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J. of Microscopy     Hybrid Journal   (Followers: 3, SJR: 0.765, h-index: 76)
J. of Midwifery & Women's Health     Hybrid Journal   (Followers: 29, SJR: 0.503, h-index: 36)
J. of Molecular Recognition     Hybrid Journal   (Followers: 2, SJR: 1.012, h-index: 60)
J. of Money, Credit and Banking     Hybrid Journal   (Followers: 30, 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 Neurochemistry     Hybrid Journal   (Followers: 1, SJR: 2.075, h-index: 172)
J. of Neuroendocrinology     Hybrid Journal   (Followers: 6, SJR: 1.417, h-index: 83)
J. of Neuroimaging     Hybrid Journal   (Followers: 2, SJR: 0.761, h-index: 43)
J. of Neuroscience Research     Hybrid Journal   (Followers: 8, SJR: 1.423, h-index: 120)
J. of Nursing and Healthcare of Chronic Illne Ss: An Intl. Interdisciplinary J.     Hybrid Journal   (Followers: 3)
J. of Nursing Management     Hybrid Journal   (Followers: 20, SJR: 1.185, h-index: 38)
J. of Nursing Scholarship     Hybrid Journal   (Followers: 4, SJR: 1.258, h-index: 49)
J. of Obstetric, Gynecologic, & Neonatal Nursing     Hybrid Journal   (Followers: 20, SJR: 0.647, h-index: 42)
J. of Obstetrics and Gynaecology Research     Hybrid Journal   (Followers: 15, SJR: 0.498, h-index: 32)
J. of Oral Pathology & Medicine     Hybrid Journal   (Followers: 3, SJR: 0.775, h-index: 58)
J. of Oral Rehabilitation     Hybrid Journal   (Followers: 4, SJR: 1.033, h-index: 57)
J. of Organizational Behavior     Hybrid Journal   (Followers: 34, SJR: 3.102, h-index: 95)
J. of Orthopaedic Research     Hybrid Journal   (Followers: 17, SJR: 1.505, h-index: 106)
J. of Paediatrics and Child Health     Hybrid Journal   (Followers: 16, SJR: 0.594, h-index: 51)
J. of Pathology     Hybrid Journal   (Followers: 9, SJR: 4.402, h-index: 131)
J. of Pathology : Clinical Research     Open Access  
J. of Peptide Science     Hybrid Journal   (Followers: 17, 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: 138, 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: 5, SJR: 0.846, h-index: 49)
J. of Policy Analysis and Management     Hybrid Journal   (Followers: 12, SJR: 1.531, h-index: 47)
J. of Policy and Practice In Intellectual Disabilities     Hybrid Journal   (Followers: 15, 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: 142, 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: 56, SJR: 0.529, h-index: 39)
J. of Psychological Issues in Organizational Culture     Hybrid Journal   (Followers: 5)
J. of Public Affairs     Hybrid Journal   (Followers: 2, SJR: 0.434, h-index: 7)
J. of Public Economic Theory     Hybrid Journal   (Followers: 3, SJR: 1.028, h-index: 21)
J. of Public Health Dentistry     Hybrid Journal   (Followers: 1, SJR: 0.757, h-index: 41)
J. of Quaternary Science     Hybrid Journal   (Followers: 22, SJR: 1.763, h-index: 65)
J. of Raman Spectroscopy     Hybrid Journal   (Followers: 11, SJR: 1.105, h-index: 69)
J. of Regional Science     Hybrid Journal   (Followers: 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: 4, SJR: 0.468, h-index: 13)
J. of Research In Reading     Hybrid Journal   (Followers: 11, SJR: 0.789, h-index: 23)
J. of Research in Science Teaching     Hybrid Journal   (Followers: 14, SJR: 4.717, h-index: 70)
J. of Research in Special Educational Needs     Hybrid Journal   (Followers: 3, SJR: 0.525, h-index: 10)
J. of Research on Adolescence     Hybrid Journal   (Followers: 5, SJR: 1.851, h-index: 55)
J. of Risk & Insurance     Hybrid Journal   (Followers: 12, 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: 10, 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: 19, SJR: 0.965, h-index: 72)
J. of Social Philosophy     Hybrid Journal   (Followers: 17, 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: 3, SJR: 1.263, h-index: 75)
J. of Synthetic Lubrication     Hybrid Journal  
J. of Systematics Evolution     Open Access   (Followers: 4, SJR: 0.647, h-index: 22)
J. of Texture Studies     Hybrid Journal   (Followers: 2, SJR: 0.773, h-index: 33)
J. of the American Association of Nurse Practitioners     Partially Free   (Followers: 3, SJR: 0.46, h-index: 27)
J. of the American Ceramic Society     Hybrid Journal   (Followers: 26, SJR: 1.247, h-index: 129)
J. of the American Geriatrics Society     Hybrid Journal   (Followers: 25, SJR: 2.112, h-index: 151)
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: 101)
J. of the CardioMetabolic Syndrome     Hybrid Journal   (Followers: 1)
J. of the European Academy of Dermatology and Venereology     Hybrid Journal   (Followers: 12, SJR: 1.422, h-index: 58)
J. of the Experimental Analysis of Behavior     Hybrid Journal   (Followers: 4, SJR: 0.907, h-index: 36)
J. of the History of the Behavioral Sciences     Hybrid Journal   (Followers: 3, SJR: 0.316, h-index: 15)
J. of the Institute of Brewing     Free   (Followers: 1, SJR: 0.562, h-index: 28)
J. of the Peripheral Nervous System     Hybrid Journal   (Followers: 3, SJR: 1.335, h-index: 45)
J. of the Royal Anthropological Institute     Hybrid Journal   (Followers: 32, SJR: 0.741, h-index: 31)
J. of the Royal Statistical Society Series A (Statistics in Society)     Hybrid Journal   (Followers: 14, 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: 18, SJR: 1.435, h-index: 51)
J. of the Science of Food and Agriculture     Hybrid Journal   (Followers: 20, SJR: 0.846, h-index: 88)
J. of the Society for Information Display     Hybrid Journal   (Followers: 1, SJR: 0.451, h-index: 32)
J. of the Society for the Anthropology of Europe     Hybrid Journal   (Followers: 8)
J. of the World Aquaculture Society     Hybrid Journal   (Followers: 13, SJR: 0.477, h-index: 38)
J. of Thrombosis and Haemostasis     Hybrid Journal   (Followers: 46, SJR: 2.56, h-index: 108)
J. of Time Series Analysis     Hybrid Journal   (Followers: 7, SJR: 1.361, h-index: 34)
J. of Tissue Engineering and Regenerative Medicine     Hybrid Journal   (Followers: 5, SJR: 1.074, h-index: 35)
J. of Traumatic Stress     Hybrid Journal   (Followers: 11, SJR: 1.63, h-index: 82)
J. of Travel Medicine     Hybrid Journal   (SJR: 0.738, h-index: 40)
J. of Urban Affairs     Hybrid Journal   (Followers: 20, SJR: 1.306, h-index: 32)

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Journal Cover   BJU International
  [SJR: 1.812]   [H-I: 104]   [76 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1464-4096 - ISSN (Online) 1464-410X
   Published by John Wiley and Sons Homepage  [1597 journals]
  • Diagnosing secondary hypogonadism: important consequences for fertility
           and reversibility
    • Authors: John Dean; Mario Maggi, Bert-Jan Boer, Wayne Hellstrom, Mohit Khera, Edward D Kim, Andrew McCullough, Frederick Wu, Michael Zitzmann
      Abstract: Hypogonadism (HG, testicular failure in men) has become a controversial and much misunderstood condition. Many men perceive testosterone as a panacea for the ills of ageing and “Low-T clinics” have sprung up to meet their demands, even though testosterone is often not the answer. In light of the unprecedented rise in testosterone prescriptions in recent years, particularly amongst middle-aged men, the US Food and Drug Administration (FDA) issued a Safety Communication in May 2015 intended to restrict the use of testosterone. This article is protected by copyright. All rights reserved.
      PubDate: 2015-09-11T09:16:28.472415-05:
      DOI: 10.1111/bju.13316
  • Training in minimally invasive surgery in urology EAU‐ICUD
    • Authors: Henk der Poel; Willem Brinkman, Ben Cleynenbreugel, Panagiotis Kallidonis, Jens-Uwe Stolzenburg, Evangelos Liatsikos, Kamran Ahmed, Oliver Brunckhorst, Mohammed Shamim Khan, Minh Do, Roman Ganzer, Declan G Murphy, Simon Van Rij, Philip E Dundee, Prokar Dasgupta
      Abstract: Objectives To describe the progress in training for minimal invasive surgery (MIS) in urology Methods A group of experts in the field provided input to come to recommendations for MIS training. A literature search was done on MIS training in general and specific for urological procedures. Results A literature search showed the rapidly developing options for e‐learning, box and virtual training and suggested that box training is a relatively cheap and effective means of improving laparoscopic skills. Development of non‐technical skills is an integral part of surgical skills training and should be included in training curricula. The application of modular training of surgical procedures showed more rapid skills acquiring. Training curricula for minimal invasive surgery in urology are being developed in both US and Europe. Conclusion Training in MIS has shifted from “see‐one‐do‐one‐teach‐one” to a structured learning from e‐learning to skills lab and modular training settings. This article is protected by copyright. All rights reserved.
      PubDate: 2015-09-09T11:32:39.096762-05:
      DOI: 10.1111/bju.13320
  • Pathologic gleason 8‐10: do all men do poorly' results from the
           search database
    • Authors: Sean Fischer; Daniel Lin, Ross M. Simon, Lauren Howard, William J. Aronson, Martha K. Terris, Christopher J. Kane, Christopher L. Amling, Matt R. Cooperberg, Stephen J. Freedland, Adriana C. Vidal
      Abstract: Objective To determine whether there are subsets of men with pathologic high‐grade disease (Gleason 8‐10) who have particularly high or low 2‐year BCR risk after radical prostatectomy (RP) when stratified into groups based on combinations of pathologic features such as surgical margins (SM), extracapsular extension (ECE) and seminal vesicle invasion (SVI). Methods We identified 459 patients treated with RP with pathologic Gleason 8‐10 in the SEARCH database. Patients were stratified into 5 groups based on pathological characteristics – Group 1: men with negative surgical margins and no extracapsular extension (‐SM/‐ECE), Group 2 (+SM/‐ECE), Group 3 (‐SM/+ECE), Group 4 (+SM/+ECE), and Group 5: men with SVI (+SVI). Cox proportional hazards models and the log‐rank test were used to compare BCR among the groups. Results At 2‐years post‐RP, pathological group was significantly correlated with BCR (log‐rank, p
      PubDate: 2015-09-09T05:17:39.519598-05:
      DOI: 10.1111/bju.13319
  • A patterns of care and health economic analysis of robotic radical
           prostatectomy in the Australian public health system
    • Authors: Marnique Basto; Niranjan Sathianathan, Luc te Marvelde, Shane Ryan, Jeremy Goad, Nathan Lawrentschuk, Anthony J Costello, Daniel Moon, Alexander Heriot, Jim Butler, Declan G Murphy
      Abstract: Objective To compare patterns of care and perioperative outcomes of robotic prostatectomy to other surgical approaches, and create an economic model to assess the viability of robotic prostatectomy in the public case‐mix funding system. Patients and Methods We retrospectively reviewed all radical prostatectomies (RP) performed for localised prostate cancer in Victoria, Australia, from the Victorian Admitted Episode Dataset (VAED), a large administrative database that records all hospital inpatient episodes in Victoria, Australia's second most populous state. The first database from July 2010 to April 2013 (n=5130) was utilised to compare length of hospital stay (LOS) and blood transfusion rates (BTR) between surgical approaches. This was subsequently integrated into an economic model. A second database (n=5581) was extracted between July 2010 and June 2013, three full financial years, to depict patterns of care and make future predictions for the 2014‐15 financial year, and to perform a hospital volume analysis. We then created an economic model to evaluate the incremental cost of robotic assisted radical prostatectomy (RARP) over open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP) incorporating the cost offset from differences in LOS and BTR. The economic model constructs estimates of the diagnosis related group (DRG) costs of ORP and LRP, adds the gross cost of the surgical robot (capital, consumables, maintenance and repairs), and manipulates these DRG costs to obtain a DRG cost per day which can be used to estimate the cost offset associated with RARP in comparison with ORP and LRP. Economic modelling was performed around a base‐case scenario, assuming a 7‐year robot lifespan and 124 robotic cases performed per financial year, and one and two‐way sensitivity analyses performed for the 4‐arm da Vinci SHD, Si and Si dual surgical systems. Results We identified 5581 patients who underwent radical prostatectomy in 20 Victorian hospitals utilising an open, laparoscopic or robotic surgical approach in the public and private sector. Overall, the majority of RP is performed in the Victorian private sector 4233 (75.8%), with an overall 11.5% decrease in the total number of RPs performed over the three‐year study period. In the most recent financial year 820 (47%), 765 (44%) and 173 (10%) underwent RARP, ORP and LRP respectively. In the same timeframe, RARP accounted for 26% and 53% of all RPs in the public and private sector respectively. Victorian public hospitals perform a median number of 14 RPs per year, 40% of hospitals perform less than ten per year. In the public system, RARP had a mean (±SD) LOS of 1.4 days (±1.3) compared to LRP 3.6 days (±2.7) and ORP 4.8 days (±3.5) (p
      PubDate: 2015-09-09T05:14:33.471566-05:
      DOI: 10.1111/bju.13317
  • In parallel comparative evaluation between multiparametric mri, pca3 and
           phi in predicting pathologically confirmed significant prostate cancer in
           men eligible for active surveillance
    • Authors: F Porpiglia; F Cantiello, S De Luca, M Manfredi, A Veltri, F Russo, A Sottile, R Damiano
      Abstract: Objective To assess the performance capabilities of multiparametric Magnetic Resonance Imaging (mpMRI), Prostate Health Index (PHI) and Prostate Cancer Antigen 3 gene (PCA3) in predicting the presence of pathologically confirmed significant Prostate Cancer (PCSPCa), according to the European Randomized Study of Screening Prostate Cancer (ERSPC) definition, in a same cohort of patients who underwent Radical Prostatectomy (RP) but eligible for Active Surveillance (AS). Materials and Methods An observational retrospective study was performed in 120 prostate cancer (PCa) patients treated with robot‐assisted RP but eligible for AS according to Prostate Cancer Research International: Active Surveillance (PRIAS) criteria. Blood and urinary specimens were collected before initial prostate biopsy for PHI and PCA3 measurements, respectively. In addition, all patients underwent preoperatively and after 6‐8 weeks from biopsy to mpMRI with a 1.5T scanner using a 4‐5 channel phase array coil combined with an endorectal coin. mpMRI images were assessed and diagrams depicting prostate sextants were used to designate regions of abnormalities within the prostate. Findings in the prostate were assigned to one of five categories according Prostate Imaging‐Reporting and Data System guidelines (PI‐RADS) and considered positive for PCa if final PI‐RADS was >3 and negative if ≤3. Results A pathologically confirmed reclassification was observed in 55 patients (45.8%). mpMRI demonstrated a good specificity and negative predictive value (0.61 and 0.73, respectively) for ruling out a PCSPCa compared with PHI and PCA3. On multivariate analyses and after one thousand bootstrapping resampling, the inclusion of both PHI and mpMRI significantly increased the accuracy of the base model in predicting PCSPCa. Particularly, to predict PCSPCa, the base model had an AUC of 0.71 which significantly increased by 4% with the addition of PHI (AUC=0.75; p
      PubDate: 2015-09-09T05:14:15.916936-05:
      DOI: 10.1111/bju.13318
  • Pediatric Urology: Contemporary Strategies from Fetal Life to Adolescence
           Mario Lima, Gianantonio Manzoni Editors, Springer‐Verlag Mailand,
           2015; hardback, 402 pages, £135.00; e‐book, £108.00.
           ISBN‐10: 8847056934, ISBN‐13: 978‐8847056923,
           e‐book ISBN: 978‐8847056930
    • Authors: Arash Taghizadeh
      PubDate: 2015-09-08T21:34:31.238616-05:
      DOI: 10.1111/bju.13236
  • Erratum
    • Authors: Ashutosh K. Tewari
      PubDate: 2015-09-08T21:34:19.066131-05:
      DOI: 10.1111/bju.13251
  • To Clamp or Not to Clamp' Long‐Term Functional Outcomes for
           Elective Off‐Clamp Laparoscopic Partial Nephrectomy
    • Authors: Paras H. Shah; Arvin K. George, Daniel M. Moreira, Manaf Alom, Zhamshid Okhunov, Simpa Salami, Nikhil Waingankar, Michael J. Schwartz, Manish A. Vira, Lee Richstone, Louis R. Kavoussi
      Abstract: Objective To evaluate whether elective off‐clamp laparoscopic partial nephrectomy affords long‐term renal functional benefit compared to the on‐clamp approach. Subjects/Patients and Methods This is a retrospective review of patients who underwent elective laparoscopic partial nephrectomy between 2006 and 2011. Patients were followed longitudinally for up to 5 years. 315 patients with radiographic evidence of a solitary renal mass and normal‐appearing contralateral kidney underwent elective laparoscopic partial nephrectomy; 209 were performed on‐clamp versus 106 off‐clamp. One patient who required conversion from laparoscopic to open partial nephrectomy was excluded from the study. Additionally, 4 patients in the on‐clamp cohort who underwent subsequent radical nephrectomy for local‐regional recurrence were excluded from longitudinal functional evaluation after their procedure. The primary objective was to evaluate differences in postoperative estimated glomerular filtration rate between hilar clamping groups. Subgroup analyses were performed for patients with clamp times >30 minutes and those with baseline renal insufficiency (estimated glomerular filtration rate 0.05). Univariable and multivariable analyses did not demonstrate significant differences in postoperative estimated glomerular filtration rate between both groups among all‐comers, those with clamp times >30 min, and patients w/ baseline renal insufficiency. Risk of chronic kidney disease was not diminished by the off‐clamp approach with up to 5 years of follow‐up. Conclusions Progressive recovery of renal function after hilar clamping in the elective setting eclipses short‐term functional benefit achieved with off‐clamp laparoscopic partial nephrectomy by 6 months; no significant difference in estimated glomerular filtration rate or percent incidence of chronic kidney disease exists between on‐clamp and off‐clamp cohorts with up to 5‐year follow‐up. As such, eliminating transient ischemia during elective laparoscopic partial nephrectomy does not confer clinical benefit. This article is protected by copyright. All rights reserved.
      PubDate: 2015-09-08T07:40:24.281247-05:
      DOI: 10.1111/bju.13309
  • Contemporary radical cystectomy outcomes in patients with invasive bladder
           cancer: a population‐based study
    • Authors: Manish I. Patel; Albert Bang, David Gillatt, David P. Smith
      Abstract: Objective To determine the contemporary survival outcomes from a whole population and identify significant predictors of survival, as contemporary population‐based survival outcomes after radical cystectomy (RC) for the treatment of bladder cancer (BC) are sparse. Reports suggest a large disparity between population outcomes and those of centres of excellence. Patients and Methods All invasive BC cases diagnosed between 2001 and 2007 in New South Wales, Australia, were identified from the Central Cancer Registry. Records of treatment and death were electronically linked. All patients who underwent RC between 2001 and 2009 were selected for this study (804 patients). Follow‐up was to the end of 2009. Outcomes assessed were disease‐specific survival (DSS) and overall survival (OS). Multivariable Cox regression and log‐rank analysis were used to model and compare survival within groups. Results Of 804 patients diagnosed during the study period 420 (52.2%) died during follow‐up. The 5‐year DSS and OS for all patients was 59.6% and 53.2%, respectively. The 5‐year DSS for patients with localised, regional and distant disease, undergoing RC was 72%, 51% and 10%, respectively. Age (P < 0.001) and stage (P < 0.001) were associated with 5‐year DSS and OS after adjusting for all other variables. High‐volume centres had significantly better 5‐year DSS compared with low‐volume centres (P < 0.05). The 30‐day mortality for high‐ vs low‐volume centres was 1.8% and 3.6%, respectively. Perioperative mortality improved over time for high‐ and moderate‐volume centres but not for low‐volume centres. Conclusion Contemporary survival outcomes after RC are much improved compared with older studies and appear close to results from academic centres of excellence. High‐volume centres report better 5‐year DSS outcomes than lower volume centres.
      PubDate: 2015-09-02T23:26:24.784738-05:
      DOI: 10.1111/bju.13152
  • The role of cystectomy in elderly patients – a multicentre analysis
    • Abstract: Introduction Life expectancy in developed countries is continuously increasing. Hence elderly patients are becoming more common in our clinical practice. Currently, one of the greatest challenges of medicine is balancing the life expectancy of elderly patients against aggressive treatments that carry significant risks. Objective To outline the complications and survival in surgical patients 80 years and over undergoing radical cystectomy for bladder cancer. Patients and Methods A review of a radical cystectomy in elderly recorded in four different institutional prospective databases during the period between 1991 and 2014. Clinical and pathologic features, complications and survival were evaluated. Results A total of 111 patients were available. Median (range) age 82.2 (80–89) years. Seventeen women and 94 men. Regarding the ASA score, 6 patients were ASA I, 47 patients were ASA II, 49 patients ASA III and 9 ASA IV. Prior to surgery, 48 patients had hydronephrosis. The median (range) creatinine series was 1.1 (0.71–11.1) ng/dL. In 88 cases an ileal conduit was performed, 17 a cutaneous ureterostomy diversion, 5 neobladders and 1 ureterosigmoidostomy case. The median (range) operative time was 230 (120–420) min and a total of 97 patients required blood transfusion. The median (range) hospital stay was 14 (7–126) days. The early and late complication rates were 50.4% and 32%, respectively. A total of 14 patients (12.6%) required surgical reintervention. Eight patients (7.2%) died in the immediate postoperative period. The readmission rate of the series was 27.2%. The mean follow‐up of the series was 18 (0.27–134.73) months. During this period 66 patients died, 52 of them due to the tumor. Twelve month tumour progression free survival was 83.9% for ≤pT1, 70.2% for pT2 and 36% for ≥pT3, respectively. Twelve month cancer specific survival was 85.6% for ≤pT1, 75.1% for pT2 and 42.5% for ≥pT3, respectively. Conclusion Radical cystectomy in elderly population is an aggressive surgical treatment with a significant complication rate, hospital readmission and perioperative mortality rate. Careful selection of patients is essential in order to minimize the complications of this surgery and balance benefits against risks in the elderly population. Tumour progression and cancer specific survival are poor for patients with ≥pT3 disease. Alternatives such as tri‐modality therapy need to be considered within a multi‐disciplinary approach. More data is required to determine which sub‐groups of elderly patients would benefit from a complication, survival and quality of life perspective.
      PubDate: 2015-09-02T22:11:39.30969-05:0
      DOI: 10.1111/bju.13227
  • Functional roles of the bladder alpha1‐adrenoceptors in the
    • Authors: Naoki Aizawa; Rino Sugiyama, Koji Ichihara, Tetsuya Fujimura, Hiroshi Fukuhara, Yukio Homma, Yasuhiko Igawa
      Abstract: Objectives To clarify the involvement of bladder α1‐adrenoceptors (α1‐ARs) in the afferent pathways, we investigated effects of silodosin and BMY7378, a selective α1A‐ or α1D‐AR antagonist, respectively, on single unit afferent nerve fiber activities (SAAs) of the primary bladder afferent nerves and its relationship with microcontractions in rats. Materials and Methods Sixty‐three female Sprague‐Dawley rats were anesthetized with urethane. The SAAs of Aδ‐ and C‐fibers generated from left L6 dorsal roots were identified by electrical stimulation of the left pelvic nerve and bladder distension. After measuring baselines of SAA during constant filling cystometry, the procedure was repeated with intravenous (0.3‐30 μg/kg) or intravesical (10 μM) administration of each antagonist. In separate animals, the bladder was filled with saline until the intravesical pressure reached 30 cmH2O, and kept under an isovolumetric condition, then the recording was performed with vehicle and silodosin (0.3 μg/kg) administered intravenously. Results Thirty‐three Aδ‐fibers and 33 C‐fibers were isolated from 63 rats. SAAs of Aδ‐fibers, but not C‐fibers, were dose‐dependently decreased after both intravenous and intravesical administrations of each of the antagonists. In the experiments under the bladder isovolumetric condition, silodosin‐administration significantly decreased the SAAs of Aδ‐fibers, but not C‐fibers, compared with vehicle‐administration. There was no significant effect on either the mean basal bladder pressure or microcontractions. Conclusion The present study suggests that both α1A‐ or α1D‐ARs in the rat bladder are involved in the activation of the bladder mechanosensory Aδ‐fibers during bladder filling, and that this activation may not be related to bladder microcontractions. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-31T10:51:24.468878-05:
      DOI: 10.1111/bju.13313
  • Prostate cancer risk prediction using the novel versions of the ERSPC and
           PCPT risk calculators: Independent validation and comparison in a
           contemporary European cohort
    • Abstract: Objectives To externally validate and compare the two novel versions of the ERSPC‐ prostate cancer (PCa) risk‐calculator (RC) and PCPT‐RC. Patients and methods All men who underwent a transrectal prostate biopsy in a European tertiary care centre between 2004 and 2012 were retrospectively identified. The probability of detecting PCa and significant PCa (Gleason score ≥7) was calculated for each man using the novel versions of the ERSPC‐RC (DRE‐based version 3 / 4) and the PCPT‐RC (version 2.0) and compared with the biopsy results. Calibration and discrimination were assessed using the calibration slope method and the area under the receiver operating characteristic curve (AUC), respectively. Additionally, decision curve analyses were performed. Results Of 1996 men, 483 (24%) were diagnosed with PCa and 226 (11%) with significant PCa. Calibration of the two RCs was comparable, although the PCPT‐RC was slightly superior in the higher risk prediction range for any and significant PCa. Discrimination of the ERSPC‐ and PCPT‐RC was comparable for any PCa (AUCs: 0.65 vs. 0.66), while the ERSPC‐RC was somewhat better for significant PCa (AUCs: 0.73 vs. 0.70). Decision curve analyses revealed a comparable net benefit for any PCa and a slightly greater net benefit for significant PCa using the ERSPC‐RC. Conclusions In our independent external validation, both updated RCs showed less optimistic performance compared to their original reports particularly for the prediction of any PCa. Risk prediction of significant PCa, which is important to avoid unnecessary biopsies and reduce overdiagnosis and overtreatment, was better for both RCs and slightly superior using the ERSPC‐RC. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-31T10:50:07.974025-05:
      DOI: 10.1111/bju.13314
  • A Positive Family History as risk factor for Prostate Cancer in a
           Population‐based Study with organized PSA‐Screening: Results
           of the Swiss ERSPC (Aarau)
    • Abstract: Objective To assess the value of positive family history (FH) as a risk factor for prostate cancer (PCa) incidence and grade among men undergoing organized PSA‐screening in a population‐based study. Patients and Methods The study cohort comprised all attendees of the Swiss arm of the ERSPC with systematic PSA‐tests every 4 years. Men reporting first‐degree relative(s) diagnosed with PCa were considered to have a positive FH. Biopsy was exclusively PSA‐triggered with a threshold of 3ng/ml. Primary endpoint was PCa diagnosis. Kaplan‐Meier and Cox regression analyses were used. Results Of 4,932 attendees with a median age of 60.9 (IQR 57.6‐65.1) years, 334 (6.8%) reported a positive FH. Median follow‐up duration was 11.6 years (IQR 10.3‐13.3). Cumulative PCa incidence was 60/334 (18%, positive FH) and 550/4,598 (12%, negative FH) (OR 1.6, 95%CI 1.2‐2.2, p=0.001), respectively. In both groups, most PCa diagnosed had a low grade. There were no significant differences of PSA at diagnosis, biopsy Gleason score or Gleason score on pathologic specimen among men who underwent radical prostatectomy between both groups, respectively. On multivariable analysis, age (HR 1.04, 95% CI 1.02‐1.06), baseline PSA (HR 1.13 95% CI 1.12‐1.14), and FH (HR 1.6, CI 1.24‐2.14) were independent predictors for overall PCa incidence (p
      PubDate: 2015-08-31T10:22:04.258927-05:
      DOI: 10.1111/bju.13310
  • Active Surveillance in localized prostate cancer: Comparison of incidental
           tumors (T1a/b) and tumors diagnosed by core needle biopsy (T1c/T2a).
           Results from the HAROW Study
    • Authors: Jan Herden; Sebastian Wille, Lothar Weissbach
      Abstract: Objective To conduct a comparative prospective analysis of patients with incidental T1a/T1b‐prostate cancer (IPC) and prostate cancer (PCa) diagnosed by core needle biopsy treated by active surveillance (AS) in terms of inclusion criteria, progression and switch to deferred treatment. Patients and Methods HAROW is an observational outcomes research study on the management of localized PCa. Treating urologists were reporting clinical parameters, information on therapy and clinical course of disease at 6‐month intervals. With respect to therapy, merely recommendations were made; the final decision of the therapeutic modality rested with the treating physician. Results Out of 2957 HAROW patients, 447 chose AS. The median follow‐up was 28.3 months. T‐categories T1a, T1b, T1c and T2a were diagnosed in 81, 18, 292 and 56 patients, respectively. The IPC patient group displayed lower PSA levels (4.2 vs. 6.1 ng/mL) and more co‐morbidities. The IPC group had fewer re‐biopsies (25.3% vs. 43.2%) and fewer changes to invasive treatment (12.1% vs. 25.9%). No significant differences were found with respect to the criteria for discontinuation, subsequent therapies and histological findings after radical prostatectomy. Conclusion Urologists are highly inclined to use AS as a therapeutic option in IPC. More IPC patients continued on AS, which was also associated with the fact that the indication for a re‐biopsy was less stringently observed. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-31T10:15:35.05587-05:0
      DOI: 10.1111/bju.13308
  • Patterns of prescription and adherence to EAU Guidelines of androgen
           deprivation therapy in prostate cancer: an Italian multicenter
           cross‐sectional analysis from the CHOsIng treatment for prostate
           canCEr (CHOICE) study
    • Abstract: Objective To evaluate the patterns of prescription of androgen deprivation therapy (ADT) in patients with prostate cancer (PCa) and the adherence to European Association Urology (EAU) guidelines for ADT prescription. Methods The CHOsIng treatment for prostate canCEr (CHOICE) study was an Italian multicenter cross‐sectional study conducted from December 2010 to January 2012. A total of 1386 patients treated with ADT for PCa (first prescription or renewal of ADT) were selected. According to EAU guidelines, the cohort was categorized in discordant ADT (Group A) and concordant ADT (Group B). Results The final cohort included 1075 patients with a geographical distribution including North‐Italy in 627 (58.3%), Center‐Italy in 233 (21.7%) and South‐Italy in 215 (20.0%). In the category of patients treated with primary ADT, a total of 125 (56.3%) were classified as low‐risk according to D'Amico Classification. According to EAU guidelines, 285 (26.51%) and 790 (73.49%) were classified as discordant (Group A) and concordant (Group B) respectively. In Group A, patients were more likely to receive primary ADT (57.5%; 164/285) than RP (30.9%; 88/285), RT (6.7%; 19/285) or RP + RT (17.7%; 14/285) (p
      PubDate: 2015-08-31T10:15:02.927678-05:
      DOI: 10.1111/bju.13307
  • Transperineal template prostate mapping biopsies: an evaluation of
           different protocols in detection of clinically significant prostate cancer
    • Authors: M Valerio; C Anele, S C Charman, J der Meulen, A Freeman, C Jameson, P B Singh, M Emberton, H U Ahmed
      Abstract: Objectives To determine whether modified transperineal template prostate mapping (TTPM) biopsy protocols, altering the template or the biopsy density, have sensitivity and negative predictive value equal to full 5mm TTPM. Materials and Methods Retrospective analysis of an institutional registry including treatment‐naïve men undergoing 5mm TTPM analysed in 20 zones fashion. The value of three modified strategies was assessed by comparing the information provided by selected zones against full 5mm TTPM. Strategy 1 did not consider the findings of anterior areas; strategies 2 and 3 simulated a reduced biopsy density by excluding intervening zones. A bootstrapping technique was employed to calculate reliable estimates of sensitivity and negative predictive value of these three strategies with respect to detection of clinically significant disease (maximum cancer core length >/= 4mm and/or Gleason score >/= 3+4). Results 391 men with median age 62 years (IQR 58‐67) were included. Median PSA and PSA density were 6.9 ng/ml (IQR 4.8‐10) and 0.17 (IQR 0.12‐0.25), respectively. A median of 6 cores (IQR 2‐9) out of 48 taken per man (IQR 33‐63) were positive for prostate cancer. No cancer was detected in 67 men (17%), whilst low, intermediate and high risk disease was identified in 78 (20%), 80 (21%) and 166 (42%), respectively. Strategy 1, 2 and 3 had sensitivities of 78% (95% CI 73‐84%), 85% (95% CI 80‐90%) and 84% (95% CI 79‐89%), respectively. The negative predictive values of the three strategies was at 73% (95% CI 67‐80%), 80% (95% CI 74‐86%) and 79% (95% CI 72‐84%), respectively. Conclusion Altering the template or decreasing sampling density has a substantial negative impact on the ability of TTPM to rule out clinically significant disease. This should be considered when modified TTPM strategies are performed to select men for tissue‐preserving approaches, and when modified TTPM are employed to validate new diagnostic tests. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-30T23:51:51.259818-05:
      DOI: 10.1111/bju.13306
  • Factors predicting outcome in micropercutaneous nephrolithotomy
           (Microperc): results from a large single centre experience
    • Authors: Arvind Ganpule; Jaspreet Singh Chhabra, Vinayak Kore, Shashikant Mishra, Ravindra Sabnis, Mahesh Desai
      Abstract: Objective To present our single center experience of the microperc technique and define its role in the management of renal calculi and to analyze the factors predicting outcome. Patients and methods We retrospectively analyzed data of 139 patients who underwent microperc for renal calculi between June 2010 and November 2014 at our institution. The factors analyzed were demographic variables which included age, sex, stone volume, stone density (Hounsfield unit), stone location, and intra and perioperative variables such as operative time, hemoglobin drop, stone clearance and complications. Results The mean age of the patients was 38.99± 17 (9 month to 73 years) years, the mean stone volume was 1095± 1035 (105 to 6650) mm3 and the mean stone density in Hounsfield units was 1298 ± 263. The duration of operation was 50.15 ± 9.8 (35‐85) min. The mean hospital stay was 2.36 ± 0.85 (2–5) days and the mean drop in the hemoglobin level was 0.63 ± 0.84 (0–3.7) gm%. 8 patients had renal colic that was managed by antispasmodics and 4 patients had renal colic severe enough to warrant Double‐J stenting and 3 patients had urinary tract infection which were managed with appropriate antibiotics. Microperc could be completed in 130 patients, with 119 (91.53%) patients being rendered completely stone free and in 11 (8.46%) cases there were some residual fragments seen on imaging. On multi‐variate analysis stone number, volume and density (Hounsfield units) were found to be significant predictors of clearance. Conversion to mini or standard percutaneous nephrolithotomy was required in 9 (6.47%) cases, with intra operative complications and stone number being the significant factors warranting conversion on a multivariate basis. Conclusion The outcomes in our study suggest that Microperc is a promising treatment modality for solitary renal stones with volumes
      PubDate: 2015-08-29T02:33:53.578891-05:
      DOI: 10.1111/bju.13263
  • Clinicopathological characteristics and management of prostate cancer in
           the human immunodeficiency virus (HIV)‐positive population:
           experience in an Australian major HIV centre
    • Authors: Wee Loon Ong; Paul Manohar, Jeremy Millar, Peter Royce
      Abstract: Objectives To characterise clinicopathological characteristics of prostate cancer among human immunodeficiency virus (HIV)‐positive men and to evaluate the current practice patterns in the management of prostate cancer in these men. Patients and Methods We retrospectively reviewed all patients with HIV in the State‐wide HIV referral centre in Victoria, who were diagnosed with prostate cancer from 2000 onwards. In all, 12 patients were identified, and the medical records were reviewed to collect data on HIV parameters at the time of prostate cancer diagnosis, as well as prostate cancer clinicopathological characteristics, treatment details and outcomes. Results At the time of prostate cancer diagnosis, eight patients had undetectable viral load, and the median cluster of differentiation 4 (CD4) count was 485 cells/μL. The average age at diagnosis of prostate cancer was 63 years and the median prostate‐specific antigen (PSA) level of 11.1 ng/mL. Four patients had Gleason 6 prostate cancer, four Gleason 7, one Gleason 8 and three Gleason 9. Seven of the 12 patients had a positive family history for prostate cancer. Of the patients with clinically localised prostate cancer (10), most were treated with radiotherapy (RT): one permanent seed brachytherapy (BT), five external beam RT (EBRT), two open radical prostatectomies (RP), one active surveillance (AS), and one on watchful waiting (WW). For the two patients with metastatic disease, one had androgen‐deprivation therapy and EBRT, while the other had a combination of EBRT and chemo‐hormonal therapy with doxetacel. All patients were followed for a median of 46 months, with three deaths reported, none of which was a prostate cancer‐specific death. Conclusions This is the first Australasian series on prostate cancer management in a HIV population. With the prolonged survival among HIV‐positive men in the highly active anti‐retroviral therapy era, PSA testing should be offered to this group of patients, especially those with a positive family history. HIV‐positive men should also be offered all treatment options in the same manner as men in the general population.
      PubDate: 2015-08-28T05:19:36.225253-05:
      DOI: 10.1111/bju.13097
  • Risk Factors for Recurrence After Surgery in Non‐ metastatic RCC
           with Thrombus; a Contemporary Multicenter Analysis
    • Abstract: Objective Few studies of renal cell cancer with tumor thrombus have evaluated the risk of recurrence after attempted curative surgery. The objective of this study was to determine predictors of postsurgical recurrence for non‐metastatic patients with RCC and venous thrombus. Methods Records from consecutive non‐metastatic RCC patients with tumor thrombus treated surgically from 2000 to 2012 at three centers were reviewed. Univariable and multivariable analysis was used to evaluate the association of risk factors for post‐surgical recurrence. Results A total of 465 non‐metastatic patients were identified including patients with thrombus present in: renal vein 257 (55.3%), infrahepatic IVC 144 (31.0%), and suprahepatic IVC 64 (13.8%). Median follow‐up was 28.3 months (IQR 12.2‐56.4) with metastatic RCC developing in 188 (40.5%) patients. Independent predictors of recurrence included: BMI ≤20 (HR 2.66; 95% CI 1.29‐5.49), low pre‐operative hemoglobin (HR 1.54; 95% CI 1.07‐2.20), perinephric fat invasion (HR 1.51; 95% CI 1.09‐2.10), IVC thrombus height (HR 2.64; 95% CI 1.47‐4.74), tumor diameter (HR 1.04 95% CI 1.00‐1.09), nuclear grade (HR 1.56 95% CI 1.12‐2.15), and non‐clear cell histology (2.13; 1.30‐3.50). Independently predictive variables were used to create a recurrence model for 3 risk groups based on 0, 1‐2, or >2 risk factors respectively. Five‐year RFS was significantly different in favorable risk (79.1%) compared to intermediate risk (55.1%) or high risk (22.1%) patients, p
      PubDate: 2015-08-25T10:43:14.713069-05:
      DOI: 10.1111/bju.13268
  • Non‐steroidal Anti‐inflammatory Drug use Not Associated with
           Erectile Dysfunction Risk: Results from the Prostate Cancer Prevention
    • Authors: Darshan P Patel; Jeannette M Schenk, Amy Darke, Jeremy B Myers, William O Brant, James M Hotaling
      Abstract: Objective To evaluate associations of NSAID use and risk of ED, considering indications for NSAID use. Patients and Methods Data are from 4,726 men in the placebo arm of the Prostate Cancer Prevention Trial (PCPT) without evidence of ED at baseline. Incident ED was defined as mild/moderate (decrease in normal function) and severe (absence of function). Proportional hazards models were used to estimate covariate‐adjusted associations of NSAID–related medical conditions and time‐dependent NSAID use with ED risk. Results Arthritis (HR: 1.56), chronic musculoskeletal pain (HR: 1.35), general musculoskeletal complaints (HR:1.36), headaches (HR:1.44), sciatica (HR:1.50), and atherosclerotic disease (HR:1.60) were all significantly associated with increased risk of, mild/moderate ED, while only general musculoskeletal complaints (HR:1.22), headaches (HR:1.47) and atherosclerotic disease (HR:1.60) were associated with increased risk of severe ED. Non‐aspirin NSAID use was associated with an increased risk of mild/moderate ED (HR: 1.16, p=0.02) and Aspirin use was associated with an increased risk of severe ED (HR: 1.16, p=0.03, respectively). Associations of NSAID use with ED risk were attenuated after controlling for indications of NSAID use. Conclusions The modest associations of NSAID use with ED risk in this cohort were likely due to confounding indications of NSAID use. NSAID use was not associated with ED risk. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-25T10:34:55.805052-05:
      DOI: 10.1111/bju.13264
  • Increased use of partial nephrectomy to treat high‐risk disease
    • Authors: Matthew J. Maurice; Hui Zhu, Simon P. Kim, Robert Abouassaly
      Abstract: Objectives To evaluate partial nephrectomy use in patients at higher risk for clinical progression, using a large national database of American patients. Patients and methods We performed a retrospective review of patients with cN0/cM0 renal cell carcinoma from 2003‐2011 using the National Cancer Data Base. Our primary endpoint was partial nephrectomy use for high‐risk disease, defined as ≥1 adverse pathologic feature(s), namely pT3 stage, high grade, or unfavorable histologic subtype). Our secondary endpoint was positive surgical margins associated with high‐risk disease after partial nephrectomy. Time trends were analyzed using the asymptotic Cochran‐Armitage trend test. Relationships between patient, provider, and pathologic factors and the likelihood of partial nephrectomy were assessed using multivariate logistic regression. Results Of 183,886 surgically treated patients, 27.4% underwent partial nephrectomy. Over time, partial nephrectomy use increased overall (17.4‐39.7%) and in tumors with ≥1 adverse pathologic feature(s) (8.5‐24.2%) (p
      PubDate: 2015-08-25T10:28:51.225439-05:
      DOI: 10.1111/bju.13262
  • Comparison of the efficacy and safety of 2 mg and 4 mg tolterodine
           combined with an α‐blocker in men with lower urinary tract
           symptoms and overactive bladder: A randomised controlled trial
    • Abstract: Objective To evaluate the efficacy and safety of low‐dose (2 mg) tolterodine extended release (ER) with an α‐blocker versus standard‐dose (4 mg) tolterodine ER with an α‐blocker for the treatment of men with residual storage symptoms after α‐blocker monotherapy. Patients and Methods This was a 12‐week, single‐blind, randomised, parallel‐group, non‐inferiority trial that included men with residual storage symptoms despite receiving at least 4 weeks of α‐blocker treatment. Inclusion criteria were total International Prostate Symptom Score (IPSS) ≥12, IPSS‐quality of life item score ≥3, and ≥8 micturitions and ≥2 urgency episodes per 24 hours. The primary outcome was change in the total IPSS score from baseline. Bladder diary variables, patient‐reported outcomes, and safety were also assessed. Results Patients were randomly assigned to addition of either 2 mg tolterodine ER (n=47) or 4 mg tolterodine ER (n=48) to α‐blocker therapy for 12 weeks. Patients in both treatment groups demonstrated significant improvement in total IPSS score (‐5.5 and ‐6.3, respectively), micturition per 24 hours (‐1.3 and ‐1.7, respectively), and nocturia per night (‐0.4 and ‐0.4, respectively). Changes in IPSS, bladder diary variables, and patient‐reported outcomes were not significantly different between the treatment groups. All interventions were well tolerated by patients. Conclusions These results suggest that 12 weeks of low‐dose tolterodine ER add‐on therapy is comparable to standard‐dose tolterodine ER add‐on therapy in terms of efficacy and safety for patients experiencing residual storage symptoms after receiving α‐blocker monotherapy. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-25T10:28:22.599679-05:
      DOI: 10.1111/bju.13267
  • Evaluation of pT0 prostate cancer in radical prostatectomy patients
    • Authors: Daniel M. Moreira; Boris Gershman, Laureano J. Rangel, Stephen A. Boorjian, R. Houston Thompson, Igor Frank, Matthew K. Tollefson, Matthew T. Gettman, R. Jeffrey Karnes
      Abstract: Objective To evaluate the incidence, predictors and oncologic outcomes of pT0 prostate cancer (PCa). Methods Retrospective analysis of 20,222 men undergoing RP for PCa at Mayo Clinic from 1987 to 2012. Disease recurrence was defined as follow‐up prostate‐specific antigen (PSA) >0.4ng/mL or biopsy‐proven local recurrence. Systemic progression was defined as development of metastatic disease on imaging. Comparisons of baseline characteristics between pT0 and non‐pT0 were done with chi‐square and tests. Recurrence‐free survival was estimated using the Kaplan‐Meier method and compared with log‐rank test. Results A total of 62 (0.3%) men had pT0 in the RP specimen. In univariable analysis, pT0 was significantly associated with older age (P=0.045), lower PSA (P=0.002), lower clinical stage (P
      PubDate: 2015-08-25T10:24:32.108315-05:
      DOI: 10.1111/bju.13266
  • Robot‐assisted partial nephrectomy in cystic tumors: analysis of the
           Vattikuti Global Quality Initiative in Robotic Urologic Surgery
           (GQI‐RUS) database
    • Abstract: Objective Limited data are available concerning the outcome of robot‐assisted partial nephrectomy (RAPN) in cystic tumors. To evaluate outcomes of RAPN in cystic tumors, analyzing a large, multi‐institutional, retrospective series of RAPN. Patients and Methods We evaluated 465 patients who received RAPN for either cystic or solid tumors from 2010 to 2013 and included in the multi‐institutional, retrospective GQI‐RUS database Univariable and multivariable linear and logistic regression models addressed the association of cystic tumors with perioperative outcomes. Results Fifty‐four (12%) tumors were cystic. Cystic tumors were associated with significantly lower operative time (t ‐3.9; p
      PubDate: 2015-08-25T10:23:55.167877-05:
      DOI: 10.1111/bju.13256
  • Suicide and accidental deaths among patients with loco‐regional
           prostate cancer
    • Abstract: Introduction Patients with cancer are at increased risk of suicide. Further, evidence suggests a relationship between suicides and deaths due to accidents and externally caused injuries. We sought to determine if American men with prostate cancer (PCa) are at increased risk of suicide/accidental death compared to other cancers, and if the receipt of definitive treatment alters this association. Material & Methods Demographic, socio‐economic and tumor characteristics of men with PCa and men with other solid malignancies were extracted from the Surveillance, Epidemiology and End Results (1988‐2010). Poisson regression models were fitted to compare the incidence of suicidal and accidental deaths in PCa vs. other solid cancers. Multivariate Cox regression was used to determine if receipt of definitive primary treatment impacted the risk of suicide or accidental death in men with localized/regional PCa. Results Risk of suicidal and accidental death was significantly lower in men with PCa [1165 (0.2%) and 3,199 (0.6%)] than men with other cancers [2,232 (0.2%) and 4,501 (0.5%) respectively], except within the first year of diagnosis (adjusted relative risk [ARR]=3.98 [95%CI 3.02‐5.23] and ARR=4.22 [95%CI 3.24‐5.51] respectively, 0‐3 months after diagnosis). Men with non‐metastatic PCa who were white, uninsured, or recommended but did not receive treatment (HR vs. treated=1.44, 95% CI 1.20‐1.72, and 1.44, 95% CI 1.30‐1.59, both p
      PubDate: 2015-08-25T10:23:40.480303-05:
      DOI: 10.1111/bju.13257
  • The impact of change in serum C ‐reactive protein level on the
           prediction of effects of molecular targeted therapy in metastatic renal
           cell carcinoma patients
    • Authors: Jun Teishima; Kohei Kobatake, Hiroyuki Kitano, Hirotaka Nagamatsu, Kousuke Sadahide, Keisuke Hieda, Shunsuke Shinmei, Koichi Shoji, Shogo Inoue, Tetsutaro Hayashi, Yoji Inoue, Shinya Ohara, Koji Mita, Akio Matsubara
      Abstract: Objectives To investigate the impact of pretreatment serum C‐reactive protein (CRP) level and its change after targeted therapy on the anti‐tumor effect of targeted agents. Patients and methods Serum CRP level in 190 cases of molecular targeted therapy for metastatic RCC (mRCC) was measured before starting the prescription of molecular targeted agents and when CT scanning showed the maximum effect. Cases in which pretreatment CRP level was 0.5 mg/dL or higher were classified into a “higher CRP” group and others into a “lower CRP” group. The higher CRP group was further classified into two subgroups, i.e., those whose serum CRP level decreased after molecular targeted therapy (“decreased CRP” subgroup), and those whose level did not decrease after therapy (“non‐decreased CRP” subgroup). All cases were also classified according to their other clinical backgrounds, and the progression‐free survival (PFS) rates of each subgroup were compared. Results Of 190 cases, 97 were categorized as lower CRP and 93 as higher CRP, with 50 and 43 cases in the higher CRP group categorized as decreased and non‐decreased CRP subgroups, respectively. As to the maximum effects of the targeted therapy determined based on the RECIST criteria in the lower group, the rate of cases with complete response (CR) and partial response (PR) was significantly higher (P=0.0016) and that with progressive disease (PD) was significantly lower (P=0.0001) than in the higher CRP group. In higher CRP group, the rate of cases with PD in the decreased CRP subgroup was significantly lower (P
      PubDate: 2015-08-25T10:21:54.110272-05:
      DOI: 10.1111/bju.13260
  • Budget impact of incorporating one instillation of hexaminolevulinate
           hydrochloride blue‐ light cystoscopy in trans‐urethral bladder
           tumour resection for non‐muscle invasive bladder cancer patients in
    • Abstract: Objectives To explore the cost impact on Swedish healthcare of incorporating one instillation of hexaminolevulinate hydrochloride (HAL) blue light cystoscopy into the transurethral resection of bladder tumours (TURBT) in patients with suspected new or recurrent non‐muscle invasive bladder cancer (NMIBC). Materials and Methods A decision tree model was built based on European Association of Urology guidelines for the treatment and management of NMIBC. Input data was compiled from two recent studies comparing recurrence rates of bladder cancer in patients undergoing TURBT with the current standard of care (SOC) of white light cystoscopy, or with the SOC and HAL blue light cystoscopy. Using this published data with clinical cost data for surgical and outpatient procedures and pharmaceutical costs the model reported on clinical and economic differences associated with the two treatment options. Results This model demonstrates the significant clinical benefits likely to be observed through the incorporation of HAL blue light cystoscopy for TURBT in terms of reductions in recurrences of bladder cancer. Analysis of economic outputs of the model found that the use of one instillation of HAL for TURBT in all Swedish NMIBC patients is likely to be cost neutral or cost saving over 5 years relative to the current SOC of white light cystoscopy. Conclusions The results of this analysis provide additional health economic rationale for the incorporation of a single instillation of HAL blue light cystoscopy for TURBT in the treatment of NMIBC patients in Sweden. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-25T10:19:09.098462-05:
      DOI: 10.1111/bju.13261
  • “Button Type” Bipolar Plasma Vaporization of the Prostate
           Compared with Standard Transurethral Resection: A Systematic Review and
           Meta‐Analysis of short‐term outcome studies
    • Authors: Marcelo Langer Wroclawski; Arie Carneiro, Rodrigo Dal Moro Amarante, Carlos Eduardo Bonafe Oliveira, Victor Shimanoe, Bianca Alves Vieira Bianco, Paulo Kouiti Sakuramoto, Antonio Carlos Lima Pompeo
      Abstract: Objective To evaluate the surgical morbidity and effectiveness in the improvement of symptoms, comparing Button type bipolar plasma vaporization (BTPV) versus Transurethral Prostate Resection (TURP). Materials and Methods We conducted a literature search of published articles until November 2014. Only prospective and randomised studies with comparative data between BTPV and conventional TURP (mono‐ or bipolar) were included in this review. Results Six articles were selected for the analyses. In a total of 871 patients evaluated, 522 were submitted to TURP and 349 to BTPV. There was a tendency to a higher transfusion rate in the TURP group, being observed in 2 cases submitted to BTPV (0.006%) and in 16 cases submitted to TURP (0.032%) (p=0.06). The number of complications was similar between groups (OR: 0.33, IC: 0.8‐1.31, p=0.12, I2=86%). In a subdivision by severity, 10.7% (14/131) and 14.6% (52/355) of the complications were classified as severe (Clavien 3 or 4) in patients submitted to BTPV and TURP, respectively (p=0.02). The average time of indwelling catheter was significantly lower in the patients underwent BTPV (SMD: ‐0.84; IC: ‐1.54‐0.14; p=0.02; I2=81%). Both treatments were related to a significant improvement of symptoms and postoperative IPSS was similar in both groups, regardless of the procedure performed (SMD: 0.09, 95%CI: ‐1.56‐1.73, p=0.92). Conclusion Button‐Type plasma vaporisation is an efficient and safe treatment of BPH. The improvement of urinary symptoms and overall complications are comparable to conventional TURP. However, BTVP appears to be associated with a lower rate of major complications. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-24T05:34:24.181414-05:
      DOI: 10.1111/bju.13255
  • Brachytherapy‐ State Of The Art Radiotherapy In Prostate Cancer
    • Authors: Michael WT Chao; Peter Grimm, John Yaxley, Raj Jagavkar, Michael Ng, Nathan Lawrentschuk
      Abstract: Contemporary treatment options for prostate cancer are considered to have comparable efficacy. Therefore other differences such as treatment related toxicities, impact on quality of life, convenience, treatment time, and cost become important considerations in influencing treatment choice. The goal of brachytherapy is to achieve high precision, targeted radiotherapy utilising advanced computerised treatment planning and image guided delivery systems to achieve tailored ablative tumour dose to the prostate whilst sparing surrounding organs at risk to minimise potential toxicities. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-11T01:52:53.264293-05:
      DOI: 10.1111/bju.13252
  • Is transperineal prostate biopsy more accurate than transrectal biopsy in
           determining final Gleason score and clinical risk category? A
           comparative analysis
    • Authors: Susan Scott; Hemamali Samaratunga, Charles Chabert, Michelle Breckenridge, Troy Gianduzzo
      Abstract: Objectives To assess the degree of upgrading and increase in clinical risk category of transperineal template biopsy (TTB) compared with transrectal ultrasonography‐guided prostate biopsy (TRUSB). Upgrading of TRUSB Gleason grade and sum after radical prostatectomy (RP) is well recognised. TTB may offer a more thorough mapping of the prostate than TRUSB, as well as a more accurate assessment of the tumour. In this retrospective cohort study of prospectively collected data, we compare the initial TRUSB and TTB Gleason grade and sum with the final assessment at RP. Patients and Methods Following Ethics Committee approval, 431 laparoscopic and robotic RP specimens of two urologists, fellowship‐trained in minimally invasive RP, were examined in the private sector between April 2009 and October 2013. Final RP Gleason grade and sum were compared with the initial prostate biopsy. All pathological assessments were performed by a dedicated uropathology unit, experienced in prostate pathology. Upgrading was defined either as an increase in the primary Gleason grade, or as identification of a higher grade tertiary pattern at final RP analysis. Increase in clinical risk category was defined as an increase from low‐ (Gleason ≤6), to either intermediate‐ (Gleason 7) or high‐risk disease (Gleason 8–10); or as an increase from intermediate‐ to high‐risk disease. The chi‐squared test was used to compare categorical variables, while the Wilcoxon rank sum was used for continuous quantitative variables. Results The 431 RP specimens comprised 283 in which the prostate cancer was diagnosed at TRUSB and 148 diagnosed at TTB. There was no difference between TRUSB and TTB in mean prostate weight (46.4 vs 44.2 g), final RP pathological stage (pT2: 187 vs 102; pT3 97 vs 48; P = 0.65) or mean tumour volume (2.15 vs 2.14 mL). Overall, 33.22% of TRUSB and 30.41% of TTB were upgraded, which was not significantly different (P = 0.55). Similarly there was no difference in whether there was an increase to a higher Gleason sum (TRUSB 23.3% vs TTB 20.9%; P = 0.57). TTB was more reflective of the actual clinical risk category, with TRUSB more likely to show an increase in clinical risk (TRUSB 22.3% vs TTB 14.2%; P = 0.04). Conclusions In this series, TTB more accurately predicted clinical risk category than TRUSB. TTB should be considered before active surveillance, to ensure that occult higher risk disease has not been under diagnosed. Upgrading and increase in clinical risk category was relatively common in each group highlighting the need for improved pretreatment staging accuracy.
      PubDate: 2015-08-11T00:50:35.478226-05:
      DOI: 10.1111/bju.13165
  • The value of MR/US fusion prostate biopsy platforms in prostate cancer
           detection, a systematic review
    • Authors: Maudy Gayet; Anouk van der Aa, Harrie P. Beerlage, Bart Ph. Schrier, Peter F.A. Mulders, Hessel Wijkstra
      Abstract: Background Despite limitations considering the presence, staging and aggressiveness of prostate cancer, systematic ultrasound (US) guided biopsies are still the golden standard in the diagnosis of prostate cancer. Recently, promising results have been published about targeted prostate biopsies using MR/US fusion platforms. Different platforms are FDA‐registered and have, mostly subjective, strengths and weaknesses. To our knowledge, no systematic review exists that objectively compared prostate cancer detection rates between the different platforms available. Objective To assess the value of the different MR/US fusion platforms in prostate cancer detection with platform guided targeted prostate biopsies compared to systematic biopsies and other ways of MR/US fusion (cognitive fusion or in‐bore MR fusion), we reviewed well‐designed prospective randomized and non‐randomized trials. Data sources A systematic review of English articles published between January 1st, 2004 and February 17th, 2015 using PubMed, Embase and Cochrane Library databases was performed. Search terms included: prostate cancer, MR/ultrasound(US) fusion and targeted biopsies. Study selection Extraction of articles was performed by two authors (M.G. and A.A.) and were evaluated by the other authors. Randomized and non‐randomized prospective clinical trials comparing targeted prostate biopsies using a MR/US fusion platform and systematic randomized prostate biopsies or other ways of targeted prostate biopsies (cognitive fusion or MR in‐bore fusion) were included. Data extraction methods and data synthesis 11 of 1865 studies met the inclusion criteria, involving seven different fusion platforms and 2626 subjects: 1119 biopsy naïve, 1433 with prior negative biopsy, 50 not mentioned (either biopsy naïve or with prior negative biopsy) and 24 on active surveillance (which were disregarded). The QUADAS‐2 tool was used to assess the quality of included articles. No clear advantage of MR/US fusion guided‐biopsies can be observed regarding cancer detection rates (CDRs) of all PCas. However, MR/US fusion guided‐biopsies tend to give a higher CDR of clinically significant PCas in our analysis. Limitations Important limitations of this systematic review include the limited number of included studies, lack of a general definition of clinically significant prostate cancer, the heterogenous study population and a reference test with low sensitivity and specificity. Conclusions Today, a limited number of prospective studies have reported CDRs of fusion platforms. Although MR/US fusion targeted‐biopsies has proved its value in men with prior negative biopsies, general use of this technique in diagnosis of prostate cancer should only be performed after critical consideration. Before bringing MR/US fusion guided biopsies in general practice, there is a need of more prospective studies in PCa diagnosis. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-03T09:58:36.431583-05:
      DOI: 10.1111/bju.13247
  • Pre‐operative double J stent placement in ureteral and renal stone
           treatment: results from the Clinical Research Office of Endourological
           Society URS Global Study
    • Authors: Dean Assimos; Alfonso Crisci, Daniel Culkin, Wei Xue, Anita Roelofs, Mordechai Duvdevani, Mahesh Desai, Jean la Rosette,
      Abstract: Objective To compare outcomes with the use a pre‐operative double J stent in ureteral and renal stone treatment with ureteroscopy (URS). Methods The Clinical Research Office of the Endourological Society (CROES) URS Global Study collected prospective data on consecutive patients with ureteral or renal stones treated with URS at 114 centres around the world for 1 yr. Pre‐operative double J stent placement was used in a subset of patients. To examine the relationship of a pre‐operative double J stent placement on stone free rate (SFR), length of hospital stay (LOHS), operation duration and complications (rate and severity), the Inverse Probability Weighted Regression Adjustment (IPWRA) was used. Results Of the 8189 patients with ureteral stones a comparison was made of 978 (11.9%) and 7133 patients with and without a pre‐operative double J stent, respectively. Of the 1622 patients with renal stones, 590 (36.4%) underwent preoperative stenting with a double J stent and 1002 did not. In renal stone treatment, a pre‐operative stent placement increased SFRs and operation time. A borderline significant decrease in intra‐operative complications was observed. For ureteral stone treatment, a pre‐operative stent placement was associated with longer operating time and decreased LOHS. No difference in SFRs and complications were observed. One major limitation of the study is that the reason for a double J stent placement was not identified preoperatively. Conclusions The use of a double J stent increases SFRs and decreases complications in patients with renal stones but not in those with ureteral stones. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-03T09:57:54.161267-05:
      DOI: 10.1111/bju.13250
  • Urinary fistula after robotic partial nephrectomy: a multicenter analysis
           of 1791 patients
    • Authors: Aaron M. Potretzke; B. Alexander Knight, Homayoun Zargar, Jihad H. Kaouk, Ravi Barod, Craig G. Rogers, Alon Mass, Michael D. Stifelman, Michael H. Johnson, Mohamad E. Allaf, R. Sherburne Figenshau, Sam B. Bhayani
      Abstract: objectives to evaluate the incidence of and risk factors for a urine leak in a large multicenter, prospective database of robotic partial nephrectomy (rpn). patients and methods a database of 1791 rpn from five centers was reviewed for urine leak as a complication of rpn. patients with postoperative urine leaks were compared to patients without postoperative urine leaks on a variety of patient and tumor characteristics. fisher's exact test was used for qualitative variables and wilcoxon sum‐rank tests were used for quantitative variables. a review of the literature on partial nephrectomy and urine leak was conducted. results urine leak was noted in 14/1791 (0.78%) patients who underwent rpn. mean nephrometry score of the entire cohort was 7.2 ± 1.9, and 8.0 ± 1.9 in patients who developed urine leak. the median postoperative day of presentation was 13 (range 3‐32). patients with urine leak presented in delayed fashion with fever (14%), gastrointestinal complaints (29%), and pain (36%). eight patients required admission (57%), while eight (57%) and nine (64%) had a drain or stent placed, respectively. drains and stents were removed after a median of eight (range 4‐13) and 21 days (8‐83), respectively. variables associated with urine leak included tumor size (p = 0.021), hilar location (p = 0.025), operative time (p=0.006), warm ischemia time (p = 0.005), and pelvicaliceal repair (p = 0.018). upon literature review, the historical incidence of leak ranged from 1.0‐17.4% for opn and 1.6‐16.5% for lpn. conclusion the incidence of urine leak after rpn is very low and may be predicted by some preoperative factors, affording better patient counseling of risks. the low urine leak may be attributed to the enhanced visualization and suturing technique that accompanies the robotic approach. This article is protected by copyright. all rights reserved.
      PubDate: 2015-08-01T02:52:21.777462-05:
      DOI: 10.1111/bju.13249
  • Association between very small tumor size and increased
           cancer‐specific mortality following radical prostatectomy in
           node‐positive prostate cancer
    • Authors: Vinayak Muralidhar; Brandon A. Mahal, Michelle D. Nezolosky, Clair J. Beard, Felix Y. Feng, Neil E. Martin, Jason A. Efstathiou, Toni K. Choueiri, Mark M. Pomerantz, Christopher J. Sweeney, Quoc-Dien Trinh, Matthew G. Vander Heiden, Paul L. Nguyen
      Abstract: Objective To determine whether very small prostate cancers present in patients who also have lymph node (LN) metastases represent a particularly aggressive disease variant compared to larger node‐positive tumors. Subjects/Patients and Methods We identified 37,501 patients diagnosed with prostate cancer between 1988 and 2001 treated with radical prostatectomy within the Surveillance, Epidemiology, and End Results database. The primary study variables were tumor size by largest dimension (stratified into: (1) microscopic focus only or 1 mm; (2) 2‐15 mm; (3) 16‐30 mm; (4) greater than 30 mm), regional LN involvement, and the corresponding interaction term. We evaluated the risk of 10‐year prostate cancer‐specific mortality (PCSM) using the Fine‐Gray model for competing risks after controlling for race, tumor grade, T stage, receipt of radiation, number of dissected LNs, number of positive LNs, year of diagnosis, and age at diagnosis. Results Median follow‐up was 11.8 years. There was a significant interaction between tumor size and LN involvement (P‐interaction < 0.001). In the absence of LN involvement (N=36,561), the risk of 10‐year PCSM increased monotonically with increasing tumor size. Among patients with LN involvement (N=940), those with the smallest tumors had increased 10‐year PCSM compared to patients with tumors sized 2‐15 mm (24.7% vs. 11.8%; adjusted hazard ratio [AHR] = 2.84; 95% confidence interval [CI], 1.21 to 6.71; P = 0.017) or 16‐30 mm (24.7% vs. 15.5%; AHR = 3.12; 95% CI, 1.51 to 6.49; P = 0.002) and similar 10‐year PCSM compared to those with tumors greater than 30 mm (24.7% vs. 24.9%; P = 0.156). Conclusion In prostate cancer patients with LN involvement, very small tumor size may predict for higher PCSM compared with some larger tumors, even after controlling for other prognostic variables. These tumors might be particularly aggressive, beyond what is captured by pathological assessment of tumor grade and stage. This article is protected by copyright. All rights reserved.
      PubDate: 2015-08-01T02:32:45.127856-05:
      DOI: 10.1111/bju.13248
  • DaPeCa‐3: Promising Results of Sentinel Node Biopsy Combined with
           18F‐FDG PET/CT in Clinically Lymph Node Negative Patients with
           Penile Cancer – a National Study from Denmark
    • Abstract: Objectives To estimate the diagnostic accuracy of sentinel node biopsy (SNB) combined with preoperative 18F‐fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for inguinal lymph node evaluation in invasive penile squamous cell carcinoma (pSCC) patients with no clinical evidence of inguinal metastases (cN0) at two tertiary centres with complete clinical follow‐up. Patients and methods From April 2010 in centre one and from January 2013 in centre two, we prospectively enrolled patients diagnosed with invasive pSCC and scheduled for SNB at the only two university centres treating penile cancer in Denmark. All patients had a FDG PET/CT prior to SNB. The sentinel nodes were preoperatively located by planar lymphoscintigraphy in 134 groins (68 patients) and by single photon emission computed tomography/CT (SPECT/CT) in 120 groins (61 patients). Primary endpoints were sensitivity, specificity, and false negative rate of SNB combined with FDG PET/CT. Secondary endpoint was SNB related morbidity. Results We examined 254 groins in 129 patients by SNB combined with FDG PET/CT. Median follow‐up of survivors was 23 (IQR: 14 ‐ 35) months. Of 201 negative groins, two disclosed false negative, and despite radio‐chemotherapy treatment, both patients died from penile cancer. Four of 23 radiotracer‐silent groins, had a FDG PET/CT positive lymph node and were surgically explored. In one out of four explored groins, a positive lymph node was found. Combined FDG PET/CT SNB sensitivity was 94.4% (95% CI, 81 – 99%) per groin. False negative rate was 5.6% (95% CI 1‐19%) per groin. Twenty‐five SNB related complications Clavien‐ Dindo grade 1‐ 3a were encountered in fifteen patients (11.6%). The only Clavien‐Dindo 3a complication was inguinal lymphocele treated by aspiration. Remaining morbidity was Clavien‐Dindo grades 1 and 2 Conclusion In the current study, we present a favourable SNB false negative rate at 5.6% in a national cohort of clinically lymph node negative patients with invasive pSCC with a pre‐SNB FDG PET/CT scan. The combination of FDG PET/CT and SNB seems to be a promising diagnostic approach. Even so, a false negative SNB was fatal in two out of two cases and we are determined to continue the development of our SNB technique. SNB‐related morbidity is limited. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-28T01:14:04.00594-05:0
      DOI: 10.1111/bju.13243
  • Adrenalectomy: a retroperitoneal procedure
    • Authors: SS Goonewardene; M Brown, BJ Challacombe
      Abstract: The investigation and management of adrenal masses are part of the core urology syllabus in both the UK and overseas (e.g. Australasia). Despite this, most adrenal pathologies are treated by endocrine surgeons, with a general surgical background. However, some regions of the UK do not have access to endocrine surgeons. Moreover, with any type of surgery, especially high risk surgery, high case volume is important to optimise outcomes. With regard to this, most urologists undertaking renal surgery will perform a median of 20‐30 nephrectomies per year (from a national total of >8000 nephrectomies) and as part of this procedure, the adrenal gland is often routinely removed. In comparison, there are approximately 570 adrenalectomies conducted per year in the UK by endocrine surgeons, with an average of 13 per surgeon. Single centre institutions in America may do a median of 60‐70 procedures per year [1]. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-27T23:56:27.848239-05:
      DOI: 10.1111/bju.13245
  • Differential Effects of Isomers of Clomiphene Citrate on Reproductive
           Tissues in Male Mice
    • Authors: Gregory K. Fontenot; Ronald D. Wiehle, Joseph S. Podolski
      Abstract: Objectives To determine in a chronic dosing study the oral toxicity potential of the test substances Enclomiphene citrate and Zuclomiphene citrate when administered to male mice by oral gavage. Methods A chronic dosing study was conducted utilizing test substances Enclomiphene citrate and Zuclomiphene citrate administered to male mice daily by oral gavage. Mice were divided into five treatment groups (Group I: Placebo; Group II: 40 MPK (mg/kg body weight)\day Enclomiphene citrate; Group III: 4 MPKday Enclomiphene citrate; Group IV: 40 MPKday Zuclomiphene citrate; Group V: 4 MKP/day Zuclomiphene citrate. Body weights were measured. Serum samples and tissues were obtained from each animal for analysis. Results In a chronic dose study in mice, profound effects on the Leydig cells, epididymis, seminal vesicles and kidneys were seen as well as effects on testosterone (T), follicle stimulating hormone (FSH) and luteinizing hormone (LH) secretion that were associated with zuclomiphene treatment only. Treatment with the isolated enclomiphene isomer has positive effects on testosterone production and no effects on testicular histology. Conclusions This work suggests that un‐opposed high dose of zuclomiphene can have pernicious effects on male mammalian reproductive organs. The deleterious effects seen when administering Zuclomiphene citrate in male mice justifies the case for a monoisomeric preparation and the development of Enclomiphene citrate, for clinical use in human males to increase serum levels of testosterone and maintaining sperm counts. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-27T23:55:50.476157-05:
      DOI: 10.1111/bju.13244
  • Super‐Mini Percutaneous Nephrolithotomy (SMP): A new concept in
           technique and instrumentation
    • Authors: Guohua Zeng; ShawPong Wan, Zhijian Zhao, Jianguo Zhu, Aierken Tuerxun, Chao Song, Liang Zhong, Ming Liu, Kewei Xu, Hulin Li, Zhiqiang Jiang, Sanjay Khadgi, SK Pal, Jianjun Liu, Guoxi Zhang, Yongda Liu, Wenqi Wu, Wenzhong Chen, Kemal Sarica
      Abstract: Aim A novel miniature endoscopic system was designed to improve the safety and efficacy of the percutaneous nephrolithotomy, as named the “Super‐Mini Percutaneous nephrolithotomy” (SMP). Patients and Methods The endoscopic system consists of a 7 Fr. nephroscope with enhanced irrigation and a modified 10‐14 Fr. access sheath with suction‐evacuation function. This system was tested in patients with renal stones up to 2.5 cm in size in a multi‐center prospective non randomized clinical trial. A total of 146 patients were accrued in 14 centers. Nephrostomy tract dilation was carried out to 10‐14 Fr. The lithotripsy was performed by using either Holmium laser or pneumatic lithotripter. Nephrostomy tube or double J stent was placed only if clinically indicated. Results SMP was completed successfully in 141 of 146 patients. Five patients required conversion to the larger nephrostomy tracts. The mean stone size was 2.2±0.6cm.Mean operative time was 45.6 minutes. The initial stone free rate (SFR) was 90.1%. SFR at three months follow up was 95.8%. Three patients required auxiliary procedures for residual stones. 12.8% complications were documented, all of which were Clavien grade II or less. There was no transfusion. 72.3% of the patients did not require any kind of catheters. 19.8% of the patients had double J stents and 5.7% had nephrostomy tubes placed. The average hospital stay was 2.1 days. Conclusions SMP is a safe and effective treatment for renal stones up to 2.5 cm. It might be particularly for patients with lower pole stones, and stones that were not amenable to RIRS. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-27T23:53:34.624663-05:
      DOI: 10.1111/bju.13242
  • A ‘One Stop’ Prostate Clinic for rural and remote men: a
           report on the first 200 patients
    • Authors: Steve P. McCombie; Cynthia Hawks, Jon D. Emery, Dickon Hayne
      Abstract: Objective To report on the structure and outcomes of a new ‘One Stop’ Prostate Clinic (OSPC) designed specifically for rural and remote men. Patients and Methods Prospective cohort study of the first 200 rural or remote men to access a new OSPC at a public tertiary‐level hospital in Western Australia between August 2011 and August 2014. Men attended for urological assessment, and proceeded to same‐day transrectal ultrasonography‐guided prostate biopsies, if appropriate. Referral criteria were either two abnormal age‐related prostate‐specific antigen (PSA) levels in the absence of urinary tract infection (UTI), or an abnormal digital rectal examination (DRE) regardless of PSA level. Results The median (range) distance travelled was 1545 (56–3229) km and median (range) time from referral to assessment was 33 (2–165) days. The median (range) age was 62 (38–85) years, PSA level was 6.7 (0.5–360) ng/mL and 39% (78/200) had a suspicious DRE. In all, 92% (184/200) of men proceeded to prostate biopsies, and 60% (111/184) of these men were diagnosed with prostate cancer. Our complication rate was 3.5% (6/172). Radical prostatectomy (46/111), active surveillance (28/111) and external beam radiation therapy (26/111) were the commonest subsequent treatment methods. A $1045 (Australian dollars) cost‐saving per person was estimated based on the reduced need for travel with the OSPC model. Conclusion The OSPC is an effective and efficient model for assessing men suspected of having prostate cancer living in rural and remote areas of Western Australia, and this model may be applicable to other areas.
      PubDate: 2015-07-27T04:56:30.00279-05:0
      DOI: 10.1111/bju.13100
  • Prostate carcinoma with positive margins at radical prostatectomy: role of
           tumour zonal origin in biochemical recurrence
    • Authors: Luke M. O'Neil; Shane Walsh, Ronald J. Cohen, Stephen Lee
      Abstract: Objective To assess the influence of tumour zonality on biochemical recurrence (BCR) after radical prostatectomy (RP) with a histologically confirmed positive surgical margin (PSM). Patients and Methods Data from 382 patients that underwent RP with either transition zone (TZ) or peripheral zone (PZ) tumours involving PSMs between 1998 and 2010 were retrieved from the Abbott West Australian Prostatectomy Database. Statistical analysis was used to evaluate the relationship of various tumour clinicopathological parameters, e.g. zonal origin of tumour, tumour volume, Gleason score, and stage to the development of BCR Results There were 51 TZ and 331 PZ tumours with PSMs identified. The TZ tumours compared with PZ tumours were larger (median 5.67 vs 3.64 mL, P < 0.001), more frequently lower grade (Gleason score 6 33% vs 5%, P < 0.01), organ confined (51% vs 35.6%, P = 0.073), and preferentially involved the bladder neck (49% vs 6%, P < 0.001). Tumour zonality was not associated with BCR for the entire cohort. TZ and PZ tumours had similar 5‐year BCR‐free survival rates (58% vs 63%, P = 0.691) and comparable time to development of BCR (14.4 vs 19.2 months, P = 0.346). On univariate analysis, preoperative PSA level, PSM at the bladder neck, tumour volume, Gleason score (P < 0.001) and tumour stage were independent predictors of BCR for the entire cohort. On multivariate analysis tumour volume and Gleason score retained significance as independent predictors of BCR. Tumour zonality was not directly associated with BCR. Of the patients who received adjuvant therapy, the incidence of BCR was similar for TZ and PZ tumours (58% vs 67%, P = 0.077), although TZ tumours failed significantly earlier (mean 4.4 vs 16.4 months, P = 0.037). Conclusions PSA recurrence in patients with histologically confirmed PSMs after RP is independent of the zonal location of the index tumour. However, tumour zonal origin may have an indirect influence on PSA relapse, as TZ tumours tend to be of large volume and more likely involve the bladder neck margin, both risk factors for BCR. Bladder neck margin involvement is associated with higher rates of BCR than other sites of PSMs. The preoperative identification of TZ tumours might aid surgical planning with appropriate alteration of RP technique to incorporate wider surgical margins at the bladder neck. Adjuvant radiotherapy appears to be associated with adverse outcome for TZ tumours, a novel finding which warrants further investigation.
      PubDate: 2015-07-27T04:56:09.15684-05:0
      DOI: 10.1111/bju.13173
  • On the origin of spontaneous activity in the bladder
    • Authors: N Kushida; C H Fry
      Abstract: Objectives To characterise separately the pharmacological profiles of spontaneous contractions from the mucosa and detrusor layers of the bladder wall and to describe the relationship in mucosa between ATP release and spontaneous contractions. Materials and Methods Spontaneous contractions were measured (36°C) from isolated mucosa or detrusor preparations, and intact (mucosa+detrusor) preparations from guinea‐pig bladders. Potential modulators were added to the superfusate. Percentage smooth muscle was measured in haematoxylin and eosin stained sections. ATP release was measured in superfusate samples from a fixed point above the preparation using a luciferin‐luciferase assay. Results The magnitude of spontaneous contractions was in the order intact>mucosa>detrusor. Percentage smooth muscle was least in mucosa and greatest in detrusor preparations. The pharmacological profiles of spontaneous contractions were different in mucosa and detrusor in response to P2X or P2Y receptor agonists, adenosine and capsaicin. Intact preparations showed responses intermediate to those from mucosa and detrusor preparations. Low extracellular pH generated large changes in detrusor, but not mucosa preparations. Mucosa preparations released ATP in a cyclical manner, followed by variations in spontaneous contractions. ATP release was greater in mucosa compared to detrusor, augmented by carbachol and reversed by the M2‐selective antagonist methoctramine. Conclusions The different pharmacological profiles of bladder mucosa and detrusor implies different pathways for contractile activation. Intermediate responses from intact preparations also implies functional interaction. The temporal relationship between cyclical variation of ATP release and amplitude of spontaneous contractions is consistent with ATP release controlling spontaneous activity. Carbachol‐mediated ATP release was independent of active contractile force. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-24T10:04:27.22425-05:0
      DOI: 10.1111/bju.13240
  • Gleason 5 + 3 = 8 Prostate Cancer: Much More like Gleason 9'
    • Authors: Brandon A Mahal; Vinayak Muralidhar, Yu-Wei Chen, Toni K Choueiri, Karen E Hoffman, Jim C Hu, Christopher J. Sweeney, James B. Yu, Felix Y Feng, Quoc-Dien Trinh, Paul L. Nguyen
      Abstract: Objective To determine whether patients with Gleason score 5+3=8 prostate cancer have outcomes more similar to other patients with Gleason 8 disease or to patients with Gleason 9 disease. Patients and Methods The SEER database was used to study 40,533 men diagnosed with N0M0 Gleason 8 or 9 prostate cancer from 2004 – 2011. Using Gleason 4+4=8 as the referent, Fine and Gray competing risks regression analyses modeled the association between Gleason score and prostate cancer‐specific mortality (PCSM). Results Five‐year PCSM rates for patients with Gleason 4+4=8, Gleason 3+5=8, Gleason 5+3=8, and Gleason 9 disease were 6.3%, 6.6%, 13.5%, and 13.9%, respectively (P
      PubDate: 2015-07-24T09:49:04.445449-05:
      DOI: 10.1111/bju.13239
  • Patterns of care for metastatic renal cell carcinoma in Australia
    • Authors: Daphne Day; Yada Kanjanapan, Edmond Kwan, Desmond Yip, Nathan Lawrentschuk, Miles Andrews, Ian D Davis, Arun A Azad, Mark Rosenthal, Shirley Wong, Alice Johnstone, Peter Gibbs, Ben Tran
      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.
      PubDate: 2015-07-21T04:04:21.31463-05:0
      DOI: 10.1111/bju.13176
  • Natural history and quality of life in patients with cystine urolithiasis:
           a single centre study
    • Authors: Justin M. Parr; Devang Desai, David Winkle
      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.
      PubDate: 2015-07-21T04:00:27.656526-05:
      DOI: 10.1111/bju.13169
  • Detection of prostate cancer index lesions with multiparametric MRI
           (mp‐MRI) using whole‐mount histological sections as the
           reference standard
    • Authors: Filippo Russo; Daniele Regge, Enrico Armando, Valentina Giannini, Anna Vignati, Simone Mazzetti, Matteo Manfredi, Enrico Bollito, Loredana Correale, Francesco Porpiglia
      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.
      PubDate: 2015-07-20T07:32:20.888141-05:
      DOI: 10.1111/bju.13234
  • 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
    • 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
    • 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
    • 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
    • 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
    • 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 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
  • 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
    • 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
  • Transcutaneous Interferential Electrical Stimulation for Management of
           Non‐neuropathic Underactive Bladder in Children: A Randomized
           Clinical Trial
    • 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
    • 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
  • The dose‐dependent effect of androgen deprivation therapy for
           localized prostate cancer on adverse cardiac events
    • 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
    • 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
    • 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
    • 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
  • 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
  • Clinical characteristics and quality‐of‐life in patients
           surviving a decade of prostate cancer with bone metastases
    • 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
  • 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
    • 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
  • Multicenter prospective evaluation of the learning curve of the holmium
           laser enucleation of the prostate (HoLEP)
    • 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
  • 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
  • Functional urology is coming to you!
    • Authors: Dirk DeRidder
      First page: 497
      PubDate: 2015-09-08T21:34:19.620248-05:
      DOI: 10.1111/bju.13253
  • Combination of solifenacin and mirabegron for overactive bladder
    • Authors: Jean-Nicolas Cornu
      First page: 498
      PubDate: 2015-09-08T21:34:31.087954-05:
      DOI: 10.1111/bju.13142
  • Chronic prostatitis: how to give our best without apposite vagueness
    • Authors: Antonella Giannantoni; Silvia Proietti
      First page: 499
      PubDate: 2015-09-08T21:34:23.723861-05:
      DOI: 10.1111/bju.13150
  • Is angiogenesis still an attractive target in metastatic
           castration‐resistant prostate cancer'
    • First page: 500
      PubDate: 2015-09-08T21:34:24.865531-05:
      DOI: 10.1111/bju.13070
  • Post‐prostatectomy incontinence in the irradiated patient: more than
           just a drop in the ocean
    • Authors: Majid Shabbir
      First page: 502
      PubDate: 2015-09-08T21:34:24.71648-05:0
      DOI: 10.1111/bju.13175
  • Intralesional collagenase injections in patients with Peyronie's disease:
           do they IMPRESS and can we afford them'
    • Authors: Tim Terry
      First page: 503
      PubDate: 2015-09-08T21:34:31.352707-05:
      DOI: 10.1111/bju.13107
  • Minimally invasive partial nephrectomy in the age of the
    • Authors: Homayoun Zargar; Riccardo Autorino, Oktay Akca, Luis Felipe Brandao, Humberto Laydner, Jihad Kaouk
      First page: 505
      PubDate: 2015-04-21T23:34:20.893066-05:
      DOI: 10.1111/bju.12698
  • 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
      First page: 507
      PubDate: 2015-06-11T00:07:21.858559-05:
      DOI: 10.1111/bju.12869
  • 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,
      First page: 509
      Abstract: Objectives To improve awareness and recognition of chronic bacterial prostatitis (CBP) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) 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 four 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, α‐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, general practitioners, cognitive behavioural therapists/psychologists, and 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.
      PubDate: 2015-06-16T06:51:21.18814-05:0
      DOI: 10.1111/bju.13101
  • Guideline of Guidelines: Imaging of Localized Prostate Cancer
    • Authors: Daniel A. Wollin; Danil V. Makarov
      First page: 526
      PubDate: 2015-06-06T00:09:11.216479-05:
      DOI: 10.1111/bju.13104
  • A systematic review of experience of 180‐W XPS GreenLight laser
           vaporisation of the prostate in 1640 men
    • Authors: Claus Brunken; Christian Seitz, Henry H. Woo
      First page: 531
      Abstract: Objective To systematically review the literature regarding clinical outcomes of 180‐W XPS GreenLight® laser (GL) vaporisation for the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). Methods Recent publications were identified in the field of 180‐W GL vaporisation for the treatment of LUTS due to BPH. We searched for peer‐reviewed original articles in the English language. Search items were: ‘180W lithium triborate laser’ or ‘180W greenlight laser’ or ‘180 watt lithium triborate laser’ or ‘180 watt greenlight laser’ or ‘XPS greenlight laser’. In all, 30 papers published between 2012 and 2014 matched this search. Of these, 10 papers were identified dealing with consecutive cohorts of patients treated with the 180‐W XPS GL Results The 10 papers included a total experience of 1640 patients. The only randomised controlled trial in this field compares 180‐W with transurethral resection of the prostate (TURP). Functional outcomes and prostate volume reduction after GL vaporisation were similar to TURP. Catheterisation time and hospital stay were shorter in patients undergoing 180W XPS GL vaporisation (41 and 66 h vs 60 and 97 h, respectively). Four papers compared the 180‐W XPS system to former GL devices showing increased operation time efficiency and comparable postoperative voiding results and adverse events. One paper defined the learning curve to achieve an expert level according to the speed of the procedure and the effectiveness of volume reduction was met after 120 procedures. Conclusion The 180‐W XPS GL offers shorter operation times than former devices. In the one randomised controlled trial comparison with TURP, volume reduction and functional results were comparable to those of TURP. Longer term studies are required.
      PubDate: 2015-06-02T07:19:43.961606-05:
      DOI: 10.1111/bju.12955
  • Evolving role of positron emission tomography (PET) in urological
    • Authors: Sebastian Mafeld; Nikhil Vasdev, Amit Patel, Tamir Ali, Timothy Lane, Gregory Boustead, Andrew C. Thorpe, James M. Adshead, Philip Haslam
      First page: 538
      Abstract: We present a review on the increasing indications for the use of positron emission tomography (PET) in uro‐oncology. In this review we describe the details of the different types of PET scans, indications for requesting PET scans in specific urological malignancy and the interpretation of the results.
      PubDate: 2015-05-25T04:05:19.474688-05:
      DOI: 10.1111/bju.12988
  • A phase I study of TRC105 anti‐endoglin (CD105) 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
      First page: 546
      Abstract: Objective TRC105 is a chimeric immunoglobulin G1 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 i.v. TRC105 until unacceptable toxicity or disease progression, up to a predetermined dose level, using a standard 3 + 3 phase I design. Results A total of 20 patients were treated. The top dose level studied, 20 mg/kg every 2 weeks, was the maximum tolerated dose. Common adverse effects included infusion‐related reaction (90%), low grade headache (67%), anaemia (48%), epistaxis (43%) and fever (43%). Ten patients had stable disease on study and eight patients had declines in prostate specific antigen (PSA). 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. A significant induction of plasma VEGF was associated with CD105 reduction, suggesting anti‐angiogenic activity of TRC105. An exploratory analysis showed a tentative correlation between the reduction of CD105 and a decrease in PSA velocity, suggestive of potential activity of TRC105 in the patients with mCRPC. The data from this exploratory analysis suggest that rising VEGF level 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
  • Clinical and genomic analysis of metastatic prostate cancer progression
           with a background of postoperative biochemical recurrence
    • Authors: Mohammed Alshalalfa; Anamaria Crisan, Ismael A. Vergara, Mercedeh Ghadessi, Christine Buerki, Nicholas Erho, Kasra Yousefi, Thomas Sierocinski, Zaid Haddad, Peter C. Black, R. Jeffrey Karnes, Robert B. Jenkins, Elai Davicioni
      First page: 556
      Abstract: Objective To better characterize the genomics of patients with biochemical recurrence (BCR) who have metastatic disease progression in order to improve treatment decisions for prostate cancer. Methods The expression profiles of three clinical outcome groups after radical prostatectomy (RP) were compared: those with no evidence of disease (NED; n = 108); those with BCR (rise in prostate‐specific antigen [PSA] level without metastasis; n = 163); and those with metastasis (n = 192). The patients were profiled using Human Exon 1.0 ST microarrays, and outcomes were supported by a median 18 years of follow‐up. A metastasis signature was defined and verified in an independent RP cohort to ensure the robustness of the signature. Furthermore, bioinformatics characterization of the signature was conducted to decipher its biology. Results Minimal gene expression differences were observed between adjuvant treatment‐naïve patients in the NED group and patients without metastasis in the BCR group. More than 95% of the differentially expressed genes (metastasis signature) were found in comparisons between primary tumours of metastasis patients and the two other outcome groups. The metastasis signature was validated in an independent cohort and was significantly associated with cell cycle genes, ubiquitin‐mediated proteolysis, DNA repair, androgen, G‐protein coupled and NOTCH signal transduction pathways. Conclusion This study shows that metastasis development after BCR is associated with a distinct transcriptional programme that can be detected in the primary tumour. Patients with NED and BCR have highly similar transcriptional profiles, suggesting that measurement of PSA on its own is a poor surrogate for lethal disease. Use of genomic testing in patients undergoing RP with an initial rise in PSA level may be useful to improve secondary therapy decision‐making.
      PubDate: 2015-03-12T01:04:22.273611-05:
      DOI: 10.1111/bju.13013
  • Transperineal biopsy prostate cancer detection in first biopsy and repeat
           biopsy after negative transrectal ultrasound‐guided biopsy: the
           Victorian Transperineal Biopsy Collaboration experience
    • Authors: Wee Loon Ong; Mahesha Weerakoon, Sean Huang, Eldho Paul, Nathan Lawrentschuk, Mark Frydenberg, Daniel Moon, Declan Murphy, Jeremy Grummet
      First page: 568
      Abstract: Objectives To present the Victorian Transperineal Biopsy Collaboration (VTBC) experience in patients with no prior prostate cancer diagnosis, assessing the cancer detection rate, pathological outcomes and anatomical distribution of cancer within the prostate. Patients and Methods VTBC was established through partnership between urologists performing transperineal biopsies of the prostate (TPB) at three institutions in Melbourne. Consecutive patients who had TPB, as first biopsy or repeat biopsy after previous negative transrectal ultrasound‐guided (TRUS) biopsy, between September 2009 and September 2013 in the VTBC database were included. Data for each patient were collected prospectively (except for TPB before 2011 in one institution), based on the minimum dataset published by the Ginsburg Study Group. Univariate and multivariate analyses were used to identify factors predictive of cancer detection on TPB. Results In all, 160 patients were included in the study, of whom 57 had TPB as first biopsy and 103 had TPB as repeat biopsy after previous negative TRUS biopsies. The median patient age at TPB was 63 years, with the repeat‐biopsy patients having a higher median serum PSA level (5.8 ng/mL for first biopsy and 9.6 ng/mL for repeat biopsy) and larger prostate volumes (40 mL for first biopsy, and 51 mL for repeat biopsy). Prostate cancer was detected in 53% of first‐biopsy patients and 36% of repeat‐biopsy patients, of which 87% and 81%, respectively, were clinically significant cancers, defined as a Gleason score of ≥7, or more than three positive cores of Gleason 6. Of the cancers detected in repeat biopsies, 75% involved the anterior region (based on the Ginsburg Study Group's recommended biopsy map), while 25% were confined exclusively within the anterior region; a lower proportion of only 5% of cancers detected in first biopsies were confined exclusively within the anterior region. Age, serum PSA level and prostate volume were predictive of cancer detection in repeat biopsies, while only age was predictive in first biopsies. Conclusions TPB is an alternative approach to TRUS biopsy of the prostate, offering a high rate of detection of clinically significant prostate cancer. It provides excellent sampling of the anterior region of the prostate, which is often under‐sampled using the TRUS approach, and should be considered as an option for all men in whom a prostate biopsy is indicated.
      PubDate: 2015-04-06T00:23:01.420536-05:
      DOI: 10.1111/bju.13031
  • Preoperative predictive model of recovery of urinary continence after
           radical prostatectomy
    • Authors: Kazuhito Matsushita; Matthew T. Kent, Andrew J. Vickers, Christian Bodman, Melanie Bernstein, Karim A. Touijer, Jonathan A. Coleman, Vincent T. Laudone, Peter T. Scardino, James A. Eastham, Oguz Akin, Jaspreet S. Sandhu
      First page: 577
      Abstract: Objective To build a predictive model of urinary continence recovery after radical prostatectomy (RP) that incorporates magnetic resonance imaging (MRI) parameters and clinical data. Patients and Methods We conducted a retrospective review of data from 2 849 patients who underwent pelvic staging MRI before RP from November 2001 to June 2010. We used logistic regression to evaluate the association between each MRI variable and continence at 6 or 12 months, adjusting for age, body mass index (BMI) and American Society of Anesthesiologists (ASA) score, and then used multivariable logistic regression to create our model. A nomogram was constructed using the multivariable logistic regression models. Results In all, 68% (1 742/2 559) and 82% (2 205/2 689) regained function at 6 and 12 months, respectively. In the base model, age, BMI and ASA score were significant predictors of continence at 6 or 12 months on univariate analysis (P 
      PubDate: 2015-03-30T08:52:41.729918-05:
      DOI: 10.1111/bju.13087
  • Pattern of invasion is the most important prognostic factor in patients
           with penile cancer submitted to lymph node dissection and pathological
           absence of lymph node metastasis
    • Authors: Giuliano Aita; Walter Henriques Costa, Stenio Cassio Zequi, Isabela Werneck Cunha, Fernando Soares, Gustavo Cardoso Guimaraes, Ademar Lopes
      First page: 584
      Abstract: Objectives To identify prognostic factors in a cohort of patients with penile carcinoma with pathological absence of lymph node metastasis (pN0), as penile carcinoma is a rare neoplasm in European countries, in which the presence of lymph node metastasis is the most important prognostic factor but few studies have examined patients with penile carcinoma with histologically negative nodes (pN0). Patients and Methods Of patients with penile carcinoma, 101 met the inclusion criteria; 47 (46.5%) underwent bilateral inguinal lymph node dissection (LND) and 54 (53.5%) underwent bilateral inguinopelvic LND. Variables that had a prognostic impact on survival rates in univariate analysis were selected for multivariate survival analysis. Results The cohorts cancer‐specific survival (CSS) and overall survival (OS) rates were 88.1% and 52.5%, respectively. Histological grade and pattern of invasion were the only features to significantly impact survival rates in the univariate analysis. The CSS and OS rates in patients with ‘pushing’ vs ‘infiltrating’ patterns of invasion were 98.0% vs 78.4% (P = 0.003) and 70.0% vs 35.3% (P = 0.005), respectively. Pattern of invasion was the only independent predictor of survival. Patients with infiltrating invasion had a higher probability of death from cancer (hazard ratio [HR] 11.5, P = 0.019) and overall death (HR 2.3, P = 0.007) compared with those with a pushing invasion pattern. Conclusions The presence of an infiltrating pattern of invasion is the most important predictor of survival in patients with penile carcinoma. We encourage other centres to confirm our findings that the pattern of invasion is an important prognostic factor in patients with penile carcinoma and pN0 disease.
      PubDate: 2015-03-28T01:44:11.563754-05:
      DOI: 10.1111/bju.13071
  • Patients with medical risk factors for chronic kidney disease are at
           increased risk of renal impairment despite the use of
           nephron‐sparing surgery
    • Authors: Prassannah Satasivam; Fairleigh Reeves, Kenny Rao, Zacchary Ivey, Marnique Basto, Marcus Yip, Hedley Roth, Jeremy Grummet, Jeremy Goad, Daniel Moon, Declan Murphy, Sree Appu, Nathan Lawrentschuk, Damien Bolton, Jamie Kearsley, Anthony Costello, Mark Frydenberg
      First page: 590
      Abstract: Objective To determine whether patients with normal preoperative renal function, but who possess medical risk factors for chronic kidney disease (CKD), experience poorer renal function after partial nephrectomy (PN) for renal cell carcinoma (RCC) compared with those without risk factors. Patients and Methods The effects of age, hypertension (HTN) and diabetes mellitus (DM) on estimated glomerular filtration rate (eGFR) were investigated in 488 consecutive operations for RCC performed during 2005–2012 at six Australian tertiary referral centres; 156 patients underwent PN and 332 patients underwent radical nephrectomy (RN). We used chi‐squared test and binary logistic regression to analyse new‐onset CKD, and multiple linear regression to investigate determinants of postoperative eGFR. Results The development of new‐onset eGFR of
      PubDate: 2015-03-30T08:52:59.073364-05:
      DOI: 10.1111/bju.13075
  • Cigarette smoking during external beam radiation therapy for prostate
           cancer is associated with an increased risk of prostate
           cancer‐specific mortality and treatment‐related toxicity
    • Authors: Emily Steinberger; Marisa Kollmeier, Sean McBride, Caroline Novak, Xin Pei, Michael J. Zelefsky
      First page: 596
      Abstract: Objective To evaluate whether a history of smoking or smoking during therapy after external beam radiotherapy (EBRT) for clinically localised prostate cancer is associated with increased treatment‐related toxicity or disease progression. Patients and Methods Of 2358 patients receiving EBRT for prostate cancer between 1988 and 2005, 2156 had chart‐recorded smoking histories. Patients were classified as ‘never smokers’, ‘current smokers’, ‘former smokers’, and ‘current smoking unknown’. Variables considered included quantity of tobacco use in pack‐years, duration of smoking, and, for former smokers, how long before initiation of RT the patient quit smoking, when available. The median EBRT dose was 8100 Gy and the median follow‐up was 95 months. Toxicity was graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events. Results Current smoking significantly increased the risks of both prostate‐specific antigen relapse [hazard ratio (HR) 1.4, P = 0.02] and distant metastases (HR 2.37, P < 0.001), as well as prostate cancer‐specific death (HR 2.25, P < 0.001). Multivariate analysis showed that smoking was also associated with increased risk of EBRT‐related genitourinary toxicities (current smoker, HR 1.8, P = 0.02; former smoker, HR 1.45, P = 0.01). Smoking did not increase gastrointestinal toxicity. Conclusions Current smokers with prostate cancer are at increased risk of biochemical recurrence, distant metastasis, and prostate cancer‐related mortality after definitive RT to the prostate. Current and former smokers, regardless of duration and quantity of exposure, are at an increased risk of long‐term genitourinary toxicity after EBRT. Oncologists should encourage patients to participate in smoking‐cessation programmes before therapy to potentially lower their risk of relapsing disease and post‐treatment toxicities.
      PubDate: 2015-01-27T01:13:36.12883-05:0
      DOI: 10.1111/bju.12969
  • Outcomes of robotic‐assisted laparoscopic upper urinary tract
           reconstruction: 250 consecutive patients
    • Authors: Tracy Marien; Marc A. Bjurlin, Blake Wynia, Matthew Bilbily, Gaurav Rao, Lee C. Zhao, Ojas Shah, Michael D. Stifelman
      First page: 604
      Abstract: Objective To evaluate the long‐term outcomes of robotic‐assisted laparoscopic (RAL) upper urinary tract (UUT) reconstruction performed at a tertiary referral centre. Materials and Methods Data from 250 consecutive patients undergoing RAL UUT reconstruction, including pyeloplasty with or without stone extraction, ureterolysis, uretero‐ureterostomy, ureterocalicostomy, ureteropyelostomy, ureteric reimplantation and buccal mucosa graft ureteroplasty, were collected at a tertiary referral centre 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 Robotic‐assisted laparoscopic 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.
      PubDate: 2015-06-16T00:25:59.641208-05:
      DOI: 10.1111/bju.13086
  • Safety and efficacy of mirabegron as ‘add‐on’ therapy in
           patients with overactive bladder treated with solifenacin: a
           post‐marketing, open‐label study in Japan (MILAI study)
    • Authors: Osamu Yamaguchi; Hidehiro Kakizaki, Yukio Homma, Yasuhiko Igawa, Masayuki Takeda, Osamu Nishizawa, Momokazu Gotoh, Masaki Yoshida, Osamu Yokoyama, Narihito Seki, Akira Okitsu, Takuya Hamada, Akiko Kobayashi, Kentarou Kuroishi
      First page: 612
      Abstract: Objective To examine the safety and efficacy of mirabegron as ‘add‐on’ therapy to solifenacin in patients with overactive bladder (OAB). Patients and Methods This multicentre, open‐label, phase IV study enrolled patients aged ≥20 years with OAB, as determined by an OAB symptom score (OABSS) total of ≥3 points and an OABSS Question 3 score of ≥2 points, who were being treated with solifenacin at a stable dose of 2.5 or 5 mg once daily for at least 4 weeks. Study duration was 18 weeks, comprising a 2‐week screening period and a 16‐week treatment period. Patients meeting eligibility criteria continued to receive solifenacin (2.5 or 5 mg once daily) and additional mirabegron (25 mg once daily) for 16 weeks. After 8 weeks of treatment, the mirabegron dose could be increased to 50 mg if the patient's symptom improvement was not sufficient, if he/she was agreeable to the dose increase, and the investigator judged that there were no safety concerns. Safety assessments included adverse events (AEs), laboratory tests, vital signs, 12‐lead electrocardiogram, QT corrected for heart rate using Fridericia's correction (QTcF) interval and post‐void residual (PVR) volume. Efficacy endpoints were changes from baseline in OABSS total score, OAB questionnaire short form (OAB‐q SF) score (symptom bother and total health‐related quality of life [HRQL] score), mean number of micturitions/24 h, mean number of urgency episodes/24 h, mean number of urinary incontinence (UI) episodes/24 h, mean number of urgency UI episodes/24 h, mean volume voided/micturition, and mean number of nocturia episodes/night. Patients were instructed to complete the OABSS sheets at weeks −2, 0, 8 and 16 (or at discontinuation), OAB‐q SF sheets at weeks 0, 8 and 16 (or at discontinuation) and patient voiding diaries at weeks 0, 4, 8, 12 and 16 (or at discontinuation). Results Overall incidence of drug‐related treatment‐emergent AEs (TEAEs) was 23.3%. Almost all TEAEs were mild or moderate. The most common TEAE was constipation, with similar incidence in the groups receiving a dose increase to that observed in the groups maintained on the original dose. Changes in PVR volume, QTcF interval, pulse rate and blood pressure were not considered to be clinically significant and there were no reports of urinary retention. Significant improvement was seen for changes in efficacy endpoints from baseline to end of treatment (EOT) in all groups (patients receiving solifenacin 2.5 or 5 mg + mirabegron 25 or 50 mg). Conclusions Add‐on therapy with mirabegron 25 mg once daily for 16 weeks, with an optional dose increase to 50 mg at week 8, was well tolerated in patients with OAB treated with solifenacin 2.5 mg or 5 mg once daily. There were significant improvements from baseline to EOT in OAB symptoms with combination therapy with mirabegron and solifenacin. Add‐on therapy with mirabegron and an antimuscarinic agent, such as solifenacin, may provide an attractive therapeutic option.
      PubDate: 2015-04-23T00:50:36.517183-05:
      DOI: 10.1111/bju.13068
  • Complications following artificial urinary sphincter placement after
           radical prostatectomy and radiotherapy: a meta‐analysis
    • Authors: Anthony S. Bates; Richard M. Martin, Tim R. Terry
      First page: 623
      Abstract: Objective To conduct a systematic review and meta‐analysis of artificial urinary sphincter (AUS) placement after radical prostatectomy (RP) and external beam radiotherapy (EBRT). Patients and Methods There were 1 886 patients available for analysis of surgical revision outcomes and 949 for persistent urinary incontinence (UI) outcomes from 15 and 11 studies, respectively. The mean age (sd) was 66.9 (1.4) years and the number of patients per study was 126.6 (41.7). The mean (sd, range) follow‐up was 36.7 (3.9, 18–68) months. A systematic database search was conducted using keywords, according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Published series of AUS implantations were retrieved, according to the inclusion criteria. The Newcastle–Ottawa Score was used to ascertain the quality of evidence for each study. Surgical results from each case series were extracted. Data were analysed using CMA® statistical software. Results AUS revision was higher in RP + EBRT vs RP alone, with a random effects risk ratio of 1.56 (95% confidence interval [CI] 1.02–2.72; P < 0.050; I2 = 82.0%) and a risk difference of 16.0% (95% CI 2.05–36.01; P < 0.080). Infection/erosion contributed to the majority of surgical revision risk compared with urethral atrophy (P = 0.020). Persistent UI after implantation was greater in patients treated with EBRT (P < 0.001). Conclusions Men receiving RP + EBRT appear at increased risk of infection/erosion and urethral atrophy, resulting in a greater risk of surgical revision compared with RP alone. Persistent UI is more common with RP + EBRT.
      PubDate: 2015-03-12T04:47:47.287848-05:
      DOI: 10.1111/bju.13048
  • Diacylglycerol kinase κ (DGKK) variants and hypospadias in Han
           Chinese: association and meta‐analysis
    • Authors: Qichao Ma; Yunman Tang, Houwei Lin, Maosheng Xu, Guofeng Xu, Xiaoliang Fang, Jianhua Chen, Zhijian Song, Zhiqiang Li, Yongyong Shi, Hongquan Geng
      First page: 634
      Abstract: Objective To investigate whether diacylglycerol kinase κ (DGKK) is a susceptibility gene for hypospadias in the Han Chinese population as has been suggested by previous publications. Patients Subjects and Methods A case‐control study involving 466 patients with hypospadias and 402 healthy subjects was conducted to assess the relationship between DGKK single nucleotide polymorphisms (SNPs) and hypospadias risk in the Han Chinese population. The 466 hypospadias patients were further divided into mild, moderate and severe subgroups for analysis. Results Six SNPs (rs1934179, rs4143304, rs9969978, rs1934188, rs4826632 and rs4599945) were marginally associated with mild and moderate hypospadias [odds ratios (ORs) > 1, P = 0.05 to P < 0.1), whereas no significant relationship was seen with the severe cases (ORs >1, P > 0.1). After correcting for multiple testing, it was determined that neither individual SNPs nor individual haplotypes were associated with hypospadias. To evaluate this relationship in multiple populations, we performed a meta‐analysis on six SNPs, using combined data from our present results and those of previous studies of different races (including 1966 patients and 2492 controls). Six SNPs (rs1934179, rs4143304, rs9969978, rs1934188, rs7063116 and rs1934190) were significantly associated with mild/moderate hypospadias (ORs >1, P < 0.05), and rs1934179 was significantly associated with severe hypospadias (OR > 1, P < 0.05). Conclusions DGKK gene variants do not appear to play a major role in hypospadias susceptibility in the Chinese Han population. Our meta‐analysis supports the hypothesis that DGKK is a common risk gene for hypospadias, particularly in cases of mild or moderate hypospadias in Caucasian populations.
      PubDate: 2015-05-24T21:07:30.602486-05:
      DOI: 10.1111/bju.12965
  • Transurethral intraprostatic injection of botulinum neurotoxin type A for
           the treatment of chronic prostatitis/chronic pelvic pain syndrome: results
           of a prospective pilot double‐blind and randomized
           placebo‐controlled study
    • Authors: Siavash Falahatkar; Elaheh Shahab, Keivan Gholamjani Moghaddam, Ehsan Kazemnezhad
      First page: 641
      Abstract: Objective To evaluate the effect of botulinum neurotoxin type‐A (BoNT‐A) on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) refractory to medical therapy. Materials and Methods Between November 2011 and January 2013, 60 men aged ≥18 years with CP/CPPS, and with National Institutes of Health Chronic Prostatitis Symptom Index (NIH‐CPSI) scores ≥10 and pain subscale scores ≥8, who were refractory to 4–6 weeks' medical therapy, underwent transurethral intraprostatic injection of BoNT‐A or normal saline in a prospective pilot double‐blind randomized study. The patients' NIH‐CPSI total and subscale scores, American Urological Association (AUA)‐symptom score (SS), visual analogue scale (VAS) and quality of life (QoL) scores and frequencies of diurnal and nocturnal urination were evaluated and compared at baseline and at 1, 3 and 6 months after injection and also were compared between the two groups. Results A total of 60 consecutive patients were randomized to a BoNT‐A (treatment) or normal saline (placebo) group. In the treatment group at the 1‐, 3‐ and 6‐month evaluation the NIH‐CPSI total and subscale scores, and the AUA‐SS, VAS and QoL scores, along with frequencies of diurnal and nocturnal urinations, had significantly improved compared with baseline values (P < 0.05). By contrast, in the placebo group, none of these values showed improvement and the values were significantly different from those in the treatment group. Although the differences between the two groups in AUA‐SS and frequencies of nocturnal urination were not significant at 1‐month follow‐up, repeated‐measure analysis showed significant improvement in each of these values over the entire follow‐up period in the treatment group. The most prominent improvement was related to the pain subscale score, which decreased by 64.76, 75.63 and 79.97% at 1, 3 and 6 months after treatment compared with baseline, followed by the VAS score, which decreased by 62.3, 72.4 and 82.1% at each follow‐up, respectively. Only two patients developed mild transient gross haematuria, which was managed conservatively. Conclusions Transurethral intraprostatic BoNT‐A injection maybe an effective therapeutic option in patients with CP/CPPS as it reduces pain and improves QoL.
      PubDate: 2015-05-25T02:55:50.85938-05:0
      DOI: 10.1111/bju.12951
  • Clinical efficacy of collagenase Clostridium histolyticum in the treatment
           of Peyronie's disease by subgroup: results from two large,
           double‐blind, randomized, placebo‐controlled, phase III
    • Authors: Larry I. Lipshultz; Irwin Goldstein, Allen D. Seftel, Gregory J. Kaufman, Ted M. Smith, James P. Tursi, Arthur L. Burnett
      First page: 650
      Abstract: Objectives To examine the efficacy of intralesional collagenase Clostridium histolyticum (CCH) in defined subgroups of patients with Peyronie's disease (PD). Patients and Methods The efficacy of CCH compared with placebo, assessed from baseline to week 52, was examined in subgroups of participants from the Investigation for Maximal Peyronie's Reduction Efficacy and Safety Studies (IMPRESS) I and II. The subgroups were defined according to: severity of penile curvature deformity at baseline (30–60° [n = 492] and 61–90° [n = 120]); PD duration (1 to ≤2 [n = 201], >2 to ≤4 [n = 212] and >4 years [n = 199]); degree of plaque calcification (no calcification [n = 447], non‐contiguous stippling [n = 103] and contiguous calcification that did not interfere with injection of CCH [n = 62]); and baseline erectile function (International Index of Erectile Function [IIEF] scores 1–5 [n = 22], 6–16 [n = 106] and ≥17 [n = 480]). Results Reductions in penile curvature deformity and PD symptom bother were observed in all subgroups. Penile curvature deformity reductions were significantly greater with CCH than with placebo for the following subgroups: baseline penile curvature 30–60° and 61–90°; disease duration >2 to ≤4 years and >4 years; no calcification; and IIEF score ≥17 (high IIEF‐erectile function score; P < 0.05 for all). PD symptom bother reductions were significantly greater in the CCH group for: penile curvature 30–60°; disease duration >4 years; no calcification; and IIEF score 1–5 (no sexual activity) and ≥17 (P < 0.05 for all). Conclusions In this analysis, clinical efficacy of CCH treatment for reducing penile curvature deformity and PD symptom bother was found across subgroups. In the IMPRESS I and II overall, adverse events (AEs) were typically mild or moderate, although treatment‐related serious AEs, including corporal rupture or penile haematoma, occurred. Future studies could be considered to directly assess the efficacy and safety of CCH treatment in defined subgroups of PD patients, with the goal of identifying predictors of optimum treatment success.
      PubDate: 2015-05-18T22:21:45.934433-05:
      DOI: 10.1111/bju.13096
  • Pharmacological characterisation of the relaxation induced by the soluble
           guanylate cyclase activator, BAY 60‐2770 in rabbit corpus cavernosum
    • First page: 657
      Abstract: Objective To characterise the relaxation induced by the soluble guanylate cyclase (sGC) activator, BAY 60‐2770 (4‐({(4‐carboxybutyl) [2‐ (5‐fluoro‐2‐{[4′‐(trifluoromethyl) biphenyl‐4‐yl]methoxy}phenyl)ethyl] amino}methyl)benzoic acid) in rabbit corpus cavernosum (CC). Material and Methods The penis from male New Zealand rabbits was removed and fours strips of CC were obtained. Concentration–response curves to BAY 60‐2770 were constructed in the absence and presence of inhibitors of nitric oxide synthase, N (G)‐nitro‐L‐ arginine methyl ester (L‐NAME, 100 μm), sGC, 1H‐[1,2,4]oxadiazolo[4,3‐a]quinoxalin‐1‐one (ODQ, 10 μm) and phosphodiesterase type 5 (PDE‐5), tadalafil (0.1 μm). The potency (pEC50) and maximal response (Emax) values were determined. Then, electrical‐field stimulation (EFS)‐induced contraction or relaxation was tested in the absence and presence of BAY 60‐2770 (0.1 or 1 μm) alone or combined with ODQ (10 μm). For EFS‐induced relaxation two protocols were used: (i) ODQ (10 μm) was first incubated for 20 min and then BAY 60‐2770 (1 μm) was added for another 20 min (ODQ + BAY 60‐2770); (ii) in different CC strips, BAY 60‐2770 was incubated for 20 min followed by another 20 min with ODQ (BAY 60‐2770 + ODQ). The intracellular levels of cyclic guanosine monophosphate (cGMP) were also determined. Results BAY 60‐2770 potently relaxed rabbit CC with mean (sem) pEC50 and Emax values of 7.58 (0.19) and 81 (4)%, respectively. The inhibitors ODQ (n = 7) or tadalafil (n = 7) produced 4.2‐ and 6.3‐leftward shifts, respectively in BAY 60‐2770‐induced relaxation without interfering with the Emax values. The intracellular levels of cGMP were augmented after stimulation with BAY 60‐2770 (1 μm) alone, whereas its co‐incubation with ODQ produced even higher levels of cGMP. The EFS‐induced contraction was reduced in the presence of BAY 60‐2770 (1 μm) and this inhibition was even greater when BAY 60‐2770 was co‐incubated with ODQ. The nitrergic stimulation induced CC relaxation, which was abolished in the presence of ODQ. BAY 60‐2770 alone increased the amplitude of relaxation. Co‐incubation of ODQ and BAY 60‐2770 did not alter the relaxation in comparison with ODQ alone. Interestingly, when BAY 60‐2770 was incubated before ODQ, EFS‐induced relaxation was partly restored in comparison with ODQ alone or ODQ + BAY 60‐2770. Conclusions The relaxation induced by the sGC activator, BAY 60‐2770 was increased after sGC oxidation and unaltered in the absence of nitric oxide. Thus, this class of substances may have advantages over sGC stimulators or PDE‐5 inhibitors for treating patients with erectile dysfunction and extensive endothelial damage.
      PubDate: 2015-06-03T06:22:05.347528-05:
      DOI: 10.1111/bju.13105
  • Simulation‐based training for prostate surgery
    • Authors: Raheej Khan; Abdullatif Aydin, Muhammad Shamim Khan, Prokar Dasgupta, Kamran Ahmed
      First page: 665
      Abstract: Objectives To identify and review the currently available simulators for prostate surgery and to explore the evidence supporting their validity for training purposes. Materials and Methods A review of the literature between 1999 and 2014 was performed. The search terms included a combination of urology, prostate surgery, robotic prostatectomy, laparoscopic prostatectomy, transurethral resection of the prostate (TURP), simulation, virtual reality, animal model, human cadavers, training, assessment, technical skills, validation and learning curves. Furthermore, relevant abstracts from the American Urological Association, European Association of Urology, British Association of Urological Surgeons and World Congress of Endourology meetings, between 1999 and 2013, were included. Only studies related to prostate surgery simulators were included; studies regarding other urological simulators were excluded. Results A total of 22 studies that carried out a validation study were identified. Five validated models and/or simulators were identified for TURP, one for photoselective vaporisation of the prostate, two for holmium enucleation of the prostate, three for laparoscopic radical prostatectomy (LRP) and four for robot‐assisted surgery. Of the TURP simulators, all five have demonstrated content validity, three face validity and four construct validity. The GreenLight laser simulator has demonstrated face, content and construct validities. The Kansai HoLEP Simulator has demonstrated face and content validity whilst the UroSim HoLEP Simulator has demonstrated face, content and construct validity. All three animal models for LRP have been shown to have construct validity whilst the chicken skin model was also content valid. Only two robotic simulators were identified with relevance to robot‐assisted laparoscopic prostatectomy, both of which demonstrated construct validity. Conclusions A wide range of different simulators are available for prostate surgery, including synthetic bench models, virtual‐reality platforms, animal models, human cadavers, distributed simulation and advanced training programmes and modules. The currently validated simulators can be used by healthcare organisations to provide supplementary training sessions for trainee surgeons. Further research should be conducted to validate simulated environments, to determine which simulators have greater efficacy than others and to assess the cost‐effectiveness of the simulators and the transferability of skills learnt. With surgeons investigating new possibilities for easily reproducible and valid methods of training, simulation offers great scope for implementation alongside traditional methods of training.
      PubDate: 2015-04-16T06:24:50.24029-05:0
      DOI: 10.1111/bju.12721
  • Indoor cold exposure and nocturia: a cross‐sectional analysis of the
           HEIJO‐KYO study
    • Abstract: Objectives To investigate the association between indoor cold exposure and the prevalence of nocturia among elderly, we conducted the present study. Subjects and methods Temperature in the living room and bedroom of 1065 home dwelling elderly volunteers (≥60 years) was measured for 48 h. Nocturia (≥2 voids per night) and nocturnal urine production were determined using an urination diary and nocturnal urine collection, respectively. Results The mean age of participants was 71.9±7.1 (standard deviation) years, and the prevalence of nocturia was 30.8%. A 1°C decrease in daytime indoor temperature was associated with higher odds ratio (OR) for nocturia (1.064, 95% confidence interval (CI) 1.016–1.114, p = 0.008), independent of outdoor temperature and other potential confounders such as basic characteristics (age, gender, body mass index, alcohol intake, smoking), comorbidities (diabetes, renal dysfunction), medications (calcium channel blocker, diuretics, sleeping pills), socioeconomic status (education, household income), nighttime dipping of ambulatory blood pressure, daytime physical activity, objectively measured sleep efficiency, and urinary melatonin excretion. The association stayed significant after adjustment for nocturnal urine production rate (OR 1.084, 95% CI 1.032–1.138, p = 0.001). Conclusions Indoor cold exposure during daytime was independently associated with nocturia among elderly participants. The mechanism is explained by cold‐induced detrusor over activity. The prevalence of nocturia could be reduced by modification of the indoor thermal environment. This article is protected by copyright. All rights reserved.
  • The prevalence of metabolic syndrome and its components amongst men with
           and without clinical benign prostatic hyperplasia: a large,
           cross‐sectional, UK epidemiological study
    • Abstract: Objectives To compare the prevalence of (1) the metabolic syndrome and (2) the components of the metabolic syndrome in men aged 50 years and older with and without clinical benign prostate hyperplasia (BPH). Subjects and methods This was a cross‐sectional study using the UK Clinical Practice Research Database (CPRD). Men were selected from the UK CPRD that were ≥50 years of age and still registered as of 31st December 2011. Cohort 1 included men with clinical BPH, and cohort 2 men without clinical BPH that were matched 1:1 to those in cohort 1 by general practice, year of birth and prior years of available history (1 to
  • Gleason pattern 4, Active Surveillance No More
    • Abstract: To reduce overtreatment of indolent prostate cancer (PCa), urologists have embraced active surveillance (AS) as a management strategy for low‐risk PCa. However, patterns‐of‐care studies are now demonstrating that AS is also being utilized for patients with intermediate‐risk disease. A contemporary Australian study of 980 men reported that 8.9% of intermediate‐risk men were placed on AS of which 53.8% had Gleason score (GS) 3+4 PCa and 10.4% with 4+3 disease[1]. The most recent update from the CaPSURE database also reflected this trend in AS. However, questions remain about the safety of this practice, particularly as the majority of AS protocols worldwide exclude men with GS4 cancers unless their life expectancy is limited. This article is protected by copyright. All rights reserved.
  • The Urologist's role in Multidisciplinary Management of Placenta Percreta
    • Abstract: Objectives To evaluate urological interventions in patients with placental adhesive disorders in our collaborative experience at a tertiary referral centre. Patients and Methods We performed a retrospective analysis of a prospectively collected data set, consisting of all women that presented with placental adhesive disorders at the Royal Women's Hospital from August 2009 to September 2013. Patients who required urological intervention were identified and perioperative details were retrieved. Results Of the 49 women that presented with placental adhesive disorders, 36 of them (73.5%) underwent urological interventions. The patients were divided into three groups: planned hysterectomy (n=37), planned conservative management (n=5) and undiagnosed placenta percreta (n=7). In the planned hysterectomy group, 29 patients underwent preoperative cystoscopy and ureteric catheter placement. In 10 patients (34%), the placenta partially invaded the bladder and/or ureter, requiring urological repair. In the conservative management group, four underwent preoperative cystoscopy and ureteric catheter placement and one case required closure of a cystotomy. Of the seven patients with undiagnosed percreta, two were noted to have bladder involvement requiring repair at the time of Caesarean hysterectomy. Conclusion Patients with placental adhesive disorders frequently require urological intervention to prevent or repair injury to the urinary tract. These cases are best managed in specialist centres with multidisciplinary expertise including urologists and interventional radiologists. This article is protected by copyright. All rights reserved.
  • Prediction of renal mass aggressiveness using clinical and radiographic
           features: A global, multicenter prospective study
    • Abstract: Objective To examine the ability of preoperative clinical characteristics to predict histological features of RMs. Materials And Methods Data from consecutive patients with clinical stage I RMs treated surgically between 2010‐2011 in the CROES Renal Mass Registry were collected. Based on surgical histology, tumors were categorized as benign, low aggressiveness cancer, and high aggressiveness cancer. Multivariate logistic regression was used to estimate the probability of the histological group by clinical and radiographic features in the entire cohort and a subcohort of cT1a tumors. The performance of the models was studied by calibration, Nagelkerke's R2, and discrimination (ROC area under the curve). A p
  • Symptom burden and information needs in prostate cancer survivors: A case
           for tailored long‐term survivorship care
    • Abstract: Objectives To determine the relationship between long‐term prostate cancer survivors’ symptom burden and information needs. Subjects/patients and methods We used population‐based data from the Michigan Prostate Cancer Survivor Study (n=2,499). We examined unadjusted differences in long‐term information needs according to symptom burden and performed multivariable logistic regression to examine symptom burden and information needs adjusting for patient characteristics. Results High symptom burden was reported across all domains (sexual 44.4%, urinary 14.4%, vitality 12.7%, bowel 8.4%, emotional 7.6%) with over half of respondents (56%) reporting they needed more information. Top information needs involved recurrence, relationships, and long‐term effects. Prostate cancer survivors with high symptom burden more often searched for information regardless of domain (p
  • Immunotherapy for Bladder Cancer: Rediscovering an Old Friend
    • Abstract: The history of bladder cancer treatment is intimately linked with the use of immunotherapy. In 1990 intravesical bacillus Calmette‐Guerin (BCG) to treat non‐muscle invasive bladder cancer (NMIBC) became the first approved cancer immunotherapy. Early in the twentieth century, Albert Calmette and Camille Guerin, developed the eponymous BCG vaccine from a strain of Mycobacterium bovis found on the udder of an infected cow. Although it was successfully developed as a tuberculosis vaccine, BCG was ineffective as a therapy in the majority of cancers (1). This article is protected by copyright. All rights reserved.
  • Variation of Serum Prostate‐Specific Antigen in Men with Prostate
           Cancer Managed with Active Surveillance
    • Abstract: Objective To describe fluctuations in PSA levels in men managed with AS to determine if a single PSA increase is a consistent measure to trigger intervention. Patients And Methods We evaluated data on 541 men on AS from 1995 through 2011. PSA variation was described by studying the Kaplan‐Meier probability of patients’ PSA levels reaching 4 or 7 ng/mL, going below those thresholds, and then rising to those thresholds again. We also examined PSA variation by calculating the Kaplan‐Meier probability of a PSA change followed by an equal or greater change in the opposite direction. Results We analyzed data on 541 AS patients with a median of 8 PSA measurements (IQR, 6‐12) on AS for a median of 4 years (IQR, 2‐6). The 5‐year estimate of the probability of reaching a threshold PSA of 7 ng/mL was 40% (95% CI, 35%‐46%) and the 5‐year estimate of subsequently falling below this threshold was 90% (95% CI, 82%‐95%). The 5 year estimate of a PSA direction change was 95% (95% CI, 93‐97%) overall and 56% (95% CI, 51%‐61%) for PSA direction changes of ≥1 ng/mL. Conclusions We observed a high probability of variability in PSA levels for men on AS. The probability of changes in PSA, defined by an increase to specified thresholds or a rise >1ng/mL within 6 months and subsequent decrease of equal or greater value on a subsequent measurement, increases over time. Therefore, a single change in PSA level is not a reliable endpoint for men on AS. This article is protected by copyright. All rights reserved.
  • Population‐based assessment of cancer specific mortality after local
           tumour ablation or observation for kidney cancer: a competing risks
    • Abstract: Objectives To examine the potential difference in cancer specific mortality that could distinguish between local tumour ablation (LTA) and observation (OBS) for patients with kidney cancer using competing risks regression. Patients and methods The study focused on 1860 patients with cT1a kidney cancer treated with either LTA or OBS between 2000 and 2009 in the Surveillance Epidemiology and End Results‐Medicare database. Propensity‐score matching was used. Cancer specific mortality (CSM) represented the study outcome. Multivariable competing risks regression analyses adjusting for other‐cause mortality as well as patient (including comorbidities) and tumour characteristics were fitted. Results Overall, fewer patients had LTA vs. OBS (30% vs. 70%; n=553 vs. n=1307). Compared to OBS patients, LTA patients were younger (median age 77 vs. 78 years; p
  • Is there a place for cytoreduction in metastatic prostate cancer'
    • Abstract: Cytoreductive treatment in metastatic prostate cancer (mPCa) primarily refers to local control of the primary tumour by radical prostatectomy (RP) or radiotherapy. However, extirpative treatment of limited metastatic disease by stereotactic body radiotherapy (SBRT) or surgical resection may further reduce or even possibly eliminate disease burden. This comment piece explores the theory and evidence for RP in the setting of mPCa. This article is protected by copyright. All rights reserved.
  • Urethral atrophy after implantation of an artificial urinary sphincter:
           fact or fiction'
    • Abstract: Objectives To investigate the concept of urethral ‘atrophy’ which is often cited as a cause of recurrent incontinence after initially successful implantation of an artificial urinary sphincter (AUS); and to investigate the specific cause of the malfunction of the AUS in these patients and address their management. Patients and methods Between January 2006 and May 2013, 50 consecutive patients (mean age 54.3 years) with recurrent incontinence had their AUS (AMS800™) explored for malfunction and replaced with a new device composed of exactly the same size components, unless there was a particular reason to use something different. Average time to replacement of the device was 10.1 years. Mean follow‐up after replacement of the device was 24.7 months. All patients without an obvious cause for their recurrent incontinence had preoperative urodynamic evaluation including measurement of the Valsalva leak point pressure (VLPP) and the retrograde cuff occlusive pressure (RCOP). After explantation of the AUS in patients without any apparent abnormality of the device at the time of replacement the pressure generated by the explanted pressure regulating balloon (PRB) was measured manometrically, when this was possible. In a select group of six consecutive patients of this type the fibrous capsule surrounding the old cuff was incised then excised to expose and evaluate the underlying corpus spongiosum. Results In 31 of the 50 (62%) undergoing exploration a specific cause for the malfunction of their AUS was defined. In the other 19 patients (38%) no cause was found, either preoperatively or at the time of exploration, other than a low VLPP and RCOP. A typical ‘waisted’ or ‘hour‐glass’ appearance of the underlying corpus spongiosum was demonstrable, to some degree, on explanting the cuff in all cases. In the 6 patients in whom the restrictive sheath surrounding the cuff was excised, the urethral circumference immediately returned to normal after the compressive effect of the sheath was released. Manometry of the explanted PRBs, when this was possible, showed a loss of pressure in all instances. Replacement of the explanted AUS with a new device with the same size cuff and PRB in 14 of these 19 patients was successful in 12 (85.7%). Conclusion These results and other theoretical considerations suggest that recurrent incontinence, years after initially successful implantation of an AUS is because of material failure of the PRB, probably due to age, and consequent loss of its ability to generate the pressure it was designed to produce, and that urethral atrophy does not occur. Simply replacing the old device with a new one with the same characteristics, unless there is a particular reason to do otherwise, is usually successful and avoids the complications of alternatives such as as cuff downsizing or implanting a PRB with a higher pressure range or implantation of a second cuff or transcorporeal cuff placement, all of which have been advocated in these patients. This article is protected by copyright. All rights reserved.
  • Men with a negative real‐time MRI/ultrasound‐fusion guided
           targeted biopsy but prostate cancer detection on TRUS‐guided random
           biopsy – what are the reasons for targeted biopsy failure'
    • Abstract: Objective To examine the value of additional TRUS‐guided random biopsy (RB) in patients with negative MRI/Ultrasound‐fusion guided targeted biopsy (TB) and to identify possible reasons for TB failure. Patients and Methods Subgroup analysis of 61 men with prostate cancer (PCa) detection by 10‐core RB but negative TB in a cohort of 408 men with suspicious multiparemetric MRI (mpMRI) between January 2012 and January 2015. Consensus re‐reading of mpMRI (using both PI‐RADS version 1 and version 2) of each suspicious lesion blinded to the biopsy results, followed by an un‐blinded anatomic correlation of the lesion on mpMRI to the biopsy result. The potential reasons for TB failure were estimated for each lesion. Definition of clinically significant PCa according to Epstein criteria and stratification into risk groups according to the EAU guideline. Results RB detected significant PCa in 64% (39/61) and intermediate/high risk PCa in 57% (35/61). The initial reading of mpMRI identified 90 suspicious lesions (PI‐RADS ≥3) in the cohort. Blinded consensus re‐reading of the mpMRI led to PI‐RADS score downgrading of 45 (50%) lesions and upgrading of 13 (14%) lesions. Thus negative TB could be explained by a false high initial PI‐RADS score for 32 (34%) lesions and sampling of the target lesion by RB in the corresponding anatomic site for 36 of 90 lesions (40%) in 35 of 61 (57%) patients. Sampling the target lesion by RB was most likely for lesions with PI‐RADS scores 4/5 and a Gleason score ≥7. 70 PCa lesions (67% Gleason score 6) in 44 (72%) patients were sampled from prostatic sites with no abnormalities on mpMRI. Conclusion In case of TB failure, RB still detected a high rate of significant PCa. The main reason for a negative TB was a TB error, compensated by positive sampling of the target lesion by the additional RB and the second reason for TB failure was a false high initial PI‐RADS score. The challenges of both MRI diagnostics and prostate lesion sampling are evident in our collective and support the integration of RB into the TB workflow. This article is protected by copyright. All rights reserved.
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