‐Specific
    • Abstract: Objectives To determine if men with adverse pathology but undetectable ultrasensitive (
  • Positive Surgical Margins in Radical Prostatectomy Patients Do Not Predict
           Long‐term Oncological Outcomes: Results from SEARCH
    • Abstract: Purpose To assess the impact of positive surgical margins (PSMs) on long‐term outcomes after radical prostatectomy (RP), including metastasis, castrate‐resistant prostate cancer (CRPC), and prostate cancer‐specific mortality (PCSM). Materials and Methods Retrospective study of 4,051 men in SEARCH treated by RP from 1988‐2013. Proportional hazard models were used to estimate hazard ratios of PSMs in predicting BCR, CRPC, metastases, and PCSM. To determine if PSMs were more predictive in certain patients, analyses were stratified by pathological Gleason score, stage, and pre‐operative PSA. Results Median follow‐up was 6.6 years (IQR 3.2‐10.6) and 1,127 patients had over 10 years of follow‐up. During this time, 302 (32%) men experienced BCR, 112 (3%) developed CRPC, 144 (4%) developed metastases, and 83 (2%) died of PC. There were 1600 (40%) men with PSMs. In unadjusted models, PSMs were significantly associated with all adverse outcomes: BCR, CRPC, metastases and PCSM (all p≤0.001). After adjusting for demographic and pathological characteristics, margins were associated with increased risk of only BCR (HR 1.98, p0.18). Similar results were seen when stratified by pathological Gleason score, stage, or PSA, and when patients who underwent adjuvant therapy were excluded. Conclusions PSMs after RP are not an independent risk factor for CRPC, metastasis, or PCSM overall or within any subset. In the absence of other high‐risk features, PSMs alone may not be an indication for adjuvant treatment. This article is protected by copyright. All rights reserved.
  • Diacylglycerol kinase κ (DGKK) variants and hypospadias in Han
           Chinese: association and meta‐analysis
    • Abstract: Objective To investigate whether diacylglycerol kinase κ (DGKK) is a susceptibility gene for hypospadias in the Han Chinese population as has been suggested by previous publications. Patients Subjects and Methods A case‐control study involving 466 patients with hypospadias and 402 healthy subjects was conducted to assess the relationship between DGKK single nucleotide polymorphisms (SNPs) and hypospadias risk in the Han Chinese population. The 466 hypospadias patients were further divided into mild, moderate and severe subgroups for analysis. Results Six SNPs (rs1934179, rs4143304, rs9969978, rs1934188, rs4826632 and rs4599945) were marginally associated with mild and moderate hypospadias [odds ratios (ORs) > 1, P = 0.05 to P < 0.1), whereas no significant relationship was seen with the severe cases (ORs >1, P > 0.1). After correcting for multiple testing, it was determined that neither individual SNPs nor individual haplotypes were associated with hypospadias. To evaluate this relationship in multiple populations, we performed a meta‐analysis on six SNPs, using combined data from our present results and those of previous studies of different races (including 1966 patients and 2492 controls). Six SNPs (rs1934179, rs4143304, rs9969978, rs1934188, rs7063116 and rs1934190) were significantly associated with mild/moderate hypospadias (ORs >1, P < 0.05), and rs1934179 was significantly associated with severe hypospadias (OR > 1, P < 0.05). Conclusions DGKK gene variants do not appear to play a major role in hypospadias susceptibility in the Chinese Han population. Our meta‐analysis supports the hypothesis that DGKK is a common risk gene for hypospadias, particularly in cases of mild or moderate hypospadias in Caucasian populations.
  • Hypothermic machine perfusion improves Doppler ultrasonography resistive
           indices and long‐term allograft function after renal
           transplantation: a single‐centre analysis
    • 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.
  • A prognostic model for survival after palliative urinary diversion for
           malignant ureteric obstruction: a prospective study of 208 patients
    • Abstract: Objective To identify factors associated with survival after palliative urinary diversion (UD) for patients with malignant ureteric obstruction (MUO) and create a risk‐stratification model for treatment decisions. Patients and Methods We prospectively collected clinical and laboratory data for patients who underwent palliative UD by ureteric stenting or percutaneous nephrostomy (PCN) between 1 January 2009 and 1 November 2011 in two tertiary care university hospitals, with a minimum 6‐month follow‐up. Inclusion criteria were age >18 years and MUO confirmed by computed tomography, ultrasonography or magnetic resonance imaging. Factors related to poor prognosis were identified by Cox univariable and multivariable regression analyses, and a risk stratification model was created by Kaplan–Meier survival estimates at 1, 6 and 12 months, and log‐rank tests. Results The median (range) survival was 144 (0–1084) days for the 208 patients included after UD (58 ureteric stenting, 150 PCN); 164 patients died, 44 (21.2%) during hospitalisation. Overall survival did not differ by UD type (P = 0.216). The number of events related to malignancy (≥4) and Eastern Cooperative Oncology Group (ECOG) index (≥2) were associated with short survival on multivariable analysis. These two risk factors were used to divide patients into three groups by survival type: favourable (no factors), intermediate (one factor) and unfavourable (two factors). The median survival at 1, 6, and 12 months was 94.4%, 57.3% and 44.9% in the favourable group; 78.0%, 36.3%, and 15.5% in the intermediate group; and 46.4%, 14.3%, and 7.1% in the unfavourable group (P < 0.001). Conclusions Our stratification model may be useful to determine whether UD is indicated for patients with MUO.
  • Candidate selection for quadrant‐based focal ablation through a
           combination of diffusion‐weighted magnetic resonance imaging and
           prostate biopsy
    • Abstract: Objectives To identify prostatic quadrants that could be preserved without intervention, using diffusion‐weighted magnetic resonance imaging (DWI) and extended core biopsy, as a step toward implementation of quadrant‐based focal ablation with potential preservation of erectile and ejaculatory functions, based on comparisons with unilateral hemi‐gland ablation. Patients and Methods We conducted a prebiopsy DWI study including 648 quadrants in 162 men who underwent 14‐core biopsy including anterior sampling and radical prostatectomy (RP) for localised cancer. Imaging and pathology were analysed on a quadrant basis. Each quadrant was assessed through four‐core sampling. Predictive performance of DWI and biopsy for quadrant status was analysed. Results On RP specimens, 170 anterior (52.5%) and 172 posterior quadrants (53.1%) harboured significant cancer. Negative predictive values of DWI, biopsy, and their combination for significant cancer were 79.7%, 70.6%, and 91.1%, respectively, in anterior quadrants, and 78.5%, 81.3%, and 91.7%, respectively, in posterior quadrants. DWI incrementally improved the negative predictive values of biopsy in anterior (P < 0.001) and posterior quadrants (P = 0.025), without untoward impacts on positive predictive values. Negative findings on both DWI and biopsy were identified in posterior quadrants of 109 sides (33.6%), but in entire hemi‐glands of 54 sides (16.7%). Conclusions The combination of DWI and 14‐core biopsy including anterior sampling efficiently identifies quadrants without significant cancer in men with localised prostate cancer; the remaining quadrants, therefore, could be potential candidate areas for focal ablation. Focal therapy designed based on quadrant‐based assessment could be superior to unilateral hemi‐gland ablation for preservation of posterior quadrants and retaining of sexual function in more sides.
  • Oncological outcomes after partial vs radical nephrectomy in renal cell
           carcinomas of ≤7 cm with presumed renal sinus fat invasion on
           preoperative imaging
    • Abstract: Objectives To compare oncological outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for renal tumours of ≤7 cm in which preoperative imaging reveals potential renal sinus fat invasion (cT3a), as RN is preferred for these tumours due to concerns about high tumour stage. Patients and Methods Among 1137 nephrectomies performed for renal tumours of ≤7 cm from January 2005 to August 2012, 401 solitary cT3a renal cell carcinomas (RCCs) without metastases were analysed. Classification as cT3a included only renal sinus fat invasion, as there were no tumours with suspected perinephric fat invasion. Multivariate models were used to evaluate predictors of recurrence‐free survival (RFS) and cancer‐specific survival (CSS). Results There were 34 RCCs (8.5%) with unexpected perinephric fat invasion, but only 77 RCCs (19.2%) were staged as pT3a. During the median follow‐up of 43.0 months, recurrence occurred in seven (6.7%) PN cases and 25 (8.4%) RN cases. Six recurred PN cases had positive surgical margins (PSMs). The two cohorts showed equal oncological outcomes for 5‐year RFS and CSS. Multivariate analyses showed PSM, pathological T stage, sarcomatoid dedifferentiation, and type of surgery as significant predictors of recurrence. Older age, pathological T stage, and sarcomatoid dedifferentiation were significant predictors of cancer‐specific mortality. Conclusions Renal tumours of ≤7 cm with presumed renal sinus fat invasion were mostly pT1. PN conferred equivalent oncological outcomes to RN. If clear surgical margins can be obtained, PN should be considered for these tumours, as patients may benefit from renal function preservation.
  • Changing trends in the causes and management of male urethral stricture
           disease in China: an observational descriptive study from 13 centres
    • 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.
  • Renal function is the same 6 months after robot‐assisted partial
           nephrectomy regardless of clamp technique: analysis of outcomes for
           off‐clamp, selective arterial clamp and main artery clamp
           techniques, with a minimum follow‐up of 1 year
    • Abstract: Objective To compare the renal functional outcomes, with >1 year of follow‐up, of patients who underwent robot‐assisted partial nephrectomy (RAPN) performed with different clamping techniques. Patients and Methods The peri‐operative data of patients undergoing RAPN performed with different clamping techniques were retrospectively analysed (group 1: off‐clamp, n = 23; group 2: selective clamp, n = 25; group 3: main artery clamp, n = 114). The main outcome measures were postoperative serum creatinine level, estimated glomerular filtration rate (eGFR) and percentage change in eGFR, the data for which were collected at periodic intervals during the first 12 months and annually thereafter, in addition to late eGFR value. Only patients with >1 year of follow‐up were included in the analysis. Results The baseline characteristics of groups 2 and 3 were similar, while patients in group 1 had smaller sized tumours and lower tumour complexity. The median follow‐up periods were 45 (group 1), 20 (group 2) and 47 (group 3) months. The median clamping times were 24.8 min in the main artery clamp and 18 min in the selective artery clamp groups. Group 2 had greater median blood loss volume (100 vs 500 vs 200 mL for groups 1, 2 and 3, respectively; P < 0.01) and a longer length of hospital stay (3 vs 4 vs 3 days for groups 1, 2 and 3, respectively; P = 0.02). No significant differences were found among the groups with regard to transfusion rates, positive surgical margin rates, complications, recurrence or mortality rates. Groups 1 and 2 had significantly less deterioration of postoperative renal function during the first 3 months after surgery (P = 0.04; percent change in eGFR −1.5, −2 and −8% for groups 1, 2 and 3, respectively), but this beneficial outcome was not observed after 6 months or for the latest eGFR measurement (P = 0.48; latest percent change in eGFR −3, −6 and −3.5% for groups 1, 2 and 3, respectively). In regression analysis, baseline eGFR, type of clamp procedure and tumour complexity score were predictive of normal renal function 7 days after surgery, while only baseline eGFR and age could predict it 1 year postoperatively. Conclusions Off‐clamp and selective artery clamp techniques result in superior short‐term renal functional outcomes compared with the main artery clamp approach; however, after the 6th postoperative month, there were no significant differences regarding the functional outcome among the above surgical techniques, as long as the warm ischaemia time was 20–30 min.
  • Real‐time in vivo periprostatic nerve tracking using
           multiphoton microscopy in a rat survival surgery model: a promising
           pre‐clinical study for enhanced nerve‐sparing surgery
    • Abstract: Objectives To assess the ability of multiphoton microscopy (MPM) to visualise, differentiate and track periprostatic nerves in an in vivo rat model, mimicking real‐time imaging in humans during RP and to investigate the tissue toxicity and reproducibility of in vivo MPM on prostatic glands in the rat after imaging and final histological correlation study. Materials and Methods In vivo prostatic rat imaging was carried out using a custom‐built bench‐top MPM system generating real‐time three‐dimensional histological images, after performing survival surgery consisting of mini‐laparotomies under xylazine/ketamine anaesthesia exteriorising the right prostatic lobe. The acquisition time and the depth of anaesthesia were adjusted for collecting multiple images in order to track the periprostatic nerves in real‐time. The rats were then monitored for 15 days before undergoing a new set of imaging under similar settings. After humanely killing the rats, their prostates were submitted for routine histology and correlation studies. Results In vivo MPM images distinguished periprostatic nerves within the capsule and the prostatic glands from fresh unprocessed prostatic tissue without the use of exogenous contrast agents or biopsy sample. Real‐time nerve tracking outlining the prostate was feasible and acquisition was not disturbed by motion artefacts. No serious adverse event was reported during rat monitoring; no tissue damage due to laser was seen on the imaged lobe compared with the contralateral lobe (control) allowing comparison of their corresponding histology. Conclusions For the first time, we have shown that in vivo tracking of periprostatic nerves using MPM is feasible in a rat model. Development of a multiphoton endoscope for intraoperative use in humans is currently in progress and must be assessed.
  • Review: The use of sling versus sphincter in post‐prostatectomy
           urinary incontinence
    • Abstract: Up till now the artificial urinary sphincter (AUS) was the so‐called gold standard in post‐prostatectomy incontinence. However, male slings have gained much popularity in recent years due to the ease in surgery, good functional results and low complications rates. This review systematically shows the evidence for the different sling systems, describes the working mechanism and compares their efficacy against that of the AUS. Furthermore subgroups of patients are defined who are not suited to undergo sling surgery.
  • Advances in the understanding of cancer immunotherapy
    • Abstract: The principal role of the immune system is to prevent and eradicate pathogens and infections. The key characteristics or features of an effective immune response include specificity, trafficking, antigen spread and durability (memory). The immune system is recognised to have a critical role in controlling cancer through a dynamic relationship with tumour cells. Normally, at the early stages of tumour development, the immune system is capable of eliminating tumour cells or keeping tumour growth abated; however, tumour cells may evolve multiple pathways over time to evade immune control. Immunotherapy may be viewed as a treatment designed to boost or restore the ability of the immune system to fight cancer, infections and other diseases. Immunotherapy manifests differently from traditional cancer treatments, eliciting delayed response kinetics and thus may be more effective in patients with lower tumour burden, in whom disease progression may be less rapid, thereby allowing ample time for the immunotherapy to evolve. Because immunotherapies may have a different mechanism of action from traditional cytotoxic or targeted biological agents, immunotherapy techniques have the potential to combine synergistically with traditional therapies.
  • Mechanisms of ATP release ‐ future therapeutic targets'
  • Trans‐Pacific variation in outcomes for men treated with primary
           androgen‐deprivation therapy (ADT) for prostate cancer
    • Abstract: Objectives To compare directly survival outcomes of primary androgen‐deprivation therapy (PADT) in Japan, where this treatment is endorsed by guidelines, with outcomes in the USA, where it is not. Patients and Methods Data were compared between men receiving PADT in the USA Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry and the Japanese Cancer of the Prostate (J‐CaP) registry database. Competing risks regression was used to assess prostate cancer‐specific mortality (CSM), adjusting for age, Japan Cancer of the Prostate Risk Assessment (J‐CAPRA) score, diagnosis year, and treatment type [combined androgen blockade (CAB) vs castration monotherapy], comorbidity, and practice type. Results Men on PADT in J‐CaP (13 880 men) were older than those in CaPSURE (1633 men), and had higher‐risk disease (mean J‐CAPRA score 3.8 vs 2.1, P < 0.001). They more often received CAB: 66.9% vs 46.4% (P < 0.001). Despite different risk profiles between the cohorts, CSM was similar on univariate analysis (log‐rank P = 0.88). On multivariable regression, the subhazard ratio for CSM was 0.52 for J‐CaP vs CaPSURE (95% confidence interval 0.40–0.68). Conclusions Men on PADT in Japan have less than half the adjusted CSM than those in the USA. These findings support both existing guidelines endorsing PADT in Asia and discouraging its use in the West. Elucidating the reasons behind these substantial differences, which probably include both genetic and dietary/environmental factors, may help explain the varying epidemiology of prostate cancer on either side of the Pacific.
  • Actions of cyclic 3'5’‐adenosine monophosphate (cAMP) on
           calcium sensitisation in human detrusor smooth muscle contraction
    • Abstract: Objectives To clarify the effect of cyclic adenosine monophosphate (cAMP) on the Ca2+‐sensitised smooth muscle contraction in human detrusor, as well as the role of novel exchange protein directly activated by cAMP (Epac) in cAMP‐mediated relaxation. Materials and Methods All experimental protocols to record isometric tension force were performed using α‐toxin‐permeabilized human detrusor smooth muscle strips. The mechanisms of cAMP‐mediated suppression of Ca2+ sensitisation activated by 10 μM carbachol (CCh) and 100 μM guanosine‐5’‐triphosphate (GTP) were studied using a selective rho kinase (ROK) inhibitor, Y‐27632, and a selective protein kinase C (PKC) inhibitor, GF‐109203X. The relaxation mechanisms were further probed using a selective protein kinase A (PKA) activator, 6‐Bnz‐cAMP, and selective Epac activator, 8‐pCPT‐2’‐O‐Me‐cAMP. Results CCh‐induced Ca2+ sensitisation was inhibited by cAMP in a concentration‐dependent manner. GF109203X (10 μM) but not Y‐27632 (10 μM) significantly enhanced the relaxation effect induced by cAMP (100 μM). 6‐Bnz‐cAMP (100 μM) predominantly decreased the tension force in comparison with 8‐pCPT‐2’‐O‐Me‐cAMP (100 μM). Conclusions We demonstrated that cAMP predominantly inhibited the ROK pathway but not the PKC pathway. The PKA‐dependent pathway is dominant, while Epac plays a minor role in human DSM Ca2+ sensitisation. This article is protected by copyright. All rights reserved.
  • The efficacy of irinotecan, paclitaxel, and oxaliplatin (IPO) in relapsed
           germ cell tumors with high dose chemotherapy as consolidation‐ a
           non‐cisplatin‐ based induction approach
    • Abstract: Objectives To determine the outcome of an expanded cohort of patients with relapsed germ cell tumors (GCT) treated with a salvage chemotherapy regimen consisting of irinotecan, paclitaxel and oxaliplatin (IPO) and assess the role of IPO as an alternative to standard cisplatin‐based chemotherapy regimens in this setting. Patients and methods The results of 72 consecutive patients were reviewed retrospectively. IPO was used either as a second‐line treatment (n=29), of which 20 patients subsequently received high‐dose chemotherapy (HDCT), or third‐line (n=43), of which 32 patients proceeded to HDCT. Results The 2‐year PFS and 3‐year OS rates for the whole cohort were 30.2% (95%CI 17.3‐40.5%) and 33.4% (95%CI: 20.1‐43.8 %) respectively. CR was achieved in 3%, m‐ve PR in 41%, m+ve PR in 18%, SD in 17% and PD in 20%. In the second‐line setting, the 2‐year PFS rate was 43.5% (95%CI: 21.7‐60.8%) and 3‐year OS 49.1% (95%CI: 24.2‐65.1%). In the third‐line setting, the 2‐year PFS rate was 21.0% (95%CI 9.5‐35.4%) and the 3‐year OS rate was 23.9% (95%CI 11.7‐38.2).According to the current international prognostic factor study group criteria for first relapse for the high and very high risk group the 2 year PFS rates were 50% and 30% respectively. There were 2 treatment related deaths from IPO, and 4 from HDCT. Grade 3 or 4 toxicities included neutropenia (35%), thrombocytopenia (18%), infection (15%), diarrhea (11%) and lethargy (8%).  Conclusions IPO offers an effective, well‐tolerated, non‐nephrotoxic alternative to cisplatin‐based salvage regimens for patients with relapsed GCT. It appears particularly useful in high risk patients and for those in whom cisplatin is ineffective or contra‐indicated.
  • Transperineal template‐guided prostate biopsy: 10 years of
    • Abstract: Objective • To assess the efficacy and safety of transperineal template‐guided prostate biopsy. Materials and Methods • From December 2003 to December 2013, a total of 3007 patients (30‐91 years old, mean age 69.1) who met the inclusion criteria underwent 11‐region transrectal ultrasound‐guided transperineal template prostate biopsy. • The inclusion criteria included a prostate‐specific antigen (PSA) level of 4.0 ng/ml or greater and abnormal prostate gland findings on digital rectal examination, ultrasound, CT or MRI. The median PSA level was 11.0 ng/ml (range 0.2‐100 ng/ml). • The prostate cancer detection rate and prostate biopsy adverse effects, as well as prostate cancer spatial distribution were analyzed. Results • A mean of 19.3 cores (range 11 to 44) were obtained for each biopsy, and more cores were obtained in larger prostates than in smaller ones. • One to four cores were collected from each region. Prostate cancer was detected in 1067 of the 3007 patients (35.5%). The prostate cancer detection rates in groups with PSA levels of 0‐4.0 ng/ml, 4.1‐10.0 ng/ml, 10.1‐20.0 ng/ml, 20.1‐50.0 ng/ml, and 50.1‐100.0 ng/ml were 15.3% (27/176), 21.0% (248/1179), 32.6% (318/975), 56.0% (232/414), and 92.0% (241/262), respectively. • The mean positives for cancer in regions 1‐10 and region 11 (the apical region) were 46.7% vs. 52.0% (P=0.014). • Regarding adverse effects, 47.0% of the patients reported hematuria, 6.1% developed hemospermia, 1.9% required short‐term catheterization after biopsy because of acute urinary retention, and 0.03% (one patient) developed urosepsis. Conclusions • Transrectal ultrasound‐guided transperineal template prostate biopsy is safe and accurate. • The current study suggests that prostate carcinoma foci are more frequently localized in the apical region.
  • Emerging trends in prostate cancer literature: medical progress or
           marketing hype'
    • Abstract: Objectives •  To review emerging trends in prostate cancer (PC) literature with a focus on the marketing and implementation of new technologies, and the use of PC terms Methods •  Literature search of MEDLINE for external‐beam radiotherapy, prostatectomy, deferred intervention and focal therapy articles pertaining to PC •  Observational trends of PC literature relating to the marketing of new technologies and the use of standardised language Results •  PC literature has proliferated across all treatment modalities, particularly in the research of new technologies (robot‐assisted prostatectomy, image‐guided radiotherapy and focal therapy) •  Marketing and implementation of new technologies has occurred in some instances before effectiveness and adverse effects have been determined •  Inconsistent use of terminology exists in the PC literature Conclusion •  There is an ever‐present need for editors and researchers to maintain integrity and relevance in PC research •  We advocate a standardised language in PC and inclusion of active surveillance and robot‐assisted prostatectomy as MeSH indexing to reflect current trends and needs in PC research
  • Welcome from the President
  • Waterloo
  • Best Academic Paper Session
  • Paper Session
  • ePoster Sessions
  • Author Index
  • Defining the learning curve for multiparametric magnetic resonance imaging
           (MRI) of the prostate using MRI‐transrectal ultrasonography (TRUS)
           fusion‐guided transperineal prostate biopsies as a validation tool
    • Abstract: Objectives To determine the accuracy of multiparametric magnetic resonance imaging (mpMRI) during the learning curve of radiologists using MRI targeted, transrectal ultrasonography (TRUS) guided transperineal fusion biopsy (MTTP) for validation. Patients and Methods Prospective data on 340 men who underwent mpMRI (T2‐weighted and diffusion‐weighted MRI) followed by MTTP prostate biopsy, was collected according to Ginsburg Study Group and Standards for Reporting of Diagnostic Accuracy standards. MRI data were reported by two experienced radiologists and scored on a Likert scale. Biopsies were performed by consultant urologists not ‘blinded’ to the MRI result and men had both targeted and systematic sector biopsies, which were reviewed by a dedicated uropathologist. The cohorts were divided into groups representing five consecutive time intervals in the study. Sensitivity and specificity of positive MRI reports, prostate cancer detection by positive MRI, distribution of significant Gleason score and negative MRI with false negative for prostate cancer were calculated. Data were sequentially analysed and the learning curve was determined by comparing the first and last group. Results We detected a positive mpMRI in 64 patients from Group A (91%) and 52 patients from Group E (74%). The prostate cancer detection rate on mpMRI increased from 42% (27/64) in Group A to 81% (42/52) in Group E (P < 0.001). The prostate cancer detection rate by targeted biopsy increased from 27% (17/64) in Group A to 63% (33/52) in Group E (P < 0.001). The negative predictive value of MRI for significant cancer (>Gleason 3+3) was 88.9% in Group E compared with 66.6% in Group A. Conclusion We demonstrate an improvement in detection of prostate cancer for MRI reporting over time, suggesting a learning curve for the technique. With an improved negative predictive value for significant cancer, decision for biopsy should be based on patient/surgeon factors and risk attributes alongside the MRI findings.
  • Is continent cutaneous urinary diversion a suitable alternative to
           orthotopic bladder substitute and ileal conduit after cystectomy'
    • Abstract: Objective To evaluate functional outcomes of continent cutaneous urinary diversion (CCUD) after radical cystectomy (RC) and to compare diversion‐related complications and long‐term renal function in a contemporary cohort of patients undergoing urinary diversion with CCUD, orthotopic bladder substitute (OBS) and ileal conduit (IC). Patients and Methods In all, 322 patients underwent RC and CCUD, OBS or IC from January 2002 to June 2013. CCUD was performed using either a modified Indiana pouch or an appendiceal stoma. For patients with CCUD, continence status and time intervals between clean intermittent catheterisations at last follow‐up were recorded. For all three diversion types, diversion‐related complications and renal function outcome, as determined by the estimated glomerular filtration rate (eGFR) at baseline and at different time intervals after surgery, were evaluated. Multivariate regression analysis was used to evaluate the association of diversion type, baseline variables and diversion‐related complications with renal function over time. Results Of all 322 patients, 73 (23%) received a CCUD, 79 (25%) received an OBS, and 170 (53%) received an IC. After a median follow‐up of 36 months, the continence rate for patients with a CCUD was 89%. In all, 64 (88%) patients with a CCUD were able to catheterise every 4–8 h and five (7%) were able to catheterise every 8–10 h. After a median follow‐up of 35 months, rates of diversion‐related complications were similar among patients who underwent a CCUD, an OBS or an IC. Patients who received an IC had poorer renal function preoperatively than those who received a CCUD or an OBS. However, at 1 year after surgery and thereafter, the three groups had comparable renal function. On multivariate analysis, the type of urinary diversion was not associated with decline in renal function. However, patient age at surgery, diabetes mellitus, baseline eGFR, postoperative non‐obstructive hydronephrosis and uretero‐enteric stricture were associated with decline in renal function. Conclusions A CCUD is associated with excellent functional outcomes. The rates of diversion‐related complications and renal function outcomes are comparable with those from an OBS and an IC. A CCUD should be considered a valid alternative for patients who undergo cystectomy and require urinary diversion.
  • ATP release from freshly isolated guinea‐pig bladder urothelial
           cells: a quantification and study of the mechanisms involved
    • Abstract: Objectives To quantify the amount of ATP released from freshly isolated bladder urothelial cells, study its control by intracellular and extracellular calcium and identify the pathways responsible for its release. Materials and Methods Urothelial cells were isolated from male guinea‐pig urinary bladders and stimulated to release ATP by imposition of drag forces by repeated pipetting. ATP was measured using a luciferin‐luciferase assay and the effects of modifying internal and external calcium concentration and blockers of potential release pathways studied. Results Freshly isolated guinea‐pig urothelial cells released ATP at a mean (sem) rate of 1.9 (0.1) pmoles/mm2 cell membrane, corresponding to about 700 pmoles/g of tissue, and about half [49 (6)%, n = 9) of the available cell ATP. This release was reduced to a mean (sem) of 0.46 (0.08) pmoles/mm2 (160 pmoles/g) with 1.8 mm external calcium, and was increased about two‐fold by increasing intracellular calcium. The release from umbrella cells was not significantly different from a mixed intermediate and basal cell population, suggesting that all three groups of cells release a similar amount of ATP per unit area. ATP release was reduced by ≈50% by agents that block pannexin and connexin hemichannels. It is suggested that the remainder may involve vesicular release. Conclusions A significant fraction of cellular ATP is released from isolated urothelial cells by imposing drag forces that cause minimal loss of cell viability. This release involves multiple release pathways, including hemichannels and vesicular release.
  • Effective non‐technical skills are imperative to
           robot‐assisted surgery
  • Predicting pathological outcomes in patients undergoing
           robot‐assisted radical prostatectomy for high‐risk prostate
           cancer: a preoperative nomogram
    • Abstract: Objective To identify which high‐risk patients with prostate cancer may harbour favourable pathological outcomes at radical prostatectomy (RP). Patients and methods We evaluated 810 patients with high‐risk prostate cancer, defined as having one or more of the following: PSA level of >20 ng/mL, Gleason score ≥8, clinical stage ≥T2c. Patients underwent robot‐assisted RP (RARP) with pelvic lymph node dissection, between 2003 and 2012, in one centre. Only 1.6% (13/810) of patients received any adjuvant treatment. Favourable pathological outcome was defined as specimen‐confined disease (SCD; pT2–T3a, node negative, and negative surgical margins) at RARP‐specimen. Logistic regression models were used to test the relationship among all available predicators and harbouring SCD. A logistic regression coefficient‐based nomogram was constructed and internally validated using 200 bootstrap resamples. Kaplan–Meier method estimated biochemical recurrence (BCR)‐free and cancer‐specific mortality (CSM)‐free survival rates, after stratification according to pathological disease status. Results Overall, 55.2% patients harboured SCD at RARP. At multivariable analysis, PSA level, clinical stage, primary/secondary Gleason scores, and maximum percentage tumour quartiles were all independent predictors of SCD (all P < 0.04). A nomogram based on these variables showed 76% discrimination accuracy in predicting SCD, and very favourable calibration characteristics. Patients with SCD had significantly higher 8‐year BCR‐ (72.7% vs 31.7%, P < 0.001) and CSM‐free survival rates (100% vs 86.9%, P < 0.001) than patients with non‐SCD. Conclusions We developed a novel nomogram predicting SCD at RARP. Patients with SCD achieved favourable long‐term BCR‐ and CSM‐free survival rates after RARP. The nomogram may be used to support clinical decision‐making, and aid in selection of patients with high‐risk prostate cancer most likely to benefit from RARP.
  • An investigation into the relationship between statins and cancer using
           population‐based data
  • The role of functional polymorphisms in immune response genes as
           biomarkers of bacille Calmette‐Guérin (BCG) immunotherapy
           outcome in bladder cancer: establishment of a predictive profile in a
           Southern Europe population
    • Abstract: Objective To evaluate the predictive value of genetic polymorphisms in the context of bacille Calmette‐Guérin (BCG) immunotherapy outcome and create a predictive profile that may allow discrimination of the risk of recurrence. Patients and Methods In a dataset of 204 patients treated with BCG, we evaluated 42 genetic polymorphisms in 38 genes involved in the BCG mechanism of action, using Sequenom MassARRAY® technology. Stepwise multivariate Cox regression was used for data mining. Results In agreement with previous studies we found that gender, age, tumour multiplicity and treatment scheme were associated with BCG failure. Using stepwise multivariate Cox regression analysis we propose the first predictive profile of BCG immunotherapy outcome and a risk score based on polymorphisms in immune system molecules [single nucleotide polymorphisms in tumour necrosis factor α (TNFA)‐1031T/C (rs1799964), interleukin 2 receptor α (IL2RA) rs2104286 T/C, IL17A‐197G/A (rs2275913), IL17RA‐809A/G (rs4819554), IL18R1 rs3771171 T/C, intercellular adhesion molecule 1 (ICAM‐1) K469E (rs5498), Fas ligand (FASL)‐844T/C (rs763110) and TNF‐related apoptosis‐inducing ligand receptor 1 (TRAILR1)‐397T/G (rs79037040)] in association with clinicopathological variables. This risk score allows the categorisation of patients into risk groups: patients within the low‐risk group have a 90% chance of successful treatment, whereas patients in the high‐risk group present a 75% chance of recurrence after BCG treatment. Conclusion We have established the first predictive score of BCG immunotherapy outcome combining clinicopathological characteristics and a panel of genetic polymorphisms. Further studies using an independent cohort are warranted. Moreover, the inclusion of other biomarkers may help to improve the proposed model.
  • Development and external validation of a prognostic tool for prediction of
           cancer‐specific mortality after complete loco‐regional
           pathological staging for squamous cell carcinoma of the penis
    • Abstract: Objective To develop a novel postoperative prognostic tool, which attempts to integrate both pathological tumour stage and histopathological factors, for prediction of cancer‐specific mortality (CSM) of squamous cell carcinoma of the penis (SCCP). Patients and Methods Patients with SCCP treated with inguinal lymph node dissection (ILND) or sentinel LN biopsy at a single institution were used for nomogram development and internal validation (n = 434), while a second cohort was used for external validation (n = 338). Multivariable Cox proportional hazards were used to examine the prognostic ability of patient age, a modified tumour staging that distinguishes between spongiosum and cavernosum body ingrowth tumours, a modified LN staging that integrates information on presence/absence of LN metastasis, extent of inguinal LN metastases, pelvic LN involvement, and extranodal involvement, and tumour grade. Model performance was quantified using measures of discrimination and calibration. Results Overall, 36% of patients had positive LN metastases (n = 156). In univariable analyses, the modified tumour and LN staging systems were statistically significantly associated with CSM, and remained in the final model with a discrimination of 89% within internal validation, and 95% within external validation. Calibration was nearly perfect. Conclusions The newly developed model integrates important prognostic factors, which existing models do not consider. Its performance was highly accurate using measures of discrimination and calibration.
  • Long‐Term Outcomes of Robot‐Assisted Radical Prostatectomy:
           Where Do We Stand'
  • Patterns of Surveillance Imaging After Nephrectomy in the Medicare
    • Abstract: Objectives To characterize patterns of imaging surveillance after nephrectomy in a population‐based cohort of older kidney cancer patients. Patients and Methods Using the Surveillance, Epidemiology, and End Results (SEER)‐Medicare database, we identified patients ≥66 years of age who had partial or radical nephrectomy for localized kidney cancer diagnosed between 2000 and 2009. Primary outcomes were chest (X‐ray or CT) and abdominal (CT, MRI or ultrasound) imaging in Medicare claims from 4 to 36 months after surgery. We estimated the frequency of imaging in three time periods (post‐operative months 4‐12, 13‐24, 25‐36), stratified by tumor stage. Repeated‐measures logistic regression was used to identify patient and disease characteristics associated with imaging. Results Rates of chest imaging were 65‐80%, with chest X‐ray surpassing CT in each time period. Rates of abdominal imaging were 58‐76%, and cross‐sectional imaging was more common than ultrasound in each time period. Use of cross‐sectional chest and abdominal imaging increased over time while chest X‐ray decreased (p
  • Robotic versus Non‐Robotic Instruments in Spatially Constrained
           Operative Workspaces – A Pre‐Clinical Randomised Crossover
    • Abstract: Objective To compare the effectiveness of robotic and non‐robotic laparoscopic instruments in spatially constrained workspaces. Materials and Methods Surgeons performed intracorporeal sutures with various instruments within 3 different cylindrical workspace sizes. Three pairs of instruments were compared; 3mm non‐robotic mini‐laparoscopy instruments, 5mm robotic instruments and 8mm robotic instruments. Workspace diameters were 4cm, 6cm and 8cm, with volumes of 50cm3, 113cm3 and 201cm3 respectively. Primary outcomes were validated objective task performance scores and instrument workspace breach counts. Results A total of 23 participants performed 276 suture task repetitions. Overall median task performance scores for 3mm, 5mm and 8mm instruments were 421, 398 and 402 respectively (P = 0.12). Task scores were highest (best) for 3mm non‐robotic instruments in all workspace sizes. Scores were significantly lower when spatial constraints were imposed, with median task scores for 4cm, 6cm and 8cm diameter workspaces being 388, 415 and 420 respectively (P = 0.026). Significant indirect relationships were seen between boundary breaches and workspace size (P < 0.001). Higher breach counts occurred with robotic instruments. Conclusion Smaller workspaces limit performance of robotic and non‐robotic instruments. In operative workspaces smaller than 200cm3, 3mm non‐robotic instruments are better suited for advanced bimanual operative tasks such as suturing. Future robotic instruments need further optimization if this technology is to be uniquely advantageous for clinical roles that involve endoscopic access to workspace restricted anatomical areas.
  • Prediction of Cancer‐Specific Survival After Radical Cystectomy in
           pT4a Urothelial Carcinoma of the Bladder – Development of a Tool for
           Clinical Decision‐making
    • Abstract: Objective To externally validate May et al.'s pT4a‐specific risk model for cancer‐specific survival (CSS) and to develop a new pT4a‐specific nomogram predicting CSS in an international multicentre cohort of patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) Patients and Methods Data of 856 pT4a patients after RC for UCB at 21 centres in Europe and North‐America was assessed. May et al.'s risk model including female gender, presence of positive LVI and lack of AC administration as adverse predictors for CSS was applied to our cohort. For the purpose of external validation, model discrimination was measured using the receiver operating characteristics derived area under the curve. A nomogram for predicting CSS in pT4a UCB after RC was developed after internal validation based on multivariable Cox proportional hazards regression analysis evaluating the impact of clinico‐pathological parameters on CSS. Decision curve analyses were applied to determine the net benefit derived from the two models. Results The estimated 5‐year‐CSS after RC was 34% in our cohort. May et al.'s risk model predicted individual 5‐year‐CSS with an accuracy of 60.1%. In multivariable Cox proportional hazards regression analysis, female gender (HR1.45), lymphovascular invasion (HR1.37), lymph node metastases (HR2.54), positive soft tissue surgical margin (HR1.39), neoadjuvant (HR2.24) and lack of adjuvant chemotherapy (HR1.67, all p
  • A phase I study of TRC105 anti‐CD105 (endoglin) antibody in
           metastatic castration‐resistant prostate cancer
    • Abstract: Objective ● TRC105 is a chimeric IgG1 monoclonal antibody that binds endoglin (CD105). ● This phase I open‐label study evaluated the safety, pharmacokinetics, and pharmacodynamics of TRC105 in patients with metastatic castration‐resistant prostate cancer (mCRPC). Patients and Methods ● Patients with mCRPC received escalating doses of intravenous TRC105 until unacceptable toxicity or disease progression, up to a predetermined dose level using a standard 3+3 phase I design. Results ● Twenty patients were treated and the top dose level studied of 20 mg/kg every two weeks was the maximum tolerated dose. ● Common adverse effects included infusion‐related reaction (90%), low grade headache (67%), anemia (48%), epistaxis (43%), and fever (43%). ● Ten patients had stable disease on study and eight patients had PSA declines. ● Significant plasma CD105 reduction was observed at the higher dose levels. In an exploratory analysis, vascular endothelial growth factor (VEGF) was increased after treatment with TRC105 and VEGF levels were associated with CD105 reduction. Conclusion ● TRC105 was tolerated at 20 mg/kg every other week with a safety profile distinct from that of VEGF inhibitors. ● There was a significant induction of plasma VEGF associated with CD105 reduction, suggesting anti‐angiogenic activity of TRC105. ● An exploratory analysis revealed a tentative correlation between the reduction of CD105 and a decrease in PSA velocity, suggestive of potential activity of TRC105 in the CRPC patients. The data from this exploratory analysis suggests rising VEGF is a possible compensatory mechanism for TRC105 induced anti‐angiogenic activity.
  • Evolving role of Positron Emission Tomography (PET) in Urological
    • Abstract: We present a review on the increasing indications for the use of Positron emission tomography (PET) in uro‐oncology. In our review we describe the details of the different types of PET scans, indications for requesting PET scans in specific urological malignancy and the interpretation of the results.
  • The cost‐effectiveness of sacral nerve stimulation for the treatment
           of idiopathic medically refractory overactive bladder (wet) in the UK
    • 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 NHS 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 five years. Costs and effects (measured as quality‐adjusted life years) were calculated to derive incremental cost‐effectiveness ratios. 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 five 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 favors 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.
  • Perioperative outcomes of cytoreductive nephrectomy in the UK in 2012
    • 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.
  • Population‐based study of long‐term functional outcomes after
           prostate cancer treatment
    • Abstract: Objective To evaluate long‐term urinary, sexual and bowel functional outcomes after prostate cancer treatment at a median follow‐up of 12 years (IQR 11‐13). Patients and methods In this nationwide, population‐based study, we identified from the National Prostate Cancer Register, Sweden, 6,003 men diagnosed with localized prostate cancer (clinical local stage T1‐2, any Gleason score, prostate specific antigen < 20 ng/mL, NX or N0, MX or M0) between 1997 and 2002 who were ≤70 years at diagnosis. 1,000 prostate cancer‐free controls were selected, matched for age and county of residence. Functional outcomes were evaluated with a validated self‐reported questionnaire. Results Responses were obtained from 3,937/6,003 cases (66%) and 459/1,000 (46%) controls. Twelve years post diagnosis, at a median age of 75 years, the proportion of cases with adverse symptoms was 87% for erectile dysfunction or sexually inactive, 20% for urinary incontinence and 14% for bowel disturbances. The corresponding proportions for controls were 62%, 6% and 7%, respectively. Men with prostate cancer, except those on surveillance, had an increased risk of erectile dysfunction, compared to control men. Radical prostatectomy was associated with increased risk of urinary incontinence (odds ratio; OR 2.29 [95% CI 1.83‐2.86] and radiotherapy increased the risk of bowel dysfunction (OR 2.46 [95% CI 1.73‐3.49]) compared to control men. Multi‐modal treatment, in particular including androgen deprivation therapy (ADT), was associated with the highest risk of adverse effects; for instance radical prostatectomy followed by radiotherapy and ADT was associated with an OR of 3.74 [95 CI 1.76‐7.95] for erectile dysfunction and OR 3.22 [95% CI 1.93‐5.37] for urinary incontinence. Conclusion The proportion of men who suffer long‐term impact on functional outcomes after prostate cancer treatment was substantial. This article is protected by copyright. All rights reserved.
  • Trifecta and optimal perioperative outcomes of robotic and laparoscopic
           partial nephrectomy in surgical treatment of small renal masses:
           a multi‐institutional study
    • Abstract: ObjectiveTo compare the perioperative outcomes of robotic partial nephrectomy (RPN) with laparoscopic PN (LPN) performed for small renal masses (SRMs), in a large multi‐institutional series and to define a new composite outcome measure, termed ‘optimal outcome’ for the RPN group. Patients and Methods Retrospective review of 2392 consecutive cases of RPN and LPN performed in five high‐volume centres from 2004 to mid‐2013. We limited our study to SRMs and cases performed by surgeons with significant expertise with the technique. The Trifecta was defined as negative surgical margin, zero perioperative complications and a warm ischaemia time of ≤25 min. The ‘optimal outcome’ was defined as achievement of Trifecta with addition of 90% estimated glomerular filtration rate preservation and no chronic kidney disease stage upgrading. Univariable and multivariable analysis were used to identify factors predicting Trifecta and ‘optimal outcome’ achievement. Results In all, 1185 RPN and 646 LPN met our inclusion criteria. Patients in the RPN group were older and had a higher median Charlson comorbidity index and higher R.E.N.A.L. nephrometry score. The RPN group had lower warm ischaemia time (18 vs 26 min), overall complication rate (16.2% vs 25.9%), and positive surgical margin rate (3.2% vs. 9.7%). There was a significantly higher Trifecta rate for RPN (70% vs 33%) and the rate of achievement of ‘optimal outcome’ for the RPN group was 38.5%. Conclusions In this large multi‐institutional series RPN was superior to LPN for perioperative surgical outcomes measured by Trifecta. Patients in the RPN group had better outcomes for all three components of Trifecta compared with their LPN counterparts. Our more strict definition for ‘optimal outcome’ might be a better tool for assessing perioperative and functional outcomes after minimally invasive PN. This tool needs to be externally validated.
  • Global surgery ‐ How much of the burden is urological'
    • Abstract: An estimated two billion people worldwide lack access to any surgical care (1) and surgical conditions account for 11 ‐ 30% of the global burden of disease (2). Delivery of surgical, and therefore, urological care is a pre‐requisite for a functioning healthcare system and vital to achieve the new post‐MDG (Millennium Development Goals) aim of ‘universal health coverage’(3). This article is protected by copyright. All rights reserved.
  • Robotic radical cystectomy with intracorporeal urinary diversion: Impact
           on an established enhanced recovery protocol
    • Abstract: Objectives To assess the impact of the introduction of robotic‐assisted radical cystectomy (RARC) on an established enhanced recovery programme (ERP). To examine the effect on mortality and morbidity rates, transfusion rates and length of stay Patients and Methods Data on 102 consecutive patients undergoing RARC with full intracorporeal reconstruction was 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 peri‐operative outcomes including transfusion rate, complication rates, 30d and 90d mortality rates and hospital stay. Results The demographics of the comparative groups showed no significant difference in age, gender distribution, American Society of Anesthesiologists grade. A significant reduction in transfusion rate was observed in the RARC versus the open groups (p
  • Could a dye offer a cheap and simple approach to detect bladder cancer
           using white‐light cystoscopy'
    • Abstract: One of the main problems following an initial diagnosis and treatment for bladder cancer is the very high level of recurrence, in up to 80% of patients and progression to more invasive types of cancer in as many as 45% (1). This necessitates a high level of patient monitoring, the most in any area of cancer care, which is both very expensive and not always reliable. The majority of this screening uses white light cystoscopy, in which a cystoscope or fibre‐optic light tube with a camera at one end, is introduced into the bladder and the lining of the bladder examined using normal white light. This techniques relies on the surgeon spotting changes in the lining of the bladder, which given its large surface area and folded nature is often difficult, particularly when the lesions are small such as papillary bladder tumours or flat such as the highly aggressive carcinoma in situ (CIS). This article is protected by copyright. All rights reserved.
  • Current challenges to urological training in sub‐Saharan Africa
    • Abstract: There is not a perfect model for overseas support, but it is clear that any intervention must be well planned, be responsive to local needs and ideally offer the opportunity for ongoing longitudinal support and training. Assessment and follow up of outcomes, whilst difficult, is essential to further improving global Urological care. It is the surgical community in low income countries that will ultimately enforce change but overseas urological input from organisations can offer significant expertise to enhance training. This article is protected by copyright. All rights reserved.
  • Long‐term results of a prospective randomised trial assessing the
           impact of readaptation of the dorsolateral peritoneal layer following
           extended pelvic lymph node dissection and cystectomy
    • Abstract: Objective To evaluate the long term oncological and functional outcomes after readaptation of the dorsolateral peritoneal layer following pelvic lymph node dissection (PLND) and cystectomy . Patients and Methods A randomised, single‐center, single‐blinded, two‐arm trial was conducted on 200 consecutive cystectomy patients who underwent PLND and cystectomy for bladder cancer (
  • Current status and effectiveness of mentorship programmes in urology: a
           systematic review
    • Abstract: The objectives of this review were to identify and evaluate the efficacy of mentorship programmes for minimally invasive procedures in urology and give recommendations on how to improve mentorship. A systematic literature search of the PubMed/Medline databases was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. In all, 21 articles were included in the review and divided into four categories: fellowships, mini‐fellowships, mentored skills courses and novel mentorship programmes. Various structures of mentorship programme were identified and in general, mentorship programmes were found to be feasible, having content validity and educational impact. Perioperative data showed equally good outcomes when comparing trainees and specialists. Mentorship programmes are effective and represent one of the best current methods of training in urology. However, participation in such programmes is not widespread. The structure of mentorship programmes is highly variable, with no clearly defined ‘best approach’ for postgraduate training. This review offers recommendations as to how this ‘best approach’ can be established.
  • Swedish National Penile Cancer Register: incidence, tumour
           characteristics, management and survival
    • Abstract: Objectives To assess penile cancer incidence, stage distribution, adherence to guidelines and prognostic factors in a population‐based setting. Patients and Methods The population‐based Swedish National Penile Cancer Register (NPECR) contains detailed information on tumour characteristics and management patterns. A total of 1 678 men with primary squamous cell carcinoma of the penis identified in the NPECR between 2000 and 2012 were included in the study. Results The mean age‐adjusted incidence of penile cancer was 2.1/100 000 men, remaining virtually unchanged during the study period. At diagnosis, 14 and 2% of the men had clinical N+ and M+ disease, respectively. Most men were staged pTis (34%), pT2 (19%), or pT1 (18%), while stage information was unavailable for 18% of the men. Organ‐preserving treatment was used in 71% of Tis–T1 tumours. Of men with cN0 and ≥pT1G2 disease, 50% underwent lymph node staging, while 74% of men with cN1–3 disease underwent lymph node dissection. The overall 5‐year relative survival rate was 82%. Men aged ≥40 years and those with pT2–3, G2–3 and N+ tumours had worse outcomes. Conclusions The incidence of penile cancer in Sweden is stable. Most men presented with localized disease, and the proportion of non‐invasive tumours was high. During the period under study, adherence to guidelines was suboptimum. The overall 5‐year relative survival rate was 82%. Older age, increasing tumour stage and grade, and increasing lymph node stage were associated with poorer survival.
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