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J. of Mass Spectrometry     Hybrid Journal   (Followers: 24, SJR: 1.207, h-index: 92)
J. of Medical Imaging and Radiation Oncology     Hybrid Journal   (Followers: 3, SJR: 0.513, h-index: 26)
J. of Medical Primatology     Hybrid Journal   (Followers: 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: 28, 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   (Followers: 1, 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: 20, SJR: 1.185, h-index: 38)
J. of Nursing Scholarship     Hybrid Journal   (Followers: 4, SJR: 1.258, h-index: 49)
J. of Obstetric, Gynecologic, & Neonatal Nursing     Hybrid Journal   (Followers: 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: 4, 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: 16, 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: 6, SJR: 0.524, h-index: 24)
J. of Pharmaceutical Sciences     Hybrid Journal   (Followers: 126, SJR: 1.284, h-index: 113)
J. of Philosophy of Education     Hybrid Journal   (Followers: 10, 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: 13, SJR: 0.62, h-index: 10)
J. of Political Philosophy     Hybrid Journal   (Followers: 30, SJR: 1.21, h-index: 31)
J. of Polymer Science Part A: Polymer Chemistry     Hybrid Journal   (Followers: 125, SJR: 1.211, h-index: 109)
J. of Polymer Science Part B: Polymer Physics     Hybrid Journal   (Followers: 24, SJR: 1.222, h-index: 96)
J. of Polymer Science Part C : Polymer Letters     Hybrid Journal   (Followers: 5)
J. of Popular Music Studies     Hybrid Journal   (Followers: 8, SJR: 0.199, h-index: 3)
J. of Product Innovation Management     Hybrid Journal   (Followers: 17, SJR: 2.115, h-index: 82)
J. of Prosthodontics     Hybrid Journal   (SJR: 0.44, h-index: 31)
J. of Psychiatric and Mental Health Nursing     Hybrid Journal   (Followers: 52, 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: 11, SJR: 2.642, h-index: 42)
J. of Religious Ethics     Hybrid Journal   (Followers: 6, SJR: 0.2, h-index: 10)
J. of Religious History     Hybrid Journal   (Followers: 19, SJR: 0.179, h-index: 7)
J. of Renal Care     Hybrid Journal   (Followers: 1, SJR: 0.468, h-index: 13)
J. of Research In Reading     Hybrid Journal   (Followers: 11, SJR: 0.789, h-index: 23)
J. of Research in Science Teaching     Hybrid Journal   (Followers: 14, SJR: 4.717, h-index: 70)
J. of Research in Special Educational Needs     Hybrid Journal   (Followers: 3, SJR: 0.525, h-index: 10)
J. of Research on Adolescence     Hybrid Journal   (Followers: 5, SJR: 1.851, h-index: 55)
J. of Risk & Insurance     Hybrid Journal   (Followers: 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: 9, SJR: 1.148, h-index: 71)
J. of Sexual Medicine     Hybrid Journal   (Followers: 6, SJR: 1.403, h-index: 65)
J. of Sleep Research     Hybrid Journal   (Followers: 11, SJR: 1.259, h-index: 73)
J. of Small Animal Practice     Hybrid Journal   (Followers: 9, 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: 17, 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: 9)
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: 25, 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: 79, 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: 8)
J. of the CardioMetabolic Syndrome     Hybrid Journal   (Followers: 1)
J. of the European Academy of Dermatology and Venereology     Hybrid Journal   (Followers: 11, 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: 33, SJR: 0.741, h-index: 31)
J. of the Royal Statistical Society Series A (Statistics in Society)     Hybrid Journal   (Followers: 13, SJR: 1.59, h-index: 49)
J. of the Royal Statistical Society Series B (Statistical Methodology)     Hybrid Journal   (Followers: 26, SJR: 7.863, h-index: 82)
J. of the Royal Statistical Society Series C (Applied Statistics)     Hybrid Journal   (Followers: 17, SJR: 1.435, h-index: 51)
J. of the Science of Food and Agriculture     Hybrid Journal   (Followers: 20, SJR: 0.846, h-index: 88)

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Journal Cover   BJU International
  [SJR: 1.812]   [H-I: 104]   [69 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  [1609 journals]
  • Proposed prognostic scoring system evaluating risk factors for biochemical
           recurrence of prostate cancer after salvage radiation therapy
    • Authors: Richard J Lee; Katherine S Tzou, Michael G Heckman, Corey J Hobbs, Bhupendra Rawal, Nancy N. Diehl, Jennifer L Peterson, Nitesh N Paryani, Stephen J Ko, Larry C Daugherty, Laura A Vallow, William Wong, Steven Schild, Thomas M Pisansky, Steven J Buskirk
      Abstract: Objective To update a previously proposed prognostic scoring system that predicts risk of biochemical recurrence (BCR) after salvage radiation therapy (SRT) for recurrent prostate cancer when using additional patients and a PSA value of 0.2 ng/ml and rising as the definition of BCR. Materials and Methods We included 577 patients who received SRT for a rising PSA following radical prostatectomy in this retrospective cohort study. Clinical, pathological, and SRT characteristics were evaluated for association with BCR using relative risks (RRs) from multivariable Cox regression models. Results With a median follow‐up of 5.5 years following SRT, 354 patients (61%) experienced BCR. At 5 years following SRT, 40% of patients were free of BCR. Independent associations with BCR were identified for pre‐SRT PSA (RR [doubling]: 1.25, P
      PubDate: 2015-07-18T03:51:10.759667-05:
      DOI: 10.1111/bju.13229
  • Sequencing Robot‐Assisted Extended Pelvic Lymph Node Dissection
           Prior to Radical Prostatectomy: A Step by Step Guide to Exposure and
    • Authors: Stephen B. Williams; Yasar Bozkurt, Mary Achim, Grace Achim, John W. Davis
      Abstract: Objective To describe a novel, step‐by‐step approach to robot‐assisted extended pelvic lymph node dissection (EPLND) at the time of robot‐assisted radical prostatectomy (RARP) for intermediate to high risk prostate cancer. Patient and Methods The sequence of EPLND is at the beginning of the operation to take advantage of greater visibility of the deeper, hypogastric planes. The urachus is left intact for an exposure/retraction point. The anatomy is described in terms of lymph nodes that are easily retrieved, versus those that require additional manipulation of the anatomy, and a determined surgeon. A representative cohort of 167 RARP's was queried for representative metrics that distinguish the EPLND: 146 primary cases and 21 with neoadjuvant systemic therapy. Results The median (Inner Quartile Range, IQR) lymph node yield was 22 (16‐28) for primary surgeries and 21 (16‐23) for neoadjuvant cases. The percentage of cases with positive nodes (pN1) was 16.4% for primary and 29% for neoadjuvant. The hypogastric lymph nodes were involved in 75% of pN1 primary cases—uniquely positive in 33%. Each side of EPLND took the attending a median 16 minutes (13‐20) and trainees 25 (24‐38). Conclusions Robotic extended pelvic lymph node dissection prior to robotic prostatectomy provides anatomical approach to surgical extirpation mimicking the open approach. We believe this sequence offers efficiency and efficacy advantages in high risk and select intermediate risk prostate cancer patients undergoing robotic prostatectomy. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-18T03:47:22.019263-05:
      DOI: 10.1111/bju.13228
  • URB937, a peripherally‐restricted inhibitor for fatty acid amide
           hydrolase, reduces prostaglandin E2‐induced bladder overactivity and
           hyperactivity of bladder mechano‐afferent nerve fibers in rats
    • Authors: Naoki Aizawa; Giorgio Gandaglia, Petter Hedlund, Tetsuya Fujimura, Hiroshi Fukuhara, Francesco Montorsi, Yukio Homma, Yasuhiko Igawa
      Abstract: Objectives To determine if an inhibition of the endocannabinoid‐degrading enzyme fatty acid amide hydrolase (FAAH) can counteract the changes in urodynamic parameters and bladder afferent activities induced by intravesical prostaglandin E2 (PGE2)‐instillation, we studied effects of URB937, a peripherally‐restricted FAAH inhibitor, on single‐unit afferent activity (SAA) during PGE2‐induced bladder overactivity in rats. Materials and methods Female Sprague‐Dawley rats were used. In SAA measurements during urethane anesthesia, SAAs of Aδ‐ and C‐fibers were identified by electrical stimulation of the pelvic nerve and by bladder distention. Cystometry in conscious animals and SAA measurements were performed during intravesical instillation of PGE2 (50 or 100 μM) after intravenous administration of URB937 (0.1 and 1 mg/kg) or vehicle. In separate experiments, comparative expressions of FAAH and cannabinoid receptors, CB1 and CB2, in microsurgically‐removed L6 dorsal root ganglion (DRG) were studied by immunofluorescence. Results During cystometry, 1mg/kg of URB937, but not vehicle or 0.1 mg/kg URB937, counteracted PGE2‐induced changes in urodynamic parameters. In SAA measurements, PGE2 increased SAAs of C‐fibers, but not Aδ‐fibers. URB937 (1 mg/kg) depressed Aδ‐fiber SAAs and abolished the facilitated C‐fiber SAAs induced by PGE2. DRG nerve cells showed strong staining for FAAH, CB1 and CB2, with 77 ± 2% and 87 ± 3% of FAAH‐positive nerve cell bodies co‐expressing CB1 or CB2‐immunofluorescence. Conclusion The present results demonstrate that URB937, a peripherally‐restricted FAAH inhibitor, reduces bladder overactivity and C‐fiber hyperactivity of the rat bladder provoked by PGE2, suggesting an important role of the peripheral endocannabinoid system in bladder overactivity and hypersensitivity. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-18T03:46:58.283778-05:
      DOI: 10.1111/bju.13223
  • Prognostic value of Caveolin‐1 in patients treated with radical
           prostatectomy: a multicentric validation study
    • Authors: Romain Mathieu; Tobias Klatte, Ilaria Lucca, Aurélie MBeutcha, Christian Seitz, Pierre I.  Karakiewicz, Harun Fajkovic, Maxine Sun, Yair Lotan, Douglas S. Scherr, Francesco Montorsi, Alberto Briganti, Morgan Rouprêt, Vitaly Margulis, Michael Rink, Luis A. Kluth, Malte  Rieken, Lukas Kenner, Martin Susani, Brian D. Robinson, Evanguelos Xylinas, Wolgang Loidl, Shahrokh F. Shariat
      Abstract: Objective To validate Caveolin‐1 as an independent prognostic marker of biochemical recurrence (BCR) in a large multi‐institutional cohort of patients treated with radical prostatectomy (RP). Subjects/patients and methods Caveolin‐1 expression was evaluated by immunochemistry on a tissue microarray from 3117 patients treated with RP for prostate cancer (PCa) at five institutions. Univariable and multivariable Cox proportional hazards regression models assessed the association of Caveolin‐1 status with BCR. Harrell's C‐index quantified prognostic accuracy (PA). Results Overexpression of Caveolin‐1 was observed in 644 (20.6%) patients and was associated with higher pathological Gleason sum (p=0.002) and lymph node metastases (p=0.05). Within a median follow‐up of 38 months (IQR 21‐66), 617 (19.8%) patients experienced BCR. Patients with overexpression of Caveolin‐1 had worse BCR free survival compared to patients with normal expression (log rank test, p=0.004). Caveolin‐1 was an independent predictor of BCR in multivariable analyses that adjusted for the effects of standard clinicopathologic features (HR=1.21, p=0.037). Addition of Caveolin‐1 in a model for prediction of BCR based on these standard prognosticators did not significantly improve predictive accuracy of the model. In subgroup analyses, Caveolin‐1 was associated with BCR in patients with favorable pathologic features (pT2pN0 and Gleason score = 6) (p=0.021). Conclusions We confirmed that the overexpression of Caveolin‐1 is associated with adverse pathologic features in PCa and independently predicts BCR after RP, especially in patients with favorable pathologic features. However, it did not add prognostically relevant information to established predictors of BCR, limiting its use in clinical practice. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-18T03:46:45.630511-05:
      DOI: 10.1111/bju.13224
  • A seer database malfunction: perceptions, pitfalls and verities
    • Authors: Maxine Sun; Quoc‐Dien Trinh
      Abstract: On April 29th 2015, the National Cancer Institute issued a statement regarding the Surveillance, Epidemiology, and End Results (SEER) database. Following a routine quality check, they found that a percentage of prostate‐specific antigen (PSA) values had been incorrectly reported. Essentially, a number of registrars were miscoding the decimal point within the 3‐digit field. For example, a PSA value of 4.0 ng/ml should be coded as 040 but would erroneously be coded as 004 in some cases. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-18T03:46:34.424291-05:
      DOI: 10.1111/bju.13226
  • Functional role of the TRPM8 ion channel in the urinary bladder assessed
           by conscious cystometry and ex vivo measurements of single‐unit
           mechanosensitive bladder afferent activities in the rat
    • Authors: Hiroki Ito; Naoki Aizawa, Rino Sugiyama, Shuzo Watanabe, Nobuyuki Takahashi, Masaomi Tajimi, Hiroshi Fukuhara, Yukio Homma, Yoshinobu Kubota, Karl‐Erik Andersson, Yasuhiko Igawa
      Abstract: Objectives To evaluate the role of the transient receptor potential melastatin 8 (TRPM8) channel on bladder mechanosensory function by using L‐menthol, a TRPM8 agonist, and RQ‐00203078 (RQ), a selective TRPM8 antagonist. Materials and methods Female Sprague‐Dawley rats were used. In conscious cystometry, the effects of intravesical instillation of L‐menthol (3 mM) were recorded after intravenous (i.v.) pretreatment with RQ (3 mg/kg) or vehicle. The direct effects of RQ on conscious cystometry and deep body temperature were evaluated with cumulative i.v.‐administrations of RQ at 0.3, 1, and 3 mg/kg. Single‐unit mechanosensitive bladder afferent activities (SAAs) were monitored in a newly established ex vivo rat bladder model to avoid systemic influences of the drugs. Recordings were performed after cumulative intra‐aortic administration of RQ (0.3 and 3 mg/kg) with or without intra‐vesical L‐menthol instillation (3 mM). Results Intravesical L‐menthol decreased bladder capacity and voided volume, which was counteracted by RQ‐pretreatment. RQ itself increased bladder capacity and voided volume, and lowered deep body temperature in a dose‐dependent manner. RQ decreased mechanosensitive SAAs of C‐fibres, and inhibited the activation of SAAs induced by intravesical L‐menthol. Conclusion Our results suggest that TRPM8 channels have a role in activation of bladder afferent pathways during filling of the bladder in the normal rat. This effect seems, at least partly, to be mediated via mechanosensitive C‐fibres. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-18T03:46:24.562355-05:
      DOI: 10.1111/bju.13225
  • The effectiveness of BCG and interferon against non‐muscle invasive
           bladder cancer: A New Zealand Perspective
    • Authors: T O'Regan; M Tatton, M Lyon, J Masters
      Abstract: Objective To ascertain whether the current practice at Auckland City Hospital of adding interferon to BCG in patients with high risk or recurrent non‐muscle invasive bladder cancer (NMIBC) unable or unwilling to undergo radical cystectomy is effective. Subjects and method This study examined all institutional cases where BCG alone had not been effective or tolerated as primary treatment for NMIBC and the next guideline agreed step of radical cystectomy was unable to be performed. We identified all patients unwilling or unable to undergo radical cystectomy due to patient co‐morbidities or preference for whom ongoing treatment and care was required and included 45 in the data analysis. Current practice at Auckland City Hospital is adding interferon α‐2b to BCG for this population group and all patients that were given this therapy with at least three years of follow up data from diagnosis were included into the study. Patients were either on maintenance BCG or single dosing. Several secondary outcomes were also assessed concurrently to the primary objective. Results This observational study showed that adding interferon to BCG proved to be an effective therapy for both treatment and salvage therapy in this patient group with 56% of the patients disease (and recurrence) free at the time of audit. 8/45 patients died whilst undergoing treatment with two of these as a direct result of bladder cancer due to disease progression. Conclusion This therapy has improved outcomes at our institution and has a place as a treatment of choice in this difficult to manage patient group. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-14T10:42:30.22682-05:0
      DOI: 10.1111/bju.13211
  • Predictors of Prostate Cancer Specific Mortality after Radical
           Prostatectomy: 10 year oncologic outcomes from the Victorian Radical
           Prostatectomy Registry
    • Authors: Damien Bolton; Nathan Papa, Anthony Ta, Jeremy Millar, Adee‐Jonathan Davidson, John Pedersen, Rodney Syme, Manish I. Patel, Graham G Giles
      Abstract: Purpose To identify the ability of multiple variables to predict prostate cancer specific mortality (PCSM) in a whole of population series of all radical prostatectomies (RP) performed in Victoria, Australia. Materials & Methods A total of 2,154 open RPs were performed in Victoria between July 1995 and December 2000. Subjects without follow up data, Gleason grade, pathological stage were excluded as were those who had pT4 disease or received neoadjuvant treatment. 1,967 cases (91.3% of total) met the inclusion criteria for this study. Tumour characteristics were collated via a central registry. We used competing hazards regression models to investigate associations. Results At median follow up of 10.3 years pT stage of RP (p
      PubDate: 2015-07-14T10:42:10.298268-05:
      DOI: 10.1111/bju.13112
  • The State Of TRUS Biopsy Sepsis: Readmissions To Victorian Hospitals With
           TRUS Biopsy‐Related Infection Over 5 Years
    • Authors: Hedley Roth; Jeremy L Millar, Allen C Cheng, Amanda Byrne, Sue Evans, Jeremy Grummet
      Abstract: Objectives To describe the incidence, morbidity and mortality of men who developed infectious complications requiring hospital admission following TRUS prostate biopsy in Victoria, Australia. Further it aimed to report the financial cost of these admissions. Subjects & Methods The Department of Health's Victorian Admitted Episodes Data Set was used to identify those patients who underwent TRUS biopsy in Victoria who were subsequently readmitted within 7 days to any Victorian hospital with infective complications from July 2007 to June 2012. All Victorian public and private hospitals were included. Patients were excluded if their biopsy was performed during a multi‐day admission. Financial costing data was obtained where available from the Department Of Health and Human Services for readmissions with post‐TRUS infection where available and adjusted to 2012 prices. Institutional ethics committee approval was granted for this study. Results 34,865 TRUS biopsies were performed in the 5‐year period. 1276 (3.66%) were readmitted to a Victorian hospital within 7 days. 604 (1.73%) of these were readmitted with a biopsy‐related infection. No significant trend in sepsis rates was seen in five years. The median readmission LOS was 4 days. The total burden of readmission was 3,686 days over 5 years. One patient readmitted with a biopsy related infection died during that episode of care. 20,051 (57.51%) of biopsies resulted in a diagnosis of prostate cancer. Financial costing data was available for 218 (36%) of infectious readmissions with a mean cost per readmission were $7,362 AUD (£4137 or $6844 USD, 95% CI $6219‐8505 AUD) or $1,256 AUD per day. Conclusion Infection following TRUS biopsy was associated with a readmission rate for infection of 1 in 57 biopsies, an excess of 3,686 bed days required over 5 years with a cost of $1,256 AUD per day. The rate of infection remained stable for the period examined. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-14T10:41:54.356373-05:
      DOI: 10.1111/bju.13209
  • Botulinum toxin (OnabotulinumtoxinA) in the male non‐neurogenic
           overactive bladder: clinical and quality of life outcomes
    • Authors: David Habashy; Giovanni Losco, Vincent Tse, Ruth Collins, Lewis Chan
      Abstract: Objective To assess the efficacy of OnabotulinumtoxinA (BTXA) injections in men with drug‐refractory non‐neurogenic overactive bladder (NNOAB). Patients and methods A total of 43 men received BTXA injections for NNOAB from 2004 to 2012. Patient Global Impression of Improvement (PGI‐I) score was obtained. For men with wet NNOAB, change in number of pads per day was also assessed. Results 43 men with a mean age of 69 (range 37‐85) received at least one injection. Of the 43 men, 20 (47%) had prior prostate surgery: 11 had radical prostatectomy (RP) and 9 had transurethral resection of prostate (TURP). Overall, average PGI‐I score was 2.7. Comparing PGI‐I score in men who had prior prostate surgery with men who have not: 2.6±0.5 Vs 2.8±0.5 respectively (average ± 95%CI), p = 0.6. Comparing PGI‐I score in men who had previous TURP with men who had previous RP: PGI‐I score: 3.3±0.8 Vs 2.0±0.5 respectively, p < 0.05. Men who had RP experienced a reduction in pad use (from 3.5±1.7 to 1.6±0.9pads/day, p < 0.05) while this was not the case amongst men who had TURP (from 1.7±1.5 to 1.4±1.5 pads/day, p = 0.4). Conclusion Overall, BTXA injection in men with drug‐refractory NNOAB does provide a symptomatic benefit. Amongst men who have had prior prostate surgery, men who have had RP experience a greater benefit than men who have had TURP, both in regards to PGI‐I score and pad use. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-14T10:41:47.765498-05:
      DOI: 10.1111/bju.13110
  • Rates of Self‐Reported Burnout and Causative Factors amongst
           Urologists in Ireland and the U.K. – A Comparative
           Cross‐Sectional Study
    • Authors: F O'Kelly; R.P Manecksha, D.M Quinlan, A Reid, A Joyce, K O'Flynn, M Speakman, J.A Thornhill
      Abstract:  Objectives To determine the incidence of burnout among UK and Irish urological consultants and trainees. The second objective was to identify possible aetiological factors and to investigate the impact of various vocational stressors that urologists face in their day‐to‐day work and to establish whether these correlate with burn out. The third objective was to develop a new questionnaire to complement the Maslach Burnout Inventory (MBI), but which would be more specific to urologists, as distinct from other surgical/medical specialties, and to use this in addition to the MBI to determine if there is a requirement to develop effective preventative measures for stress in the work place, and develop targeted remedial measures when individuals are affected by burnout Materials&Methods A joint collaboration was carried out between the Irish Society of Urology (ISU) and the British Association of Urological Surgeons (BAUS). Anonymous voluntary questionnaires were sent to all current registered members of both governing bodies. The questionnaire comprised of two parts. The first part encompassed sociodemographic data collection and identifying potential risk factors for burnout, and the second utilized the Maslach Burnout inventory (MBI) to objectively assess for workplace burnout. Statistical analysis was performed using GraphPad Prism Version 6.0b for Mac OS X. To evaluate differences in burnout, 2x2 contingency tables and Fischer's exact probability tests were used to demonstrate statistical significance. P‐values
      PubDate: 2015-07-14T10:11:58.633402-05:
      DOI: 10.1111/bju.13218
  • Baicalein ameliorates renal interstitial fibrosis by inducing
           myofibroblast apoptosis in vivo and in vitro
    • Authors: Wei Wang; Pang‐hu Zhou, Chang‐geng Xu, Xiang‐jun Zhou, Wei Hu, Jie Zhang
      Abstract: Objective To investigate antifibrotic effects of baicalein and its influence on myofibroblasts in vivo and in vitro. Materials and Methods Unilateral ureteral obstruction mouse in vivo and TGF‐β1 activated NRK49F in vitro models were established. After that, baicalein treatment was applied to investigate its anti‐fibrotic effects and potential mechanisms. Results Baicalein attenuated renal fibrosis by ameliorating kidney injury, reducing deposition of fibronectin and collagen‐I, and inducing apoptosis on myofibroblasts in unilateral ureteral obstruction mice model. Baicalein also induced the apoptosis of TGF‐β1‐activated myofibroblasts in vitro in a dose‐dependent manner. Furthermore, baicalein triggered a cascade of mitochondrion‐associated apoptosis by upregulating cleaved caspase‐3, Bax, and cleaved caspase‐9 while downregulating the protein expression of Bcl‐2. Additionally, down‐regulation of pAkt was found in the baicalein‐induced pro‐apoptotic components. Conclusions The findings demonstrated that baicalein can ameliorate tubulointerstitial fibrosis by inducing myofibroblast apoptosis through the mitochondrion‐associated intrinsic pathway might mediated by the inhibition of PI3k/Akt. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-14T10:11:44.030857-05:
      DOI: 10.1111/bju.13219
  • Comparison of Survival Rates in Stage 1 Renal Cell Carcinoma Between
           Partial Nephrectomy and Radical Nephrectomy Patients According to Age
           Distribution: A Propensity Score Matching Study
    • Authors: Toshio Takagi; Tsunenori Kondo, Junpei Iizuka, Kenji Omae, Hirohito Kobayashi, Kazuhiko Yoshida, Yasunobu Hashimoto, Kazunari Tanabe
      Abstract: Objective To assess differences in overall survival (OS) between patients receiving partial nephrectomy (PN) and radical nephrectomy (RN) for Stage 1 renal cell carcinoma (RCC) according to age distribution. The survival advantage of PN vs. RN in RCC patients has been unclear owing to conflicting data. Methods We studied 952 Stage 1 RCC patients who underwent either PN or RN. Patients were divided into 3 groups according to age: Group 1 (≤54 years), Group 2 (55–64 years), and Group 3 (≥65 years). Patient variables including age, BMI, sex, presence of hypertension (HT) and/or diabetes mellitus (DM), performance status, tumor size, pathological diagnosis, nuclear grade, and preoperative estimated glomerular filtration rate (eGFR) were adjusted using 1:1 propensity score matching between PN and RN. Results Group 1 included 66 matched patients; Group 2, 72; and Group 3, 70. Group 1 tended to have higher preoperative eGFR values and lower rates of HT and DM compared to Groups 2 and 3. Postoperative eGFR dropped by 11–13% in PN patients and by 34–36% in RN patients. In Group 3, PN patients had longer OS than RN patients (5‐year OS: PN 96%, RN 81%, p = 0.0430); however, there was no significant difference in Group 1 (5‐year OS: PN 100%, RN 93%, p = 0.3021) or Group 2 (5‐year OS: PN 94%, RN 87%, p = 0.3577). Conclusions Only the oldest group of patients showed significantly better OS owing to PN compared to RN; however, we still recommend PN in young patients. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-02T03:47:01.446397-05:
      DOI: 10.1111/bju.13200
  • Actions of cyclic 3'5’‐adenosine monophosphate (cAMP) on
           calcium sensitisation in human detrusor smooth muscle contraction
    • Authors: Maya Hayashi; Shunichi Kajioka, Momoe Itsumi, Ryosuke Takahashi, Nouval Shahab, Takao Ishigami, Masahiro Takeda, Noriyuki Masuda, Akito Yamaguchi, Seiji Naito
      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.
      PubDate: 2015-07-02T03:30:29.076746-05:
      DOI: 10.1111/bju.13180
  • Guidelines of Guidelines: Urinary Incontinence
    • Authors: Raveen Syan; Benjamin M. Brucker
      Abstract: Objective to review key guidelines on the management of urinary incontinence in order to guide clinical management in a practical way. Materials and methods guidelines produced by the European Association of Urology (updated in 2014), the Canadian Urological Association (updated in 2012), the International Consultation on Incontinence (updated in 2012), and the National Collaborating Centre for Women's and Children's Health (updated in 2013) were examined and their recommendations compared. In addition, specialized guidelines produced by the collaboration between the American Urological Association and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction on overactive bladder and the use of urodynamics were reviewed. The Appraisal of Guidelines for Research & Evaluation II (AGREE) Instrument was used to evaluate the quality of these guidelines. Results there is general agreement between the groups on the recommended initial workup and the use of conservative therapies for first line treatment, with limited role for imaging or invasive testing in the uncomplicated patient. These groups have greater variability in their recommendations for invasive procedures, however generally the mid‐urethral sling is recommended for uncomplicated stress urinary incontinence, with different recommendations on the approach as well as the comparability to other treatments, such as the autologous fascial sling. Conclusion this Guideline of Guidelines provides a summary of the salient similarities and differences between prominent groups on the management of urinary incontinence. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-01T19:26:13.691765-05:
      DOI: 10.1111/bju.13187
  • Comparison of Robotic and Laparoscopic for Complex Renal Tumors with RENAL
           nephrometry score ≥7: Perioperative and Oncological outcomes
    • Authors: Yubin Wang; Xin Ma, Qingbo Huang, Qingshan Du, Huijie Gong, Jiwen Shang, Xu Zhang
      Abstract: Objective To evaluate the perioperative, functional and oncological outcomes of robotic partial nephrectomy (RPN) and laparoscopic partial nephrectomy (LPN) for moderately or highly complex tumors (RENAL nephrometry score≥7). Patients and Methods We retrospectively analyzed the medical charts of 216 patients with complex tumors who underwent LPN(N = 135)or RPN (N = 81) from 2008 to 2014. Perioperative data, pathologic variables, complications, functional and oncological outcomes were reviewed. Results Demographic characteristics were similar between both groups. LPN associated with longer operative time (149.6 vs 135.6 min; P = 0.017) and increased estimated blood loss (220.8 vs 196.5 ml; P = 0.013). Patients undergoing RPN required more direct cost. There were no differences in warm ischemia time, transfusion rate, conversion rate, hospital stay, operative complications and eGFR change at 6 mo after surgery. Mean follow‐up for LPN and RPN was 31.4 mo and 16.5 mo, respectively. The 3‐year recurrence‐free survival rate was 95.2% for LPN and 97.1% for RPN (P = 0.71). Conclusions RPN and LPN performed in patients with complex tumors offer acceptable and comparable results in terms of perioperative, functional and oncological outcomes. Additionally, RPN was superior to LPN in term of estimated blood loss and operation time, and LPN was the more cost‐effective approach. Both surgery techniques remain viable options in the management of complex tumors with RENAL score≥7. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-01T10:18:00.546558-05:
      DOI: 10.1111/bju.13214
  • Cellular basis of detrusor smooth muscle contraction
    • Authors: Martin C. Michel
      Abstract: The cellular mechanisms and particularly the signal transduction pathways controlling contraction and relaxation of detrusor smooth muscle are insufficiently understood [1]. A better understanding could lead to novel therapeutics for patients with detrusor over‐ or underactivity, making this a question of potential clinical relevance. What determines smooth muscle tone? At the cellular level, smooth muscle contraction in the detrusor and other tissues is primarily driven by an increase of the free intracellular Ca2+ concentration. However, the extent of smooth muscle contraction in response to an intracellular Ca2+ concentration is determined by the phosphorylation state of several enzymes [2]. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-29T08:21:25.835975-05:
      DOI: 10.1111/bju.13216
  • Does transition from daVinci Si to daVinci Xi robotic platform impact
           single‐docking technique for robot‐assisted laparoscopic
    • Authors: Manish Patel; Ahmed Aboumohamed, Ashok Hemal
      Abstract: Objectives To describe technique for performing robot‐assisted nephroureterectomy (RNU) for benign and RNU with enblock excision of a bladder cuff (BCE) and lymphadenectomy (LND) for malignant indications utilizing da Vinci Si and da Vinci Xi robotic platform with its pros and cons. The port placement described for Si can be used for standard and S robotic system. This is the first report in the literature on the use of the da Vinci Xi robotic platform for nephroureterectomy. Patients & Methods After a substantial experience of RNU utilizing different da Vinci robots from standard to Si platform in a single docking fashion for benign and malignant conditions, we started using the newly released da Vinci Xi robot since 2014. The most important differences are in port placements and effective use of features of da Vinci Xi robot while performing simultaneous upper and lower tract surgery. Patient positioning, port placements, step‐by step technique of single docking RNU‐LND‐BCE utilizing da Vinci Si and da Vinci Xi robot are demonstrated in accompanying video with the goal that centers using either robotic system can be benefitted with the tips. The first segment of video describe RNU‐LND‐BCE utilizing da Vinci Si followed by da Vinci Xi to highlight differences. There was no need for patient repositioning or robot re‐docking with the new daVinci Xi robotic platform. Results We have experience of using different robotic system for single docking nephroureterectomy in 70 cases for benign and malignant conditions. The daVinci Xi robotic platform helps operating room personnel in its easy movement, allows easier patient side‐docking with the help of its boom feature, in addition to easy and swift movements of the robotic arms. The patient clearance feature can be used to avoid collision with the robotic arms or patient's body. In patients with difficult body habitus and in situations where bladder cuff management is difficult; modifications can be made through reassigning the camera to different port with utilization of the retargeting feature of the daVinci Xi when working on the bladder cuff or in pelvis. The vision of the camera used for daVinci Xi is initially felt to be inferior to that of the daVinci Si; however, subsequent software upgrade much improved the vision with the new robot. The base of the daVinci Xi is bigger which does not slide and occasionally requires change in table placement / operating room setup and require side‐docking especially when dealing with very tall and obese patient for pelvic surgery. Summary / Conclusions RNU alone or with LND‐BCE is a challenging surgical procedure which addresses the upper and lower urinary tract simultaneously. Single docking and single robotic port placement for RNU‐LND‐BCE has evolved with the development of different generations of the robotic system. These procedures can be performed safely and effectively using the da Vinci S, Si or Xi robotic platform. The new da Vinci Xi robotic platform is more user‐friendly, has easy installation and is intuitive for surgeons utilizing its features. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-29T04:42:39.481927-05:
      DOI: 10.1111/bju.13210
  • Variability of Inter‐observer Agreement on Feasibility of Partial
           Nephrectomy Before and After Neoadjuvant Axitinib for Locally Advanced
           RCC: Independent Analysis from a Phase II Trial
    • Authors: Jose A. Karam; Catherine E. Devine, Bryan M. Fellman, Diana L. Urbauer, E. Jason Abel, Mohamad E. Allaf, Axel Bex, Brian R. Lane, R. Houston Thompson, Christopher G. Wood
      Abstract: Objective To evaluate how many patients could have undergone PN instead of RN before and after neoadjuvant axitinib therapy, as assessed by 5 independent urologic oncologists, and to study the variability of inter‐observer agreement. Patients and Methods Pre‐ and post systemic treatment CT scans from 22 patients with ccRCC in a phase II neoadjuvant axitinib trial were reviewed by 5 independent urologic oncologists. RENAL score and Kappa statistics were calculated. Results Median RENAL score changed from 11 pre‐treatment to 10 post‐treatment, p=0.0017. Five tumors with moderate‐complexity pre‐treatment remained moderate‐complexity post‐treatment. Of 17 tumors with high‐complexity pre‐treatment, 3 became moderate‐complexity post‐treatment. Overall kappa statistic was 0.611. Moderate‐complexity kappa was 0.611 vs. high‐complexity kappa of 0.428. Pre‐treatment kappa was 0.550 vs. post‐treatment of 0.609. After treatment with axitinib, all 5 reviewers agreed that only 5 patients required RN (instead of 8 pre‐treatment) and that 10 patients could now undergo PN (instead of 3 pre‐treatment). The odds of PN feasibility were 22.8‐times higher after treatment with axitinib. Conclusions There is considerable variability in inter‐observer agreement on the feasibility of PN in patients treated with neoadjuvant targeted therapy. Although more patients were candidates for PN after neoadjuvant therapy, it remains difficult to identify these patients a priori. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-29T01:36:04.952909-05:
      DOI: 10.1111/bju.13188
  • Global surgery ‐ How much of the burden is urological'
    • Authors: Nicholas J. Campain; Ruaraidh P. MacDonagh, Kien Alfred Mteta, John S. McGrath,
      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.
      PubDate: 2015-06-29T01:01:35.363567-05:
      DOI: 10.1111/bju.13170
  • Current challenges to urological training in sub‐Saharan Africa
    • Authors: Nicholas J. Campain; Ruaraidh P. MacDonagh, Kien A. Mteta, John S. McGrath,
      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.
      PubDate: 2015-06-28T23:57:26.120704-05:
      DOI: 10.1111/bju.13168
  • Oncologic control associated with surgical resection of isolated
           retroperitoneal lymph node recurrence from renal cell carcinoma
    • Authors: Christopher M. Russell; Kathy Lue, John Fisher, Wassim Kassouf, Thomas Schwaab, Wade J. Sexton, Simon Tanguay, Sarah P. Psutka, R. Houston Thompson, Bradley C. Leibovich, Michael I. Hanzly, Philippe E. Spiess, Stephen A. Boorjian
      Abstract: Objective To evaluate the outcome of patients following surgical resection of isolated retroperitoneal lymph node (RPLN) recurrence of renal cell carcinoma (RCC) using a multicenter international cohort. Materials And Methods Fifty patients were identified who underwent resection of isolated RPLN recurrence of RCC at four institutions following nephrectomy for pTanyNanyM0 disease. Progression‐free (PFS) and cancer‐specific survival (CSS) were estimated using the Kaplan‐Meier method. Cox proportional hazards regression models were utilized to assess the association of clinicopathological characteristics with disease progression. Results Median age at resection was 57.0 years (IQR 50.0‐62.5). Median time to RPLN recurrence following nephrectomy was 12.6 months (IQR 6.9‐39.5), with no significant difference in median time to RPLN recurrence noted between patients with N+ disease at nephrectomy (10.7 months (IQR 6.5‐24.6)) and patients with Nx/pN0 disease at nephrectomy (13.7 months (IQR 8.7‐44.2)) (p=0.66). Median size of the RPLN recurrence prior to resection was 2.6 cm (IQR 1.9‐5). The most common site for RPLN recurrence was within the interaortocaval region (34%). Median follow‐up after RPLN resection for patients alive at last follow‐up was 28.0 months (IQR 13.7, 51.2). During follow‐up, 26 patients developed RCC recurrence, at a median of 9.9 (IQR 4.0‐18.5) months after RPLN resection. Of those who developed a secondary recurrence, disease was again isolated to the retroperitoneum in 7 patients. Eleven patients subsequently died, including 10 who died of disease. Median PFS after RPLN resection was 19.5 months, with a 3‐ and 5‐year PFS of 40.5% and 35.4%, respectively. We moreover found that RPLN recurrence ≤ 12 months after nephrectomy was associated with a significantly inferior median PFS (12.3 months) compared to RPLN recurrence > 12 months following nephrectomy (47.6 months; p=0.003). Moreover, on multivariate analysis, a shorter time to recurrence remained associated with a significantly increased risk for subsequent disease progression (HR 3.51; p=0.005). Conclusion Surgical resection of isolated RPLN recurrence from RCC may result in durable cancer control in appropriately selected patients. Recurrence ≤ 12 months following nephrectomy was associated with a significantly increased risk of progression following resection, underscoring the importance of this variable for risk stratification. Thus, we recommend that, in the setting of isolated RPLN recurrence of RCC (in patients without precluding comorbidities), careful consideration with the patients and medical oncology colleagues be undertaken regarding the relative and individualized benefits of surgical resection, systemic therapy, and surveillance. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-26T23:41:52.492971-05:
      DOI: 10.1111/bju.13212
  • Wound dehiscence in a sample of 1,776 cystectomies – identification
           of predictors and implications for outcomes
    • Authors: Christian P. Meyer; Arturo J. Rios Diaz, Deepansh Dalela, Julian Hanske, Daniel Pucheril, Marianne Schmid, Vincent Q. Trinh, Jesse D. Sammon, Mani Menon, Felix K.H. Chun, Joachim Noldus, Margit Fisch, Quoc‐Dien Trinh
      Abstract: Objective To investigate the incidence and predictors of wound dehiscence in patients undergoing cystectomy. Materials and Methods 1776 patient records with Current Procedural Terminology (CPT) codes for radical cystectomy were extracted from the American College of Surgeons National Quality Improvement Program (ACS‐NSQIP) between 2005 and 2012. Stratification was made on the basis of the occurrence of postoperative wound dehiscence, defined as loss of integrity of fascial closure. Descriptive and logistic regression models were performed to identify predictors of postoperative wound dehiscence. The implications of wound dehiscence on peri‐ and postoperative outcomes such as complications, mortality, prolonged length of stay (pLOS >11 days) and prolonged operative time (pOT > 411 minutes), were assessed. Results Of 1776 patients analyzed, 57 (3.2%) had a documented wound dehiscence. In multivariable analyses, COPD (OR: 2.0, 95% CI: 1.0‐4.0, p=0.03) and high BMI (OR: 2.3, 95% CI: 1.3‐4.4, p=0.008) were significant predictors of wound dehiscence. While female gender had significantly lower proportions of wound dehiscence, multivariable analyses did not confirm this (OR: 0.4, 95% CI: 0.4‐1.4, p=0.75). Conclusions Our study is the first to identify predictors of wound dehiscence following radical cystectomy in a large, contemporary multi‐institutional cohort. Identifying patients at risk for postoperative wound complications may guide the use preventative measures at the time of surgery. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-26T23:41:37.283149-05:
      DOI: 10.1111/bju.13213
  • Association between number of prostate biopsies and patient‐reported
           functional outcomes after radical prostatectomy: implications for active
           surveillance protocols
    • Authors: Christopher B. Anderson; Amy L. Tin, Daniel D. Sjoberg, John P. Mulhall, Jaspreet Sandhu, Karim Touijer, Vincent P. Laudone, James A. Eastham, Peter T. Scardino, Behfar Ehdaie
      Abstract: Objectives To evaluate whether the number of preoperative prostate biopsies affects functional outcomes after radical prostatectomy (RP). Methods We identified men treated with RP at our institution between 2008 and 2011. At 6 and 12 months post‐operatively, patients completed questionnaires assessing erectile and urinary function. Men with preoperative incontinence or erectile dysfunction or who did not complete the questionnaire were excluded. Primary outcomes were urinary and erectile function at 12 months postoperatively. We used logistic regression to estimate the impact of number of prostate biopsies on functional outcomes after adjusting for demographic and clinical factors. Results We identified 2,712 men treated with RP between 2008 and 2011. Most men (80%) had 1 preoperative prostate biopsy, 16% had 2, and 4% had at least 3. On adjusted analysis, erectile function at 12 months was not significantly different for men with 2 (OR 1.25; 95% CI 0.90, 1.75) or 3 or more (OR 1.52; 95% CI 0.84, 2.78) biopsies, compared to those with 1. Similarly, urinary function at 12 months was not significantly different for men with 2 (0.84, 95% CI 0.64, 1.10) or 3 or more (0.99, 95% CI 0.60, 1.61) biopsies compared to those with 1. Conclusions We did not find evidence that more preoperative prostate biopsies adversely affected erectile or urinary function at 12 months following RP. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-26T23:41:29.115138-05:
      DOI: 10.1111/bju.13215
  • 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
    • Authors: Mihai Dorin Vartolomei; Bernhard Kiss, Alvaro Vidal, Fiona Burkhard, George N. Thalmann, Beat Roth
      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 (
      PubDate: 2015-06-25T21:52:50.155679-05:
      DOI: 10.1111/bju.13178
  • The cost‐effectiveness of sacral nerve stimulation for the treatment
           of idiopathic medically refractory overactive bladder (wet) in the UK
    • Authors: Silke Walleser Autiero; Natalie Hallas, Christopher D. Betts, Jeremy L. Ockrim
      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.
      PubDate: 2015-06-25T04:21:37.931144-05:
      DOI: 10.1111/bju.12972
  • Population‐based study of long‐term functional outcomes after
           prostate cancer treatment
    • Authors: Sigrid Carlsson; Linda Drevin, Stacy Loeb, Anders Widmark, Ingela Franck Lissbrant, David Robinson, Eva Johansson, Pär Stattin, Per Fransson
      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.
      PubDate: 2015-06-23T21:48:22.692237-05:
      DOI: 10.1111/bju.13179
  • Positive Surgical Margins in Radical Prostatectomy Patients Do Not Predict
           Long‐term Oncological Outcomes: Results from SEARCH
    • Authors: Prabhakar Mithal; Lauren E. Howard, William J. Aronson, Martha K. Terris, Matthew R. Cooperberg, Christopher J. Kane, Christopher Amling, Stephen J. Freedland
      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.
      PubDate: 2015-06-23T21:47:45.625591-05:
      DOI: 10.1111/bju.13181
  • Applications of Three‐Dimensional Printing Technology in Urologic
    • Authors: Ramy F. Youssef; Kyle Spradling, Renai Yoon, Benjamin Dolan, Joshua Chamberlin, Zhamshid Okhunov, Ralph Clayman, Jaime Landman
      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.
      PubDate: 2015-06-23T04:37:46.924066-05:
      DOI: 10.1111/bju.13183
  • Adverse Pathology and Undetectable Ultrasensitive Prostate‐Specific
    • Authors: Ross M. Simon; Lauren E. Howard, Stephen J. Freedland, William J. Aronson, Martha K. Terris, Christopher J. Kane, Christopher L. Amling, Matthew R. Cooperberg, Adriana C. Vidal
      Abstract: Objectives To determine if men with adverse pathology but undetectable ultrasensitive (
      PubDate: 2015-06-23T04:37:14.260913-05:
      DOI: 10.1111/bju.13182
  • Radical Cystectomy with Super‐extended Lymphadenectomy: Impact of
           Separate Versus en Bloc Lymph Node Submission on Analysis and Outcomes
    • Authors: Pascal Zehnder; Felix Moltzahn, Anirban P. Mitra, Jie Cai, Gus Miranda, Eila C. Skinner, Inderbir S. Gill, Siamak Daneshmand
      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
      PubDate: 2015-06-22T00:34:38.203731-05:
      DOI: 10.1111/bju.12956
  • Patterns of Surveillance Imaging After Nephrectomy in the Medicare
    • Authors: Michael A. Feuerstein; Coral L. Atoria, Laura C. Pinheiro, William C. Huang, Paul Russo, Elena B. Elkin
      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
      PubDate: 2015-06-22T00:32:17.253188-05:
      DOI: 10.1111/bju.12980
  • Transcutaneous Interferential Electrical Stimulation for Management of
           Non‐neuropathic Underactive Bladder in Children: A Randomized
           Clinical Trial
    • Authors: Abdol‐Mohammad Kajbafzadeh; Lida Sharifi‐Rad, Seyedeh‐Sanam Ladi‐Seyedian, Sarah Mozafarpour
      Abstract: Objectives To assess the efficacy of transcutaneous interferential (IF) electrical stimulation and urotherapy in the management of non‐neuropathic underactive bladder (UB) in children with voiding dysfunction (VD). Patients and methods A total of 36 children with UB without neuropathic disease (15 boys, 21 girls; mean age 8.9±2.6) were enrolled and then randomly allocated to two equal treatment groups comprising IF and control groups. The control group underwent only standard urotherapy comprising diet, hydration, scheduled voiding, toilet training and pelvic floor and abdominal muscles relaxation. Children in the IF group, likewise underwent standard urotherapy and also received IF electrical stimulation. Children in both groups underwent a 15‐ course treatment program two times per week. A complete voiding and bowel habit diary was filled out by parents before, after treatment and one year later. Bladder ultrasound and uroflowmetry/EMG were performed before, at the end of treatment courses and at one year follow‐up. Results The mean number of voiding episodes before treatment was 2.6±1 and 2.7±0.76 times/day in IF and control groups, respectively which significantly increased after IF therapy in IF group, compared with only standard urotherapy in control group (6.3±1.4 times/day vs. 4.7±1.3 times/day, P < 0.002). The mean bladder capacity prior to treatment was 424±123 and 463±121ml in control and IF groups, respectively. This finding decreased significantly one year after the treatment in IF group compared to controls (227±86 vs.344±127 ml, P < 0.01). Maximum urine flow increased and voiding time decreased significantly in IF group compared with controls at the end of treatment sessions and one year later (P < 0.05). All children had abnormal flow curve at the beginning of the study. Flow curve became normal in 14/18 (77%) of children in IF group and 6/18 (33%) in control group, respectively at the end of follow up (P
      PubDate: 2015-06-18T09:10:09.847871-05:
      DOI: 10.1111/bju.13207
  • Low testosterone level is an independent risk factor for high‐grade
           prostate cancer detection via biopsy
    • Authors: Juhyun Park; Sung Yong Cho, Seung‐hwan Jeong, Seung Bae Lee, Hwancheol Son, Hyeon Jeong
      Abstract: Objectives To investigate the relationship between low testosterone level and prostate cancer detection risk in a biopsy population. Patients and Methods A total of 681 men who underwent initial 12‐core transrectal prostate biopsy at our institution were included in this retrospective study. Patients were divided into groups with low (< 300 ng/dL) and normal testosterone levels (≥ 300 ng/dL). Clinical and pathological data were analyzed. Results Among 681 men, 86 men (12.6%) showed low testosterone level, 143 (32.7%) had a positive biopsy, and 99 (14.5%) were revealed to have high‐grade prostate cancer. Mean age, prostate‐specific antigen (PSA), PSA density (PSAD), body mass index (BMI), the numbers of abnormal digital rectal examination (DRE) findings and diabetes mellitus (DM) history were significantly different between the low and normal testosterone groups. A low testosterone level was significantly associated with a higher risk of detection of overall prostate cancer than a normal testosterone level in univariate analysis (odds ratio [OR] = 2.545, P = 0.001), but not in multivariate analysis adjusting for parameters such as age, PSA, prostate volume, BMI, abnormal DRE findings and DM (OR = 1.583, P = 0.277). Meanwhile, the low testosterone level was significantly related with a higher rate of high‐grade prostate cancer compared to the normal testosterone level in univariate (OR = 3.324, P < 0.001) and multivariate analysis adjusting for other parameters (OR = 2.138, P = 0.035). Conclusions Low testosterone level is an independent risk factor for high‐grade prostate cancer detection via biopsy. Therefore, checking testosterone levels could help to determine whether prostate biopsy should be carried out. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-18T09:09:52.721083-05:
      DOI: 10.1111/bju.13206
  • Could a dye offer a cheap and simple approach to detect bladder cancer
           using white‐light cystoscopy'
    • Authors: Linda M. McLatchie
      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.
      PubDate: 2015-06-16T00:28:30.289118-05:
      DOI: 10.1111/bju.13177
  • The dose‐dependent effect of androgen deprivation therapy for
           localized prostate cancer on adverse cardiac events
    • Authors: Marianne Schmid; Jesse D. Sammon, Gally Reznor, Victor Kapoor, Jacqueline M. Speed, Firas A. Abdollah, Akshay Sood, Felix K.‐H. Chun, Adam S. Kibel, Mani Menon, Margit Fisch, Maxine Sun, Quoc‐Dien Trinh
      Abstract: Objectives To investigate the dose‐dependent effect of androgen deprivation therapy (ADT) on adverse cardiac events in elderly men with non‐metastatic prostate cancer (PCa) stratified according to life expectancy (LE). Patients and methods 50,384 men diagnosed with localized PCa between 1992 and 2007 were identified within the SEER registry areas. We compared those who did receive ADT vs. those who did not within 2 years of PCa diagnosis, calculated as monthly equivalent doses of Gonadotropin‐releasing hormone (GnRH) agonists (
      PubDate: 2015-06-13T07:01:15.363346-05:
      DOI: 10.1111/bju.13203
  • Assessing the impact of mass media public health campaigns:‘Be Clear
           on Cancer: Blood in Pee’ a case in point
    • Authors: Archie Hughes‐Hallett; Daisy Browne, Elsie Mensah, Justin Vale, Erik Mayer
      Abstract: Objectives To assess the impact of Public Health England's recent ‘Be clear on cancer: Blood in the pee’ mass media campaign on suspected cancer referral burden and new cancer diagnosis. Methods A retrospective cohort study design was used; for two distinct time periods, August 2012 to May 2013 and August 2013 to May 2014, all referrals deemed to be at risk of urological cancer by the referring primary health care physician to Imperial College NHS Healthcare Trust were screened. Data points collected were: age and sex, whether the referral was for visible haematuria, non‐visible haematuria or other suspected urological cancer. In addition to referral data, hospital episode data for all new renal cell, and upper and lower tract transitional cell carcinoma, as well as testicular and prostate cancer diagnoses for the same time periods were obtained. Results Over the campaign period and the subsequent three months, the number of haematuria referrals increased by 92% (p=0.013) when compared to the same period a year earlier. This increase in referrals was not associated with a significant corresponding rise in cancer diagnosis; instead changes of 26.8% (p=0.56) and ‐3.3% (p=0.84) were seen in renal and transitional cell carcinomas respectively. Conclusion This study has demonstrated that the ‘Be clear on cancer: Blood in pee’ mass media campaign significantly increased the number of new suspected cancer referrals, but no significant change in the diagnosis of target cancers across a large catchment. Mass media campaigns are expensive; require significant planning and appropriate implementation and while the findings of this study do not challenge their fundamental objective, more work needs to be done to understand why no significant change in target cancers were observed. Further consideration should also be given to the increased referral burden that results from these campaigns such that pre‐emptive strategies, including educational and process mapping, across primary and secondary care can be implemented. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-13T03:05:11.988892-05:
      DOI: 10.1111/bju.13205
  • Iodinated contrast reactions – ending the myth of contrast allergic
           reactions to iodinated contrast agents in Urological Practice
    • Authors: Veeru Kasivisvanathan; Bhamini Vadhwana, Ben Challacombe, Asif Raza
      Abstract: Iodinated contrast agents (ICA) are an essential part of the urologist's everyday practice, allowing enhanced imaging of the urinary tract. Contrast is administered directly into the urinary tract during retrograde pyelograms, JJ stent insertion, ureterorenoscopy, urethrography and cystography. Contrast can also be administered intravenously, for example during CT urogram studies in the investigation of haematuria. Increasingly, patients are labelled as having a contrast “allergy” when in fact this is a misnomer as it is not a true allergy. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-13T03:00:15.857309-05:
      DOI: 10.1111/bju.13204
  • Laparoscopic extended pelvic lymph node dissection as validation of the
           performance of [11C]‐acetate‐PET/CT in detection of lymph node
           metastasis in intermediate and high‐risk prostate cancer
    • Authors: Georgios Daouacher; Catrin von Below, Charlotta Gestblom, Håkan Ahlström, Rafael Grzegorek, Cecilia Wassberg, Jens Sörensen, Mauritz Waldén
      Abstract:  Objectives To evaluate the accuracy of the radiopharmaceutical [11C]‐acetate combined with positron emission tomography/computer tomography (acetate‐PET/CT) in lymph node staging in newly diagnosed prostate cancer (PCa) cases. A second aim was to evaluate the potential discriminative properties of acetate‐PET/CT in clinical routine. Patients and methods In a prospective comparative study, from July 2010 to June 2013, 53 men with newly histologically diagnosed intermediate or high risk PCa underwent acetate‐PET/CT investigation at one regional center prior to laparoscopic extended pelvic lymph node dissection (ePLND) at one referral center. The sensitivity, specificity and accuracy of acetate‐PET/CT were calculated. Comparisons were made between true positive and false negative PET/CT cases to identify differences in the clinical parameters: PSA, Gleason status, lymph metastasis burden and size, calculated risk of lymph node involvement, and curative treatment decisions. Results 26 patients had surgically/histologically proven lymph node metastasis (LN+). Acetate‐PET/CT was true positive in 10 patients, false positive in 1 patient, false negative in 16 patients and true negative in 26 cases. The individual sensitivity was 38%, specificity 96% and accuracy 68%. The PET/CT‐positive nodes (N+) cases had significantly more involved nodes (mean 7,9 vs. 2,4, p
      PubDate: 2015-06-13T02:47:52.236078-05:
      DOI: 10.1111/bju.13202
  • Sexual function and stress level of male partners of infertile couples
           during fertile period
    • Authors: Seung‐Hun Song; Dong Suk Kim, Tae Ki Yoon, Jae Yup Hong, Sung Han Shim
      Abstract: Objectives To evaluate the sexual function and stress level during timed intercourse (TI) of male partners of infertile couples. Patients and Methods The study included 236 male partners of couples with more than 1 year of infertility who sought medical care or an evaluation of couple infertility. Besides infertility evaluation, all participants were asked to complete the International Index of Erectile Function (IIEF) ‐5 for evaluation of sexual function and stresses related to infertility and timed intercourse were measured using ten‐division VAS questionnaires. Results Stress levels regarding sexual function were higher during fertile than infertile periods in109 of the 236 (46.2%) male partners, with 122 (51.7%) reporting no difference in stress during fertile and non‐fertile periods. Mean VAS score of sexual relationship stress was significantly higher during fertile than non‐fertile periods (3.4 ±2.6 vs. 2.1±2.2, p < 0.001). Of the 236 men, 21 (8.9%) reported more than mild to moderate ED (IIEF‐5 score≤16) and 99 (42%) reported mild ED (IIEF‐5 score 17‐21). Conclusion This is the first report showing quantitatively that male partners of infertile couples experience significantly higher TI related stresses during fertile than during non‐fertile period. Sexual dysfunction is also common in male partners of infertile couple. Medical personnel dealing with infertile couples should be aware of these potential problems in male partners and provide appropriate counseling. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-13T02:02:27.630152-05:
      DOI: 10.1111/bju.13201
  • 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
    • Authors: Waleed Badreldin; Jonathan Krell, Simon Chowdhury, Stephen J. Harland, Danish Mazhar, Victoria Harding, Adam E. Frampton, Peter Wilson, Daniel Berney, Justin Stebbing, Jonathan Shamash
      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.
      PubDate: 2015-06-13T00:52:29.042048-05:
      DOI: 10.1111/bju.13004
  • Emerging trends in prostate cancer literature: medical progress or
           marketing hype'
    • Authors: Jonathon Lo; Nathan Papa, Damien M. Bolton, Declan Murphy, Nathan Lawrentschuk
      Abstract: Objectives •  To review emerging trends in prostate cancer (PC) literature with a focus on the marketing and implementation of new technologies, and the use of PC terms Methods •  Literature search of MEDLINE for external‐beam radiotherapy, prostatectomy, deferred intervention and focal therapy articles pertaining to PC •  Observational trends of PC literature relating to the marketing of new technologies and the use of standardised language Results •  PC literature has proliferated across all treatment modalities, particularly in the research of new technologies (robot‐assisted prostatectomy, image‐guided radiotherapy and focal therapy) •  Marketing and implementation of new technologies has occurred in some instances before effectiveness and adverse effects have been determined •  Inconsistent use of terminology exists in the PC literature Conclusion •  There is an ever‐present need for editors and researchers to maintain integrity and relevance in PC research •  We advocate a standardised language in PC and inclusion of active surveillance and robot‐assisted prostatectomy as MeSH indexing to reflect current trends and needs in PC research
      PubDate: 2015-06-11T00:15:59.943807-05:
      DOI: 10.1111/bju.13015
  • Argument for prostate cancer screening in populations of
           African‐Caribbean origin
    • Authors: Alan L. Patrick; Clareann H. Bunker, Joel B. Nelson, Rajiv Dhir, Victor W. Wheeler, Joseph M. Zmuda, Jean‐Robert Richard, Andrew C. Belle, Lewis H. Kuller
      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)
      PubDate: 2015-06-11T00:07:21.858559-05:
      DOI: 10.1111/bju.12869
  • Transperineal template‐guided prostate biopsy: 10 years of
    • Authors: Zhipeng Mai; Weigang Yan, Yi Zhou, Zhien Zhou, Jian Chen, Yu Xiao, Zhiyong Liang, Zhigang Ji, Hanzhong Li
      Abstract: Objective • To assess the efficacy and safety of transperineal template‐guided prostate biopsy. Materials and Methods • From December 2003 to December 2013, a total of 3007 patients (30‐91 years old, mean age 69.1) who met the inclusion criteria underwent 11‐region transrectal ultrasound‐guided transperineal template prostate biopsy. • The inclusion criteria included a prostate‐specific antigen (PSA) level of 4.0 ng/ml or greater and abnormal prostate gland findings on digital rectal examination, ultrasound, CT or MRI. The median PSA level was 11.0 ng/ml (range 0.2‐100 ng/ml). • The prostate cancer detection rate and prostate biopsy adverse effects, as well as prostate cancer spatial distribution were analyzed. Results • A mean of 19.3 cores (range 11 to 44) were obtained for each biopsy, and more cores were obtained in larger prostates than in smaller ones. • One to four cores were collected from each region. Prostate cancer was detected in 1067 of the 3007 patients (35.5%). The prostate cancer detection rates in groups with PSA levels of 0‐4.0 ng/ml, 4.1‐10.0 ng/ml, 10.1‐20.0 ng/ml, 20.1‐50.0 ng/ml, and 50.1‐100.0 ng/ml were 15.3% (27/176), 21.0% (248/1179), 32.6% (318/975), 56.0% (232/414), and 92.0% (241/262), respectively. • The mean positives for cancer in regions 1‐10 and region 11 (the apical region) were 46.7% vs. 52.0% (P=0.014). • Regarding adverse effects, 47.0% of the patients reported hematuria, 6.1% developed hemospermia, 1.9% required short‐term catheterization after biopsy because of acute urinary retention, and 0.03% (one patient) developed urosepsis. Conclusions • Transrectal ultrasound‐guided transperineal template prostate biopsy is safe and accurate. • The current study suggests that prostate carcinoma foci are more frequently localized in the apical region.
      PubDate: 2015-06-10T05:01:04.41374-05:0
      DOI: 10.1111/bju.13024
  • Disease reclassification risk with stringent criteria and frequent
           monitoring in men with favorable‐risk prostate cancer undergoing
           active surveillance
    • Authors: John W. Davis; John F. Ward, Curtis A. Pettaway, Xuemei Wang, Deborah Kuban, Steven J. Frank, Andrew K. Lee, Louis L. Pisters, Surena F. Matin, Jay B. Shah, Jose A. Karam, Brian F. Chapin, John N. Papadopoulos, Mary Achim, Karen E. Hoffman, Thomas J. Pugh, Seungtaek Choi, Patricia Troncoso, Christopher J. Logothetis, Jeri Kim
      Abstract: Objective To determine the frequency of disease reclassification and to identify clinicopathologic variables associated with it in patients with favorable‐risk prostate cancer undergoing active surveillance. Patients and Methods We assessed 191 men selected by what may be the most stringent criteria used in active surveillance studies yet conducted who enrolled in a prospective cohort active surveillance trial. Clinicopathologic characteristics were analyzed in a multivariate Cox proportional hazards regression model. Key features were an extended biopsy with a single core positive for Gleason score (GS) 3+3 (
      PubDate: 2015-06-08T09:22:27.792806-05:
      DOI: 10.1111/bju.13193
  • A phase I study of TRC105 anti‐CD105 (endoglin) antibody in
           metastatic castration‐resistant prostate cancer
    • Authors: Fatima H. Karzai; Andrea B. Apolo, Liang Cao, Ravi A. Madan, David E. Adelberg, Howard Parnes, David G. McLeod, Nancy Harold, Cody Peer, Yunkai Yu, Yusuke Tomita, Min‐Jung Lee, Sunmin Lee, Jane B. Trepel, James L. Gulley, William D. Figg, William L. Dahut
      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.
      PubDate: 2015-06-08T05:38:17.65448-05:0
      DOI: 10.1111/bju.12986
  • A Phase II, Randomized, Double‐blind, Placebo‐Controlled Trial
           of Methylphenidate for Reduction of Fatigue in Prostate Cancer Patients
           Receiving LHRH‐Agonist Therapy
    • Authors: Patrick O. Richard; Neil E. Fleshner, Jaimin R. Bhatt, Karen M. Hersey, Rehab Chahin, Shabbir M.H. Alibhai
      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.
      PubDate: 2015-06-08T01:08:22.827863-05:
      DOI: 10.1111/bju.12755
  • Long‐Term Response to Renal Ischemia in the Human Kidney After
           Partial Nephrectomy – Results from a Prospective Clinical Trial
    • Authors: George J.S. Kallingal; Joel M. Weinberg, Isildinha M. Reis, Avinash Nehra, Manjeri A. Venkatachalam, Dipen J. Parekh
      Abstract: Objective To assess the one‐year renal functional changes in patients undergoing partial nephrectomy with intraoperative renal biopsies. Subjects and Methods 40 patients with a single renal mass deemed fit for a partial nephrectomy were recruited prospectively between January 2009 and October 2010. We performed renal biopsies of normal renal parenchyma and collected serum markers before, during, and after surgically induced renal clamp ischemia during the partial nephrectomy. We then followed patients clinically with interval serum creatinine and physical exam. Results Perioperative data in 40 patients showed a transient increase in creatinine which did not correlate with ischemia time. Renal ultra‐structural changes were generally mild and the mitochondrial swelling which as noted, resolved at the post‐perfusion biopsy. 37 patients had one‐year follow‐up data. Creatinine (Cr) at one year increased by 0.121 mg/dl, which represents 12.99% decrease in renal function from baseline (preop Cr= 0.823mg/dl, eGFR=93.9). The only factors predicting creatinine change on multivariate analysis were patient age, race and ischemia type with cold ischemia associated with increased creatinine. Importantly, the duration of ischemia did not show any significant correlation with renal function change, either as a continuous variable (p=0.452) or as a categorical variable (p = 0.792). Conclusions Out data suggest that limited ischemia is generally well‐tolerated in the setting of partial nephrectomy and does not directly correspond to long‐term renal functional decline. For surgeons performing partial nephrectomy, the kidney can be safely clamped to ensure optimal oncologic outcomes. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-06T02:01:25.999741-05:
      DOI: 10.1111/bju.13192
  • Prostate Biopsy Decisions: One Size Fits All Approach with Total PSA is
           Out and a Multivariable Approach with the Prostate Health Index is In
    • Authors: Stacy Loeb
      Abstract: The days of using one PSA threshold to trigger a biopsy for all men are over, and the field has moved toward a more individualized approach to prostate biopsy decisions taking into account each patient's specific set of risk factors. Foley et al. provide compelling evidence supporting the use of the Prostate Health Index (phi) as part of this multivariable approach to prostate biopsy decisions.[1] There is now a large body of evidence showing that phi is more specific for prostate cancer than total PSA and percent free PSA, as was concluded in a 2014 systematic review.[2] This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-05T10:24:59.659737-05:
      DOI: 10.1111/bju.13195
  • Metastases to the Kidney: A Comprehensive Analysis of 151 Patients from a
           Tertiary Referral Center
    • Authors: Cathy Zhou; Diana L. Urbauer, Bryan M. Fellman, Pheroze Tamboli, Miao Zhang, Surena F. Matin, Christopher G. Wood, Jose A. Karam
      Abstract: Purpose Metastases to the kidney are a rare entity, historically described in autopsy studies. The primary aim of this study was to describe the presentation, treatment, and outcomes of patients with metastatic tumors to the kidney treated at a tertiary referral center. Patients and Methods We retrospectively identified 151 patients diagnosed with a primary non‐renal malignancy with renal metastasis. Clinical, radiographic and pathologic characteristics were assessed. Overall survival (OS) was calculated using Kaplan‐Meier methods. Results Median patient age was 56.7 years. The most common presenting symptoms were flank pain (30%), hematuria (16%) and weight loss (12%). Most primary cancers were carcinomas (80.8%). The most common primary tumor sites were lung (43.7%), colorectal (10.6%), ENT (6%), breast (5.3%), soft tissue (5.3%), and thyroid (5.3%). Renal metastases were typically solitary (77.5%). Concordance between radiologist and clinician imaging assessment was 54.0%. Three ablations and 48 nephrectomies were performed. For non‐surgical patients, renal metastasis diagnosis was made with FNA or biopsy. Median OS from primary tumor diagnosis was 3.08 years and median OS from time of metastatic diagnosis was 1.13 years. For patients treated with surgery, median OS from primary tumor diagnosis was 4.81 years, and OS from metastatic diagnosis was 2.24 years. Conclusions Metastases to the kidney are a rare entity. Survival appears to be longer in patients who are candidates for, and are treated with surgery. Surgical intervention in carefully selected patients with oligometastatic disease and good performance status should be considered. A multi‐disciplinary approach with input from urologists, oncologists, radiologists, and pathologists is needed to achieve the most optimal outcomes for this specific patient population. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-05T10:05:44.34543-05:0
      DOI: 10.1111/bju.13194
  • Clinical characteristics and quality‐of‐life in patients
           surviving a decade of prostate cancer with bone metastases
    • Authors: Rami Klaff; Anders Berglund, Eberhard Varenhorst, Per Olov Hedlund, Morten Jǿnler, Gabriel Sandblom,
      Abstract: Objective To describe characteristics and quality‐of‐life (QOL) and to define factors associated with long‐term survival in a subgroup of prostate cancer patients with M1b disease. Methods and patients The study was based on 915 patients from a prospective randomised multicentre trial (no.5) by the Scandinavian Prostate Cancer Group, comparing parenteral oestrogen with total androgen blockade (TAB). Long‐term survival was defined as patients having an overall survival >10 year, and logistic regression models were constructed to identity clinical predictors of survival. QOL during follow‐up was assessed using EROTC‐30 ratings. . Results Forty (4.4%) of the 915 men survived longer than 10 years. Factors significantly associated with increased likelihood of surviving more than ten years in the univariate analyses were: absence of cancer‐related pain; performance status < 2; negligible analgesic consumption; T‐category 1‐2; PSA
      PubDate: 2015-06-01T01:50:48.637381-05:
      DOI: 10.1111/bju.13190
  • Robot Assisted Intracorporeal Pyramid Neo‐bladder
    • Authors: Wei Shen Tan; Ashwin Sridhar, Miles Goldstraw, Evangelos Zacharakis, Senthil Nathan, John Hines, Paul Cathcart, Tim Briggs, John D Kelly
      Abstract: Objective To describe the a robotic assisted intracorporeal Pyramid neo‐bladder (NB) reconstruction technique and report operative and peri‐operative metrics, post‐operative upper tract imaging, neo‐bladder functional outcomes and oncological outcomes. Patients and methods A total of 19 male and 1 female patients with a mean age 57.2±12.4 years (range: 31.0‐78.2 years) underwent robotic assisted radical cystectomy (RARC). Most cases were ≤pT1 (n=17), while the remaining three patients had muscle invasive bladder cancer (MIBC) at RARC histopathology although 50% (n=10) actually had MIBC at transurethral resection histopathology. All patients underwent RARC, bilateral pelvic lymphadenectomy and intracorporeal NB formation using a pyramid detubularised folding pouch configuration. Results Median estimated blood loss was 250 ml and median operating time was 5.5 hours. The mean number of lymph nodes removed was 16.5±7.8 and median hospital stay was 10 days. Early postoperative complications include urinary tract infection (UTI) (n=4), ileus (n=4), diarrhoea and vomiting (n=3), post‐operative collection (n=2), and blocked stent (n=1). Late postoperative complications include UTI (n=7), NB stone (n=2), voiding hem‐o‐loc (n=2), NB leak (n=2), diarrhoea and vomiting (n=1), uretero‐ileal stricture (n=1), vitamin B12 deficiency (n=1) and port site hernia (n=1). There was no evidence of hydronephrosis in 18 patients with a median follow‐up of 21.5 months. At 24 months, recurrence free survival was 86% and overall survival was 100%. Nineteen patients and 13 patients report 6 month day time and night time continence respectively. Conclusions The pyramid NB is technically feasible using a robotic platform and provides satisfactory functional outcomes at median of 21.5 months. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-01T01:35:43.636583-05:
      DOI: 10.1111/bju.13189
  • A novel FISH‐based definition of BCG failure to enhance recruitment
           into clinical trials of intravesical therapies
    • Authors: Ashish M. Kamat; Daniel L Willis, Rian J. Dickstein, Rooselvelt Anderson, Graciela Nogueras‐González, Ruth L. Katz, Xifeng Wu, H. Barton Grossman, Colin P. Dinney
      Abstract: Objectives To present a (molecular) definition of BCG failure which incorporates fluorescence in situ hybridization (FISH) testing to predict BCG failure before it becomes clinically evident. This will help in trial designs for patients with non‐muscle invasive bladder cancer (NMIBC) who fail BCG and thus lack an adequate control arm other than radical cystectomy. Patients and Methods We used data from 143 patients were followed prospectively for 2 years during intravesical BCG therapy during which time FISH assays were collected and correlated to clinical outcomes. Results Of the 95 patients with no evidence of tumor at 3‐month cystoscopy, 23 developed tumor recurrence, and 17 developed disease progression by 2 years. Patients with a positive FISH at both 6‐weeks and 3‐months were more likely to develop tumor recurrence (17/37, 46% and 16/28, 57%, respectively) compared to patients with a negative FISH (6/58, 10% and 3/39, 8%, respectively) (both: p
      PubDate: 2015-06-01T01:33:48.779717-05:
      DOI: 10.1111/bju.13186
  • Prognosis of patients with metastatic renal cell carcinoma and pancreatic
    • Authors: Sarathi Kalra; Bradley J. Atkinson, Marc Ryan Matrana, Surena F. Matin, Christopher G. Wood, Jose A. Karam, Pheroze Tamboli, Kanishka Sircar, Priya Rao, Paul Gettys Corn, Nizar M. Tannir, Eric Jonasch
      Abstract: Objectives To identify the clinical outcomes of mRCC patients with PM treated with either pazopanib or sunitinib and assess whether PM is an independent prognostic variable in the current therapeutic environment. Patients and Methods Retrospective review of mRCC patients in an outpatient clinic was done from January 2006 to November 2011. Patient characteristics including demographics, laboratory data, and outcomes were analyzed. Comparison of baseline characteristics was done using chi² and t‐test and Overall Survival (OS) and Cancer‐Specific Survival (CSS) was estimated using Kaplan‐Meier methods. Predictors of OS were analyzed using Cox regression. Results A total of 228 patients were reviewed of which 44 (19.3%) had metastases to the pancreas and 184 (81.7%) had metastasis to sites other than the pancreas. The distribution of baseline characteristics was equal in both groups with the exception of a higher incidence of prior nephrectomy, diabetes and number of metastatic sites in the pancreatic metastasis group. 4 patients had isolated metastases to the pancreas, however, the majority of patients (68%) with pancreatic metastases had at least three different organ sites of metastases, as compared to 29% in patients without pancreatic metastases (p0.05), excluding pancreas. Median OS was 39 months (95% confidence interval [CI], 24‐57, HR=0.66, 95% CI = 0.42‐0.94, p=0.02) for patients with pancreatic metastases, compared to 26 months (95% CI, 21‐31) for patients without pancreatic metastases (p‐value
      PubDate: 2015-06-01T00:54:14.523966-05:
      DOI: 10.1111/bju.13185
  • Immunocytochemical detection of ERG expression in exfoliated urinary cells
           identifies patients with prostate cancer with high specificity
    • Authors: RP Pal; RC Kockelbergh, JH Pringle, L Cresswell, R Hew, J Dormer, C Cooper, JK Mellon, JG Barwell, EJ Hollox
      Abstract: Objectives To evaluate immunocytochemical detection of ERG protein in exfoliated cells as a means of identifying patients with prostate cancer (CaP) prior to prostate biopsy. Patients and methods 30 mls of post‐ digital rectal examination (DRE) urine was collected from 158 patients with an elevated age‐specific PSA and/or an abnormal DRE who underwent prostate biopsy. In all cases, exfoliated urinary cells from half of the sample underwent immunocytochemical assessment for ERG protein expression. Exfoliated cells in the remaining half underwent assessment of TMPRSS2:ERG status using either nested reverse‐transcriptase‐PCR (151 cases) or fluorescence in‐situ hybridisation (FISH, 8 cases). Corresponding tissue samples were evaluated using FISH to determine chromosomal gene fusion tissue status, and immunohistochemistry (IHC) to determine ERG protein expression. Results were correlated with clinico‐pathological variables. Results The sensitivity and specificity of urinary ERG immunocytochemistry (ICC) for CaP was 22.7% and 100% respectively. ERG ICC correlated with advanced tumour grade, stage and higher serum PSA. In comparison urine TMPRSS2:ERG transcript analysis had 27% sensitivity and 98% specificity for CaP. On tissue IHC, ERG staining was highly specific for CaP. 52% of cancers harboured foci of ERG staining. However, only 46% of cancers which demonstrated ERG overexpression were positive on urine ICC. ERG ICC demonstrated strong concordance with urinary RT‐PCR and FISH, and tissue IHC and FISH. Conclusion This is the first study to demonstrate that cytological gene fusion detection using ICC is feasible and identifies patients with adverse disease parameters. ERG ICC was highly specific but this technique was less sensitive than RT‐PCR.
      PubDate: 2015-06-01T00:52:24.627536-05:
      DOI: 10.1111/bju.13184
  • Robotic radical cystectomy with intracorporeal urinary diversion: Impact
           on an established enhanced recovery protocol
    • Authors: Anthony Koupparis; Christian Villeda‐Sandoval, Nicola Weale, Motaz El‐Mahdy, David Gillatt, Edward Rowe
      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
      PubDate: 2015-05-05T08:53:06.577015-05:
      DOI: 10.1111/bju.13171
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • Effect of surgical approach on erectile function recovery following
           bilateral nerve‐sparing radical prostatectomy: an evaluation
           utilising data from a randomised, double‐blind, double‐dummy
           multicentre trial of tadalafil vs placebo
    • Abstract: Objectives To report pre‐specified and exploratory results on the effect of different surgical approaches on erectile function (EF) after nerve‐sparing radical prostatectomy (nsRP) obtained from the multicentre, randomised, double‐blind, double‐dummy REACTT trial of tadalafil (once a day [OaD] or on‐demand [pro‐re‐nata, PRN]) vs placebo. Patients and Methods Patients aged
  • The changing reality of urothelial bladder cancer: should
           non‐squamous variant histology be managed as a distinct clinical
    • Abstract: Objectives To assess the effect of non‐squamous differentiation (non‐SQD) variant histology on survival in muscle‐invasive bladder urothelial cancer (UC). Patients and Methods A cohort of 411 radical cystectomy (RC) cases performed with curative intent for muscle‐invasive primary UC was identified between 2008 and June 2013. Survival analysis was evaluated using Kaplan–Meier methodology comparing non‐variant (NV) + SQD histology to non‐SQD variant histology (non‐SQD variants). Multivariable cox proportional hazards regression assessed all‐cause and disease‐specific mortality. Results Of the 411 RC cases, 77 (19%) had non‐SQD variant histology. The median overall survival (OS) for non‐SQD variant histology was 28 months, whereas the NV+SQD group had not reached the median OS at 74 months (log‐rank test P < 0.001). After adjusting for sex, age, pathological stage, and any systemic chemotherapy, patients with non‐SQD variant histology at RC had a 1.57‐times increased adjusted risk of all‐cause mortality (P = 0.027) and 1.69‐times increased risk of disease‐specific mortality (P = 0.030) compared with NV+SQD patients. Conclusions While SQD behaves similarly to NV, non‐SQD variant histology portends worse OS and disease‐specific survival regardless of neoadjuvant or adjuvant chemotherapy and pathological stage. Non‐SQD variants of UC could perhaps be considered a distinct clinical entity in UC with goals for developing new treatment algorithms through novel clinical trials.
  • Detection of prostate cancer index lesions with multiparametric MRI
           (mp‐MRI) using whole‐mount histological sections as the
           reference standard
    • Abstract: Objectives To evaluate the sensitivity of mp‐MRI for prostate cancer (PCa) foci, including index lesions. Materials and methods 115 patients with ultrasound biopsy confirmed PCa underwent mp‐MRI, and radical prostatectomy. A single expert radiologist recorded all PCa foci including the largest (index) lesion blinded to pathologist's biopsy report. The reference standard was 5 μm microsections obtained from 3mm thick whole mount histological sections. All lesions were contoured by an experienced uropathologist who assessed their volume and pathological Gleason Score (pGS). PCas with volume>0.5 cc and/or pGS>6 were defined as clinically significant. Multivariate analysis to describe the characteristics of lesions identified by MRI was performed. The study received approval by the local ethical board and was conducted according to the principles of the Helsinki Declaration. Results Mp‐MRI correctly diagnosed 104/115 index lesions (sensitivity=90.4%; 95% CI 83.5%‐95.1%), including 98/105 clinically significant index lesions (93.3%; 95% CI=86.8%‐97.3%) among which 3/3 lesions with volume6. Overall mp‐MRI detected 131/206 lesions including 13 of 68 insignificant PCa. The multivariate logistic regression modeling showed that pGS value (ORs, 11.7; 95% CI: 2.3‐59.8; P=0.003) and lesion volume (ORs, 4.24; 95% CI: 1.3‐14.7; P=0.022) were independently associated to detection of index lesion at MRI. Conclusions This study shows that mp‐MRI has a high sensitivity in the detection of clinically significant PCa index lesions, while it has disappointing results in the detection of small volume low pGS prostate cancer foci. Mp‐MRI may be used to stratify patients according to risk, allowing better treatment selection. This article is protected by copyright. All rights reserved.
  • Disease‐specific death and metastasis do not occur in patients with
           Gleason score ≤6 at radical prostatectomy
    • Abstract: Objectives To assess the metastasis‐free survival (MFS) and disease‐specific survival (DSS) in men with Gleason score ≤6 prostate cancer at radical prostatectomy (RP). Patients and Methods We included 1101 consecutive RP patients operated between March 1985 to July 2013 at a single institution. The outcome variables were MFS and DSS. The postoperative survival was estimated by the Kaplan–Meier method. Results The Gleason score distribution of the study population (1101 patients) was Gleason score ≤6 (449, 41%), Gleason score 3 + 4 = 7 (436, 40%), Gleason score 4 + 3 = 7 (99, 9%) and Gleason score 8–10 (117, 11%). The median (interquartile range) postoperative follow‐up was 100 (48–150) months. During follow‐up 197 men (18%) died, of whom 42 (3.8%) died from prostate cancer‐related causes. In all, 19/1101 patients (1.7%) had documented lymph node metastasis at the time of RP: none with Gleason score ≤6, seven with Gleason score 3 + 4 = 7 (1.6%), six with Gleason score 4 + 3 = 7 (6.1%) and six with Gleason score 8–10 (5.1%). Distant metastasis occurred in 56/1101 patients (5.1%): none with Gleason score ≤6, 23 with Gleason score 3 + 4 = 7 (5.3%), 17 with Gleason score 4 + 3 = 7 (17%) and 16 with Gleason score 8–10 (14%). Disease‐specific death, stratified per Gleason‐score group was: none in ≤6, 16 (3.7%) in 3 + 4 = 7, 16 (16%) in 4 + 3 = 7 and 10 (8.5%) in 8–10 group. Conclusion No metastasis or disease‐specific death were seen in men with Gleason score ≤6 prostate cancer at RP, showing the negligible potential to metastasise in this large subgroup of patients with prostate cancer.
  • Does cumulative prostate cancer length (CCL) in prostate biopsies improve
           prediction of clinically insignificant cancer at radical prostatectomy in
           patients eligible for active surveillance'
    • Abstract: Objectives To evaluate if cumulative prostate cancer length (CCL) on prostate needle biopsy divided by the number of biopsy cores (CCL/core) could improve prediction of insignificant cancer on radical prostatectomy (RP) in patients with prostate cancer eligible for active surveillance (AS). Patients and Methods Patients diagnosed with prostate cancer on extended (≥10 cores) biopsy with an initial prostate‐specific antigen (iPSA) level of
  • Altered significance of D'Amico risk classification in patients with
           prostate cancer linked to a familial breast cancer (kConFab) cohort
    • Abstract: Objective To ascertain whether D'Amico risk classification is an accurate discriminator of prostate cancer mortality risk in BRCA2 pathogenic mutation carriers and non‐carriers from a familial breast cancer cohort. Patients and Methods From family cancer pedigrees of patients evaluated through a familial breast cancer cohort all related men with a diagnosis of prostate cancer were identified. Genotyping of each patient or of the dominant familial BRCA2 mutation was undertaken in each instance. Prostate cancers were analysed by BRCA2 carrier vs non‐carrier status for their clinical progression and survival according to their D'Amico risk groups. Results For patients who were BRCA2‐mutation positive, there was no significant difference in cancer‐specific survival (CSS) between those patients who were graded as having D'Amico high‐ or intermediate‐risk disease. For patients who were BRCA2‐mutation negative, but were identified via a family cancer pedigree, there was no statistically significant difference in CSS between D'Amico high‐ and intermediate‐risk prostate cancers. Patients with D'Amico high‐risk disease who were BRCA2‐mutation carriers had substantially increased disease‐specific mortality compared with high‐risk non‐carriers (hazard ratio 2.94, P = 0.004). Conclusion D'Amico risk classification has limitations in predicting variations in prostate cancer‐specific mortality for this group of patients.
  • Upper limit of cancer extent on biopsy defining very low‐risk
           prostate cancer
    • Abstract: Objective To investigate how much Gleason pattern 3 cancer prostate biopsy specimens may contain without an increased risk of undetected more aggressive cancer, compared with the risk for cancers fulfilling the National Comprehensive Cancer Network (NCCN) criteria for very low‐risk prostate cancer. Patients and Methods We identified 1286 men aged
  • Histopathological characteristics of microfocal prostate cancer detected
           during systematic prostate biopsy
    • Abstract: Objective To evaluate the prevalence of adverse pathological features and the percentage of multifocal and/or bilateral disease in a series of patients who underwent radical prostatectomy (RP) for unique, microfocal prostate cancer (miPCa) detected on prostate biopsy in the pre‐active surveillance (AS) era. Patients and Methods In this retrospective, multi‐institutional study, we analysed the clinical records of 131 consecutive patients who underwent either retropubic or robot‐assisted RP for miPCa at two referral centres from January 2000 to December 2011. miPCa was defined as a neoplastic lesion present in ≤10% of core with biopsy Gleason score not applicable or biopsy Gleason score 6. Results There were 17 (13%) pT3–4 prostate cancers and a single case (0.8%) of pN+ tumour. Moreover, 31 (24.1%) patients had a Gleason score of >6 in the RP specimen. Therefore, unfavourable pathological features (pT3–4/N+ and/or Gleason score >6) were present in 40 (30.5%) patients. The median (interquartile range) prostate‐specific antigen (PSA) density was 0.11 (0.09–0.17) and 0.16 (0.11–0.24) ng/mL/mL in patients with favourable and unfavourable pathological characteristics, respectively (P = 0.003). The receiver operating characteristic curve had an area under the curve value of 0.67 (95% confidence interval 0.56–0.77) for PSA density to predict the risk of unfavourable pathological features. Conclusion Patients with miPCa who are candidates for an AS protocol should be adequately informed that in ≈30% of cases the cancer might be locally advanced and/or with a Gleason score of >6. Those unfavourable pathological characteristics could be predicted by the PSA density value. Further studies should investigate the role of a more extensive biopsy sampling to reduce the risk of under‐staging and/or under‐grading in patients with an initial diagnosis of miPCa.
  • Predicting postoperative complications of inguinal lymph node dissection
           for penile cancer in an international multicentre cohort
    • Abstract: Objectives To assess the potential complications associated with inguinal lymph node dissection (ILND) across international tertiary care referral centres, and to determine the prognostic factors that best predict the development of these complications. Materials and Methods A retrospective chart review was conducted across four international cancer centres. The study population of 327 patients underwent diagnostic/therapeutic ILND. The endpoint was the overall incidence of complications and their respective severity (major/minor). The Clavien–Dindo classification system was used to standardize the reporting of complications. Results A total of 181 patients (55.4%) had a postoperative complication, with minor complications in 119 cases (65.7%) and major in 62 (34.3%). The total number of lymph nodes removed was an independent predictor of experiencing any complication, while the median number of lymph nodes removed was an independent predictor of major complications. The American Joint Committee on Cancer stage was an independent predictor of all wound infections, while the patient's age, ILND with Sartorius flap transposition, and surgery performed before the year 2008 were independent predictors of major wound infections. Conclusions This is the largest report of complication rates after ILND for squamous cell carcinoma of the penis and it shows that the majority of complications associated with ILND are minor and resolve without prolonged morbidity. Variables pertaining to the extent of disease burden have been found to be prognostic of increased postoperative morbidity.
  • Guideline of guidelines: kidney stones
    • Abstract: Several professional organizations have developed evidence‐based guidelines for the initial evaluation, diagnostic imaging selection, symptomatic management, surgical treatment, medical therapy, and prevention of recurrence for both ureteric and renal stones. The purpose of this article is to summarize these guidelines with reference to the strength of evidence. All guidelines endorse an initial evaluation to exclude concomitant infection, imaging with a non‐contrast computed tomography scan, and consideration of medical expulsive therapy or surgical intervention depending on stone size and location. Recommends for metabolic evaluation vary by guideline, but all endorse increasing fluid intake to reduce the risk of recurrence.
  • A prospective study of erectile function after transrectal
           ultrasonography‐guided prostate biopsy
    • Abstract: Objective To prospectively evaluate the effect of transrectal ultrasonography (TRUS)‐guided prostate biopsy on erectile and voiding function at multiple time‐points after biopsy. Patients and Methods All men who underwent TRUS‐guided prostate biopsy completed a five‐item version of the International Index of Erectile Function (IIEF‐5) and the International Prostate Symptom Score (IPSS) before and at 1, 4 and 12 weeks after TRUS‐guided biopsy. Statistical analyses used were a general descriptive analysis, continuous variables using a t‐test and categorical data using chi‐square analysis. A paired t‐test was used to compare each patient's baseline score to their own follow‐up survey scores. Results In all, 220 patients were enrolled with a mean age of 64.1 years and PSA level of 6.7 ng/dL. At initial presentation, 38.6% reported no erectile dysfunction (ED), 22.3% mild ED, 15.5% mild‐to‐moderate ED, 10% moderate ED, and 13.6% severe ED. On paired t‐test there was a statistically significant reduction in IIEF‐5 score at 1 week after biopsy compared with before biopsy (18.2 vs 15.5; P < 0.001). This remained significantly reduced at 4 (18.4 vs 17.3; P = 0.008) and 12 weeks (18.4 vs 16.9, P = 0.004) after biopsy. Conclusions The effects of TRUS‐guided prostate biopsy on erectile function have probably been underestimated. It is important to be aware of these transient effects so patients can be appropriately counselled. The exact cause of this effect is yet to be determined.
  • Perineal repair of pelvic fracture urethral injury: in pursuit of a
           successful outcome
    • Abstract: Objective To determine perioperative factors that may optimize the outcome after delayed perineal repair of a pelvic fracture urethral injury (PFUI). Patients and Methods In all, 86 consecutive patients who underwent perineal repair of a PFUI between 2004 and 2011 were prospectively enrolled in this study. The mean (range) patient age was 23 (5–50) years. The mean (range) follow‐up was 5.5 (2–8) years. We examined seven perioperative variables that might influence the outcome including: prior failed treatment, condition of the bulbar urethra, displacement of the prostate, excision of scarred tissues, fixation of the mucosae of the two urethral ends, and the number and size of sutures used for urethral anastomosis. Univariate and multivariate analyses were used to identify factors that influence postoperative outcome. Results Of the patients, 76 (88%) had successful outcomes and 10 (12%) were considered treatment failures. On univariate analysis, four variables were significant factors influencing the outcome: excision of scarred tissues, prostatic displacement, condition of the bulbar urethra and fixation of the mucosae. On multivariate analysis only two remained strong and independent factors namely complete excision of scarred tissues and prostatic displacement in a lateral direction. Conclusions Meticulous and complete excision of scar tissue is critically important to optimise the outcome after perineal urethroplasty. This is particularly emphasised in cases associated with lateral prostatic displacement. Six sutures of 3/0 or 4/0 polyglactin 910 are usually sufficient to create a sound urethral anastomosis. Prior treatment and scarring of the anterior urethra do not affect the outcome.
  • Comparative effectiveness and safety of various treatment procedures for
           lower pole renal calculi: a systematic review and network
    • Abstract: Objective To compare the effectiveness of various treatments used for lower pole renal calculi. Methods We searched PubMed, EMBASE, CINAHL, the Cochrane Collaboration's Database of Systematic Reviews, the Cochrane Collaboration Central Register of Controlled Clinical Trials as well as for reports up to 1 April 2014. The search was supplemented with abstract reports from various urology conferences. All randomised, ‘blinded’ clinical studies including patients treated for lower pole renal calculi of
  • A novel interface for the telementoring of robotic surgery
    • Abstract: Objective To prospectively evaluate the feasibility and safety of a novel, second‐generation telementoring interface (Connect™; Intuitive Surgical Inc., Sunnyvale, CA, USA) for the da Vinci robot. Materials and Methods Robotic surgery trainees were mentored during portions of robot‐assisted prostatectomy and renal surgery cases. Cases were assigned as traditional in‐room mentoring or remote mentoring using Connect. While viewing two‐dimensional, real‐time video of the surgical field, remote mentors delivered verbal and visual counsel, using two‐way audio and telestration (drawing) capabilities. Perioperative and technical data were recorded. Trainee robotic performance was rated using a validated assessment tool by both mentors and trainees. The mentoring interface was rated using a multi‐factorial Likert‐based survey. The Mann–Whitney and t‐tests were used to determine statistical differences. Results We enrolled 55 mentored surgical cases (29 in‐room, 26 remote). Perioperative variables of operative time and blood loss were similar between in‐room and remote mentored cases. Robotic skills assessment showed no significant difference (P > 0.05). Mentors preferred remote over in‐room telestration (P = 0.05); otherwise no significant difference existed in evaluation of the interfaces. Remote cases using wired (vs wireless) connections had lower latency and better data transfer (P = 0.005). Three of 18 (17%) wireless sessions were disrupted; one was converted to wired, one continued after restarting Connect, and the third was aborted. A bipolar injury to the colon occurred during one (3%) in‐room mentored case; no intraoperative injuries were reported during remote sessions. Conclusion In a tightly controlled environment, the Connect interface allows trainee robotic surgeons to be telementored in a safe and effective manner while performing basic surgical techniques. Significant steps remain prior to widespread use of this technology.
  • Inhibition of urothelial P2X3 receptors prevents desensitization of
           purinergic detrusor contractions in the rat bladder
    • Abstract: Objectives To evaluate whether P2X3 receptors (P2X3R) are expressed in the bladder urothelium and to determine their possible function in modulating purinergic detrusor contractions in the rat urinary bladder. Materials and Methods The expression of urothelial receptors was determined using conventional immunohistochemistry in bladders from normal Sprague–Dawley rats. The urothelial layer was removed by incubation with protamine, and disruption of the urothelium was confirmed using haematoxylin and eosin staining on bladder sections. Open cystometry was used to determine the effects of both urothelial removal as well as intravesical application of a specific P2X3R antagonist on bladder properties from intact and protamine‐treated rats. Isometric contractile responses to potassium chloride (KCl) depolarization, electrical field stimulation (EFS) or chemical P2X activation were determined in normal and urothelium‐denuded bladder strips, with and without application of the P2X3R antagonist. Results Immunohistochemical staining showed high expression of P2X3R in the medial and basal layers of the urothelium. Removal of the urothelial layer disturbed normal bladder performance in vivo and eliminated the effects of the P2X3R antagonist on increasing the contractile interval and reducing the amplitude of voiding contractions. Removal of the urothelium did not affect bladder strip contractile responses to KCl depolarization or EFS. Pharmacological inhibition of P2X3R prevented desensitization to P2X‐mediated detrusor muscle contractions during EFS only in the strips with an intact urothelium. A concentration‐dependent, specific inhibition of P2X3R also prevented desensitization of purinergic contractile responses in intact bladder strips. Conclusions In the rat bladder, medial and basal urothelial cells express P2X3R, and specific inhibition of the receptor leads to a more hyporeflexive bladder condition. This pathway may involve P2X3R driving a paracrine amplification of ATP released from umbrella cells to increase afferent transmission in the sub‐urothelial sensory plexus and desensitization of P2X1‐mediated purinergic detrusor contractions.
  • Demographic and socio‐economic differences between men seeking
           infertility evaluation and those seeking surgical sterilization: from the
           National Survey of Family Growth
    • Abstract: Objective To identify differences in demographic and socio‐economic factors between men seeking infertility evaluation and those undergoing vasectomy, to address disparities in access to these services. Patients and Methods Data from Cycle 6 and Cycle 7 (2002 and 2006–2008) of the National Survey of Family Growth (NSFG) were reviewed. The NSFG is a multistage probability survey designed to capture a nationally representative sample of households with men and women aged 15–45 years in the USA. The variables analysed included age, body mass index, self‐reported health, alcohol use, race, religious affiliation, marital status, number of offspring, educational attainment, income level, insurance status and metropolitan home designation. Our primary outcome was the correlation of these demographic and socio‐economic factors with evaluation for male infertility or vasectomy. Results Of the 11 067 men identified through the NSFG, 466 men (4.2%) sought infertility evaluation, representing 2 187 455 men nationally, and 326 (2.9%) underwent a vasectomy, representing 1 510 386 men nationally. Those seeking infertility evaluation were more likely to be younger and have fewer children (P = 0.001, 0.001) and less likely to be currently married (78 vs 74%; P = 0.010) or ever married (89 vs 97%; P = 0.002). Men undergoing a vasectomy were more likely to be white (86 vs 70%; P = 0.001). Men seeking infertility evaluation were more likely to have a college or graduate degree compared with men undergoing a vasectomy (68 vs 64%; P = 0.015). There was no difference between the two groups for all other variables. Conclusion While differences in demographic characteristics such as age, offspring number and marital status were identified, measures of health, socio‐economic status, religion and insurance were similar between men undergoing vasectomy and those seeking infertility services. These factors help characterize the utilization of male reproductive health services in the USA and may help address disparities in access to these services and improve public health strategies.
  • Temporary implantable nitinol device (TIND): a novel, minimally invasive
           treatment for relief of lower urinary tract symptoms (LUTS) related to
           benign prostatic hyperplasia (BPH): feasibility, safety and functional
           results at 1 year of follow‐up
    • Abstract: Objectives To report the first clinical experience with a temporary implantable nitinol device (TIND; Medi‐Tate®) for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Patients and Methods In all, 32 patients with LUTS were enrolled in this prospective study, which was approved by our Institutional Ethics Committee. Inclusion criteria were: age >50 years, International Prostate Symptom Score (IPSS) of ≥10, maximum urinary flow rate (Qmax) of ≤12 mL/s, and prostate volume of
  • Prediction and predicament: complications after inguinal lymph node
           dissection for penile cancer
  • Specialty within a specialty: posterior urethroplasty
  • Robotic networks: delivering empowerment through integration
  • Exercise, diet and weight loss before therapy for lower urinary tract
           symptoms/benign prostatic hyperplasia'
  • Targeted local therapy in oligometastatic prostate cancer: a promising
           potential opportunity after failed primary treatment
  • Pelvic recurrence after radical cystectomy: a call to arms
  • Psychosocial interventions for men with prostate cancer: a Cochrane
           systematic review
    • Abstract: To evaluate the effectiveness of psychosocial interventions for men with prostate cancer in improving quality of life (QoL), self‐efficacy and knowledge and in reducing distress, uncertainty and depression. We searched for trials using a range of electronic databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsycINFO to October 2013, together with hand searching of journals and reference lists. Randomised controlled trials were eligible if they included psychosocial interventions that explicitly used one or a combination of the following approaches: cognitive behavioural, psycho‐educational, supportive and counselling. Interventions had to be delivered or facilitated by trained or lay personnel. Our outcomes were an improvement in QoL, self‐efficacy and knowledge and a reduction in distress, uncertainty and depression. Pairs of review authors independently extracted data and assessed risk of bias. We analysed data using standardised mean differences (SMDs), random‐effects models and 95% confidence intervals (CIs). In all, 19 studies with a total of 3 204 men, with a diagnosis of prostate cancer, comparing psychosocial interventions vs usual care were included in this review. Men in the psychosocial intervention group had a small, statistically significant improvement in the physical component of general health‐related QoL (GHQoL) at end of intervention (SMD 0.12, 95% CI 0.01–0.22) based on low quality evidence. There was no clear evidence of benefit associated with psychosocial interventions for the mental component of GHQoL at end of intervention (SMD −0.04, 95% CI −0.15 to 0.06) based on moderate quality evidence. At end of intervention, cancer‐related QoL showed a small improvement after psychosocial interventions (SMD 0.21, 95% CI 0.04–0.39). For prostate cancer‐specific and symptom‐related QoL, the differences between intervention and control groups were not significant. There was no clear evidence that psychosocial interventions were beneficial in improving self‐efficacy at end of intervention (SMD 0.16, 95% CI −0.05 to 0.38) based on very low quality evidence. Men in the psychosocial intervention group had a moderate increase in prostate cancer knowledge at end of intervention (SMD 0.51, 95% CI 0.32–0.71) based on very low quality evidence. A small increase in knowledge with psychosocial interventions was noted at 3 months after intervention (SMD 0.31, 95% CI 0.04–0.58). The results for uncertainty (SMD −0.05, 95% CI −0.35 to 0.26) and distress (SMD 0.02, 95% CI −0.11 to 0.15) at end of intervention were compatible with both benefit and harm based on very low quality evidence. Finally, there was no clear evidence of benefit associated with psychosocial interventions for depression at end of intervention (SMD −0.18, 95% CI −0.51 to 0.15) based on very low quality evidence. The overall risk of bias in the included studies was unclear or high, primarily as the result of performance bias. No data about stage of disease or treatment with androgen‐deprivation therapy were extractable for subgroup analysis. Only one study addressed adverse effects. Overall, this review shows that psychosocial interventions may have small, short‐term beneficial effects on certain domains of wellbeing, as measured by the physical component of GHQoL and cancer‐related QoL when compared with usual care. Prostate cancer knowledge was also increased. However, this review failed to show a statistically significant effect on other domains such as symptom‐related QoL, self‐efficacy, uncertainty, distress or depression. Moreover, when beneficial effects were seen, it remained uncertain whether the magnitude of effect was large enough to be considered clinically important. The quality of evidence for most outcomes was rated as very low according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, reflecting study limitations, loss to follow‐up, study heterogeneity and small sample sizes. We were unable to perform meaningful subgroup analyses based on disease stage or treatment method. Although some findings of this review are encouraging, they do not provide sufficiently strong evidence to permit meaningful conclusions about the effects of these interventions in men with prostate cancer. Additional well executed and transparently reported research studies are necessary to establish the role of psychosocial interventions in men with prostate cancer.
  • Natural history and quality of life in patients with cystine urolithiasis:
           a single centre study
    • Abstract: Objective To describe the natural history and quality of life (QoL) in patients with cystine urolithiasis. Patients and Methods A cohort study was carried out involving participants recruited from a single surgeon's case mix. Patients with cystinuria and related urolithiasis were invited to complete a questionnaire involving demographic information, use of medical treatment, surgical interventions and the 36‐item short‐form 36‐item short‐form health survey (SF‐36). Results In all, 14 patients completed the survey. The SF‐36 survey showed lower QoL than the general public in seven of eight domains. The mean interventional rate in patients with cystinuria was 10.6 procedures per patient. Most patients reported previous use of d‐penicillamine and urinary alkalinisation medications, with most ceasing due to side‐effects or lack of perceived efficacy. Conclusion Cystinuria is associated with a high rate of surgical intervention and lower QoL than the general public. Individuals with this condition report that medical management is either ineffective or poorly tolerated. There is a need for further improvements in medical management of cystinuria, to reduce the rate of operative intervention.
  • Here comes the sun
  • Temporary erectile dysfunction after prostate biopsy
  • Central obesity is predictive of persistent storage lower urinary tract
           symptoms (LUTS) after surgery for benign prostatic enlargement: results of
           a multicentre prospective study
    • Abstract: Objective To evaluate the impact of components of metabolic syndrome (MetS) on urinary outcomes after surgery for severe lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE), as central obesity can be associated with the development of BPE and with the worsening of LUTS. Patients and Methods A multicentre prospective study was conducted including 378 consecutive men surgically treated for large BPE with simple open prostatectomy (OP) or transurethral resection of the prostate (TURP), between January 2012 and October 2013. LUTS were measured by the International Prostate Symptom Score (IPSS), immediately before surgery and at 6–12 months postoperatively. MetS was defined according the USA National Cholesterol Education Program‐Adult Treatment Panel III. Results The improvement of total and storage IPSS postoperatively was related to diastolic blood pressure and waist circumference (WC). A WC of >102 cm was associated with a higher risk of an incomplete recovery of both total IPSS (odds ratio [OR] 0.343, P = 0.001) and storage IPSS (OR 0.208, P < 0.001), as compared with a WC of
  • Patterns of care for metastatic renal cell carcinoma in Australia
    • Abstract: Objective To examine the patterns of care and outcomes for metastatic renal cell carcinoma (mRCC) in Australia, where there are limited reimbursed treatment options. In particular, we aim to explore prescribing patterns for first‐line systemic treatment, the practice of an initial watchful‐waiting approach, and the use of systemic treatments in elderly patients. Subjects/Patients and Methods Patients with mRCC undergoing treatment between 2006 and 2012 were identified from four academic hospitals in Victoria and Australian Capital Territory. Demographic, clinicopathological, treatment, and survival data were recorded by chart review. Descriptive statistics were used to report findings. Survival was estimated by the Kaplan–Meier method and compared using the log‐rank test. The study was supported by a grant from Pfizer Australia. Results Our study identified 212 patients with mRCC for analysis. Patients were predominantly of clear cell histology (75%), Eastern Cooperative Oncology Group performance status 90 days before initiating treatment; these patients had a median OS of 56.3 months. Elderly patients (50 patients aged ≥70 years) were more likely to receive BSC alone than younger patients (46% vs 16%, P < 0.001). Of those who received systemic therapy, elderly patients were also more likely to have upfront dose reductions (30% vs 8%, P = 0.03). Conclusion Our study of patients with mRCC treated in Australian centres showed that sunitinib was the most commonly prescribed systemic treatment between 2006 and 2012, associated with survival outcomes similar to pivotal studies. We also found that an initial watchful‐waiting approach is commonly adopted without apparent detriment to survival. And finally, we found that age has an impact on the prescribing of systemic therapy.
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