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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: 28, SJR: 2.128, h-index: 61)
J. of Morphology     Hybrid Journal   (Followers: 3, SJR: 0.767, h-index: 49)
J. of Multi-Criteria Decision Analysis     Hybrid Journal   (Followers: 2)
J. of Multicultural Counseling and Development     Hybrid Journal   (Followers: 1, SJR: 0.267, h-index: 25)
J. of 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: 19, SJR: 0.647, h-index: 42)
J. of Obstetrics and Gynaecology Research     Hybrid Journal   (Followers: 14, SJR: 0.498, h-index: 32)
J. of Oral Pathology & Medicine     Hybrid Journal   (Followers: 3, SJR: 0.775, h-index: 58)
J. of Oral Rehabilitation     Hybrid Journal   (Followers: 4, SJR: 1.033, h-index: 57)
J. of Organizational Behavior     Hybrid Journal   (Followers: 35, SJR: 3.102, h-index: 95)
J. of Orthopaedic Research     Hybrid Journal   (Followers: 17, SJR: 1.505, h-index: 106)
J. of Paediatrics and Child Health     Hybrid Journal   (Followers: 16, SJR: 0.594, h-index: 51)
J. of Pathology     Hybrid Journal   (Followers: 9, SJR: 4.402, h-index: 131)
J. of Pathology : Clinical Research     Open Access  
J. of Peptide Science     Hybrid Journal   (Followers: 18, SJR: 0.641, h-index: 47)
J. of Periodontal Research     Hybrid Journal   (SJR: 0.781, h-index: 58)
J. of Personality     Hybrid Journal   (Followers: 12, SJR: 2.266, h-index: 83)
J. of Petroleum Geology     Hybrid Journal   (Followers: 6, SJR: 0.524, h-index: 24)
J. of Pharmaceutical Sciences     Hybrid Journal   (Followers: 129, 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: 4, SJR: 0.846, h-index: 49)
J. of Policy Analysis and Management     Hybrid Journal   (Followers: 12, SJR: 1.531, h-index: 47)
J. of Policy and Practice In Intellectual Disabilities     Hybrid Journal   (Followers: 13, SJR: 0.62, h-index: 10)
J. of Political Philosophy     Hybrid Journal   (Followers: 30, SJR: 1.21, h-index: 31)
J. of Polymer Science Part A: Polymer Chemistry     Hybrid Journal   (Followers: 126, 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: 55, SJR: 0.529, h-index: 39)
J. of Psychological Issues in Organizational Culture     Hybrid Journal   (Followers: 4)
J. of Public Affairs     Hybrid Journal   (Followers: 2, SJR: 0.434, h-index: 7)
J. of Public Economic Theory     Hybrid Journal   (Followers: 3, SJR: 1.028, h-index: 21)
J. of Public Health Dentistry     Hybrid Journal   (Followers: 1, SJR: 0.757, h-index: 41)
J. of Quaternary Science     Hybrid Journal   (Followers: 22, SJR: 1.763, h-index: 65)
J. of Raman Spectroscopy     Hybrid Journal   (Followers: 11, SJR: 1.105, h-index: 69)
J. of 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: 2, SJR: 0.468, h-index: 13)
J. of Research In Reading     Hybrid Journal   (Followers: 11, SJR: 0.789, h-index: 23)
J. of Research in Science Teaching     Hybrid Journal   (Followers: 14, SJR: 4.717, h-index: 70)
J. of Research in Special Educational Needs     Hybrid Journal   (Followers: 3, SJR: 0.525, h-index: 10)
J. of Research on Adolescence     Hybrid Journal   (Followers: 5, SJR: 1.851, h-index: 55)
J. of Risk & Insurance     Hybrid Journal   (Followers: 11, SJR: 0.925, h-index: 36)
J. of School Health     Hybrid Journal   (Followers: 7, SJR: 1.099, h-index: 52)
J. of Sensory Studies     Hybrid Journal   (Followers: 3, SJR: 1.136, h-index: 30)
J. of Separation Science     Hybrid Journal   (Followers: 9, SJR: 1.148, h-index: 71)
J. of Sexual Medicine     Hybrid Journal   (Followers: 6, SJR: 1.403, h-index: 65)
J. of Sleep Research     Hybrid Journal   (Followers: 11, SJR: 1.259, h-index: 73)
J. of Small Animal Practice     Hybrid Journal   (Followers: 9, SJR: 0.71, h-index: 44)
J. of Small Business Management     Hybrid Journal   (Followers: 12, 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: 2, SJR: 1.263, h-index: 75)
J. of Synthetic Lubrication     Hybrid Journal  
J. of Systematics Evolution     Open Access   (Followers: 4, SJR: 0.647, h-index: 22)
J. of Texture Studies     Hybrid Journal   (Followers: 2, SJR: 0.773, h-index: 33)
J. of the American Association of Nurse Practitioners     Partially Free   (Followers: 3, SJR: 0.46, h-index: 27)
J. of the American Ceramic Society     Hybrid Journal   (Followers: 25, SJR: 1.247, h-index: 129)
J. of the American Geriatrics Society     Hybrid Journal   (Followers: 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: 90)
J. of the CardioMetabolic Syndrome     Hybrid Journal   (Followers: 1)
J. of the European Academy of Dermatology and Venereology     Hybrid Journal   (Followers: 11, SJR: 1.422, h-index: 58)
J. of the Experimental Analysis of Behavior     Hybrid Journal   (Followers: 4, SJR: 0.907, h-index: 36)
J. of the History of the Behavioral Sciences     Hybrid Journal   (Followers: 3, SJR: 0.316, h-index: 15)
J. of the Institute of Brewing     Free   (Followers: 1, SJR: 0.562, h-index: 28)
J. of the Peripheral Nervous System     Hybrid Journal   (Followers: 3, SJR: 1.335, h-index: 45)
J. of the Royal Anthropological Institute     Hybrid Journal   (Followers: 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: 50, 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]   [72 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]
  • 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 Survival Rates in Stage 1 Renal Cell Carcinoma Between
           Partial Nephrectomy and Radical Nephrectomy Patients According to Age
           Distribution: A Propensity Score Matching Study
    • Authors: Toshio Takagi; Tsunenori Kondo, Junpei Iizuka, Kenji Omae, Hirohito Kobayashi, Kazuhiko Yoshida, Yasunobu Hashimoto, Kazunari Tanabe
      Abstract: Objective To assess differences in overall survival (OS) between patients receiving partial nephrectomy (PN) and radical nephrectomy (RN) for Stage 1 renal cell carcinoma (RCC) according to age distribution. The survival advantage of PN vs. RN in RCC patients has been unclear owing to conflicting data. Methods We studied 952 Stage 1 RCC patients who underwent either PN or RN. Patients were divided into 3 groups according to age: Group 1 (≤54 years), Group 2 (55–64 years), and Group 3 (≥65 years). Patient variables including age, BMI, sex, presence of hypertension (HT) and/or diabetes mellitus (DM), performance status, tumor size, pathological diagnosis, nuclear grade, and preoperative estimated glomerular filtration rate (eGFR) were adjusted using 1:1 propensity score matching between PN and RN. Results Group 1 included 66 matched patients; Group 2, 72; and Group 3, 70. Group 1 tended to have higher preoperative eGFR values and lower rates of HT and DM compared to Groups 2 and 3. Postoperative eGFR dropped by 11–13% in PN patients and by 34–36% in RN patients. In Group 3, PN patients had longer OS than RN patients (5‐year OS: PN 96%, RN 81%, p = 0.0430); however, there was no significant difference in Group 1 (5‐year OS: PN 100%, RN 93%, p = 0.3021) or Group 2 (5‐year OS: PN 94%, RN 87%, p = 0.3577). Conclusions Only the oldest group of patients showed significantly better OS owing to PN compared to RN; however, we still recommend PN in young patients. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-02T03:47:01.446397-05:
      DOI: 10.1111/bju.13200
  • Actions of cyclic 3'5’‐adenosine monophosphate (cAMP) on
           calcium sensitisation in human detrusor smooth muscle contraction
    • Authors: Maya Hayashi; Shunichi Kajioka, Momoe Itsumi, Ryosuke Takahashi, Nouval Shahab, Takao Ishigami, Masahiro Takeda, Noriyuki Masuda, Akito Yamaguchi, Seiji Naito
      Abstract: Objectives To clarify the effect of cyclic adenosine monophosphate (cAMP) on the Ca2+‐sensitised smooth muscle contraction in human detrusor, as well as the role of novel exchange protein directly activated by cAMP (Epac) in cAMP‐mediated relaxation. Materials and Methods All experimental protocols to record isometric tension force were performed using α‐toxin‐permeabilized human detrusor smooth muscle strips. The mechanisms of cAMP‐mediated suppression of Ca2+ sensitisation activated by 10 μM carbachol (CCh) and 100 μM guanosine‐5’‐triphosphate (GTP) were studied using a selective rho kinase (ROK) inhibitor, Y‐27632, and a selective protein kinase C (PKC) inhibitor, GF‐109203X. The relaxation mechanisms were further probed using a selective protein kinase A (PKA) activator, 6‐Bnz‐cAMP, and selective Epac activator, 8‐pCPT‐2’‐O‐Me‐cAMP. Results CCh‐induced Ca2+ sensitisation was inhibited by cAMP in a concentration‐dependent manner. GF109203X (10 μM) but not Y‐27632 (10 μM) significantly enhanced the relaxation effect induced by cAMP (100 μM). 6‐Bnz‐cAMP (100 μM) predominantly decreased the tension force in comparison with 8‐pCPT‐2’‐O‐Me‐cAMP (100 μM). Conclusions We demonstrated that cAMP predominantly inhibited the ROK pathway but not the PKC pathway. The PKA‐dependent pathway is dominant, while Epac plays a minor role in human DSM Ca2+ sensitisation. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-02T03:30:29.076746-05:
      DOI: 10.1111/bju.13180
  • Guidelines of Guidelines: Urinary Incontinence
    • Authors: Raveen Syan; Benjamin M. Brucker
      Abstract: Objective to review key guidelines on the management of urinary incontinence in order to guide clinical management in a practical way. Materials and methods guidelines produced by the European Association of Urology (updated in 2014), the Canadian Urological Association (updated in 2012), the International Consultation on Incontinence (updated in 2012), and the National Collaborating Centre for Women's and Children's Health (updated in 2013) were examined and their recommendations compared. In addition, specialized guidelines produced by the collaboration between the American Urological Association and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction on overactive bladder and the use of urodynamics were reviewed. The Appraisal of Guidelines for Research & Evaluation II (AGREE) Instrument was used to evaluate the quality of these guidelines. Results there is general agreement between the groups on the recommended initial workup and the use of conservative therapies for first line treatment, with limited role for imaging or invasive testing in the uncomplicated patient. These groups have greater variability in their recommendations for invasive procedures, however generally the mid‐urethral sling is recommended for uncomplicated stress urinary incontinence, with different recommendations on the approach as well as the comparability to other treatments, such as the autologous fascial sling. Conclusion this Guideline of Guidelines provides a summary of the salient similarities and differences between prominent groups on the management of urinary incontinence. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-01T19:26:13.691765-05:
      DOI: 10.1111/bju.13187
  • Comparison of Robotic and Laparoscopic for Complex Renal Tumors with RENAL
           nephrometry score ≥7: Perioperative and Oncological outcomes
    • Authors: Yubin Wang; Xin Ma, Qingbo Huang, Qingshan Du, Huijie Gong, Jiwen Shang, Xu Zhang
      Abstract: Objective To evaluate the perioperative, functional and oncological outcomes of robotic partial nephrectomy (RPN) and laparoscopic partial nephrectomy (LPN) for moderately or highly complex tumors (RENAL nephrometry score≥7). Patients and Methods We retrospectively analyzed the medical charts of 216 patients with complex tumors who underwent LPN(N = 135)or RPN (N = 81) from 2008 to 2014. Perioperative data, pathologic variables, complications, functional and oncological outcomes were reviewed. Results Demographic characteristics were similar between both groups. LPN associated with longer operative time (149.6 vs 135.6 min; P = 0.017) and increased estimated blood loss (220.8 vs 196.5 ml; P = 0.013). Patients undergoing RPN required more direct cost. There were no differences in warm ischemia time, transfusion rate, conversion rate, hospital stay, operative complications and eGFR change at 6 mo after surgery. Mean follow‐up for LPN and RPN was 31.4 mo and 16.5 mo, respectively. The 3‐year recurrence‐free survival rate was 95.2% for LPN and 97.1% for RPN (P = 0.71). Conclusions RPN and LPN performed in patients with complex tumors offer acceptable and comparable results in terms of perioperative, functional and oncological outcomes. Additionally, RPN was superior to LPN in term of estimated blood loss and operation time, and LPN was the more cost‐effective approach. Both surgery techniques remain viable options in the management of complex tumors with RENAL score≥7. This article is protected by copyright. All rights reserved.
      PubDate: 2015-07-01T10:18:00.546558-05:
      DOI: 10.1111/bju.13214
  • Cellular basis of detrusor smooth muscle contraction
    • Authors: Martin C. Michel
      Abstract: The cellular mechanisms and particularly the signal transduction pathways controlling contraction and relaxation of detrusor smooth muscle are insufficiently understood [1]. A better understanding could lead to novel therapeutics for patients with detrusor over‐ or underactivity, making this a question of potential clinical relevance. What determines smooth muscle tone? At the cellular level, smooth muscle contraction in the detrusor and other tissues is primarily driven by an increase of the free intracellular Ca2+ concentration. However, the extent of smooth muscle contraction in response to an intracellular Ca2+ concentration is determined by the phosphorylation state of several enzymes [2]. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-29T08:21:25.835975-05:
      DOI: 10.1111/bju.13216
  • Does transition from daVinci Si to daVinci Xi robotic platform impact
           single‐docking technique for robot‐assisted laparoscopic
    • Authors: Manish Patel; Ahmed Aboumohamed, Ashok Hemal
      Abstract: Objectives To describe technique for performing robot‐assisted nephroureterectomy (RNU) for benign and RNU with enblock excision of a bladder cuff (BCE) and lymphadenectomy (LND) for malignant indications utilizing da Vinci Si and da Vinci Xi robotic platform with its pros and cons. The port placement described for Si can be used for standard and S robotic system. This is the first report in the literature on the use of the da Vinci Xi robotic platform for nephroureterectomy. Patients & Methods After a substantial experience of RNU utilizing different da Vinci robots from standard to Si platform in a single docking fashion for benign and malignant conditions, we started using the newly released da Vinci Xi robot since 2014. The most important differences are in port placements and effective use of features of da Vinci Xi robot while performing simultaneous upper and lower tract surgery. Patient positioning, port placements, step‐by step technique of single docking RNU‐LND‐BCE utilizing da Vinci Si and da Vinci Xi robot are demonstrated in accompanying video with the goal that centers using either robotic system can be benefitted with the tips. The first segment of video describe RNU‐LND‐BCE utilizing da Vinci Si followed by da Vinci Xi to highlight differences. There was no need for patient repositioning or robot re‐docking with the new daVinci Xi robotic platform. Results We have experience of using different robotic system for single docking nephroureterectomy in 70 cases for benign and malignant conditions. The daVinci Xi robotic platform helps operating room personnel in its easy movement, allows easier patient side‐docking with the help of its boom feature, in addition to easy and swift movements of the robotic arms. The patient clearance feature can be used to avoid collision with the robotic arms or patient's body. In patients with difficult body habitus and in situations where bladder cuff management is difficult; modifications can be made through reassigning the camera to different port with utilization of the retargeting feature of the daVinci Xi when working on the bladder cuff or in pelvis. The vision of the camera used for daVinci Xi is initially felt to be inferior to that of the daVinci Si; however, subsequent software upgrade much improved the vision with the new robot. The base of the daVinci Xi is bigger which does not slide and occasionally requires change in table placement / operating room setup and require side‐docking especially when dealing with very tall and obese patient for pelvic surgery. Summary / Conclusions RNU alone or with LND‐BCE is a challenging surgical procedure which addresses the upper and lower urinary tract simultaneously. Single docking and single robotic port placement for RNU‐LND‐BCE has evolved with the development of different generations of the robotic system. These procedures can be performed safely and effectively using the da Vinci S, Si or Xi robotic platform. The new da Vinci Xi robotic platform is more user‐friendly, has easy installation and is intuitive for surgeons utilizing its features. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-29T04:42:39.481927-05:
      DOI: 10.1111/bju.13210
  • Variability of Inter‐observer Agreement on Feasibility of Partial
           Nephrectomy Before and After Neoadjuvant Axitinib for Locally Advanced
           RCC: Independent Analysis from a Phase II Trial
    • Authors: Jose A. Karam; Catherine E. Devine, Bryan M. Fellman, Diana L. Urbauer, E. Jason Abel, Mohamad E. Allaf, Axel Bex, Brian R. Lane, R. Houston Thompson, Christopher G. Wood
      Abstract: Objective To evaluate how many patients could have undergone PN instead of RN before and after neoadjuvant axitinib therapy, as assessed by 5 independent urologic oncologists, and to study the variability of inter‐observer agreement. Patients and Methods Pre‐ and post systemic treatment CT scans from 22 patients with ccRCC in a phase II neoadjuvant axitinib trial were reviewed by 5 independent urologic oncologists. RENAL score and Kappa statistics were calculated. Results Median RENAL score changed from 11 pre‐treatment to 10 post‐treatment, p=0.0017. Five tumors with moderate‐complexity pre‐treatment remained moderate‐complexity post‐treatment. Of 17 tumors with high‐complexity pre‐treatment, 3 became moderate‐complexity post‐treatment. Overall kappa statistic was 0.611. Moderate‐complexity kappa was 0.611 vs. high‐complexity kappa of 0.428. Pre‐treatment kappa was 0.550 vs. post‐treatment of 0.609. After treatment with axitinib, all 5 reviewers agreed that only 5 patients required RN (instead of 8 pre‐treatment) and that 10 patients could now undergo PN (instead of 3 pre‐treatment). The odds of PN feasibility were 22.8‐times higher after treatment with axitinib. Conclusions There is considerable variability in inter‐observer agreement on the feasibility of PN in patients treated with neoadjuvant targeted therapy. Although more patients were candidates for PN after neoadjuvant therapy, it remains difficult to identify these patients a priori. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-29T01:36:04.952909-05:
      DOI: 10.1111/bju.13188
  • 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
  • Long‐term results of a prospective randomised trial assessing the
           impact of readaptation of the dorsolateral peritoneal layer following
           extended pelvic lymph node dissection and cystectomy
    • Authors: Mihai Dorin Vartolomei; Bernhard Kiss, Alvaro Vidal, Fiona Burkhard, George N. Thalmann, Beat Roth
      Abstract: Objective To evaluate the long term oncological and functional outcomes after readaptation of the dorsolateral peritoneal layer following pelvic lymph node dissection (PLND) and cystectomy . Patients and Methods A randomised, single‐center, single‐blinded, two‐arm trial was conducted on 200 consecutive cystectomy patients who underwent PLND and cystectomy for bladder cancer (
      PubDate: 2015-06-25T21:52:50.155679-05:
      DOI: 10.1111/bju.13178
  • The cost‐effectiveness of sacral nerve stimulation for the treatment
           of idiopathic medically refractory overactive bladder (wet) in the UK
    • Authors: Silke Walleser Autiero; Natalie Hallas, Christopher D. Betts, Jeremy L. Ockrim
      Abstract: Objective To estimate the long‐term cost‐effectiveness of specialised treatment options for medically refractory idiopathic overactive bladder (OAB) wet. Patients and Methods The cost‐effectiveness of competing treatment options for patients with medically refractory idiopathic OAB wet was estimated from the perspective of the NHS in the UK. We compared sacral nerve stimulation (SNS) with percutaneous nerve evaluation (PNE) or tined lead evaluation (TLE) with optimal medical therapy (OMT), botulinum toxin type A (BoNT‐A) injections, and percutaneous tibial nerve stimulation (PTNS). We used a Markov model with a 10 year time horizon for all treatment options with the exception of PTNS, which has a time horizon of five years. Costs and effects (measured as quality‐adjusted life years) were calculated to derive incremental cost‐effectiveness ratios. Direct medical resources included are: device and drug acquisition costs, pre‐procedure and procedure costs, and the cost of managing adverse events. Deterministic sensitivity analyses were performed to test robustness of results. Results At five years, SNS (PNE or TLE) was more effective and less costly than PTNS. Compared with OMT at 10 years, SNS (PNE or TLE) was more costly and more effective, and compared with BoNT‐A, SNS PNE was less costly and more effective, and SNS TLE was more costly and more effective. Decreasing the BoNT‐A dose from 150 to 100 IU marginally increased the 10 year ICERs for SNS TLE and PNE (SNS PNE was no longer dominant). However, both SNS options remained cost‐effective. Conclusion In the management of patients with idiopathic OAB wet, the results of this cost‐utility analysis favors SNS (PNE or TLE) over PTNS or OMT, and the most efficient treatment strategy is SNS PNE over BoNT‐A over a 10 year period.
      PubDate: 2015-06-25T04:21:37.931144-05:
      DOI: 10.1111/bju.12972
  • Population‐based study of long‐term functional outcomes after
           prostate cancer treatment
    • Abstract: Objective To evaluate long‐term urinary, sexual and bowel functional outcomes after prostate cancer treatment at a median follow‐up of 12 years (IQR 11‐13). Patients and methods In this nationwide, population‐based study, we identified from the National Prostate Cancer Register, Sweden, 6,003 men diagnosed with localized prostate cancer (clinical local stage T1‐2, any Gleason score, prostate specific antigen < 20 ng/mL, NX or N0, MX or M0) between 1997 and 2002 who were ≤70 years at diagnosis. 1,000 prostate cancer‐free controls were selected, matched for age and county of residence. Functional outcomes were evaluated with a validated self‐reported questionnaire. Results Responses were obtained from 3,937/6,003 cases (66%) and 459/1,000 (46%) controls. Twelve years post diagnosis, at a median age of 75 years, the proportion of cases with adverse symptoms was 87% for erectile dysfunction or sexually inactive, 20% for urinary incontinence and 14% for bowel disturbances. The corresponding proportions for controls were 62%, 6% and 7%, respectively. Men with prostate cancer, except those on surveillance, had an increased risk of erectile dysfunction, compared to control men. Radical prostatectomy was associated with increased risk of urinary incontinence (odds ratio; OR 2.29 [95% CI 1.83‐2.86] and radiotherapy increased the risk of bowel dysfunction (OR 2.46 [95% CI 1.73‐3.49]) compared to control men. Multi‐modal treatment, in particular including androgen deprivation therapy (ADT), was associated with the highest risk of adverse effects; for instance radical prostatectomy followed by radiotherapy and ADT was associated with an OR of 3.74 [95 CI 1.76‐7.95] for erectile dysfunction and OR 3.22 [95% CI 1.93‐5.37] for urinary incontinence. Conclusion The proportion of men who suffer long‐term impact on functional outcomes after prostate cancer treatment was substantial. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-23T21:48:22.692237-05:
      DOI: 10.1111/bju.13179
  • Positive Surgical Margins in Radical Prostatectomy Patients Do Not Predict
           Long‐term Oncological Outcomes: Results from SEARCH
    • Authors: Prabhakar Mithal; Lauren E. Howard, William J. Aronson, Martha K. Terris, Matthew R. Cooperberg, Christopher J. Kane, Christopher Amling, Stephen J. Freedland
      Abstract: Purpose To assess the impact of positive surgical margins (PSMs) on long‐term outcomes after radical prostatectomy (RP), including metastasis, castrate‐resistant prostate cancer (CRPC), and prostate cancer‐specific mortality (PCSM). Materials and Methods Retrospective study of 4,051 men in SEARCH treated by RP from 1988‐2013. Proportional hazard models were used to estimate hazard ratios of PSMs in predicting BCR, CRPC, metastases, and PCSM. To determine if PSMs were more predictive in certain patients, analyses were stratified by pathological Gleason score, stage, and pre‐operative PSA. Results Median follow‐up was 6.6 years (IQR 3.2‐10.6) and 1,127 patients had over 10 years of follow‐up. During this time, 302 (32%) men experienced BCR, 112 (3%) developed CRPC, 144 (4%) developed metastases, and 83 (2%) died of PC. There were 1600 (40%) men with PSMs. In unadjusted models, PSMs were significantly associated with all adverse outcomes: BCR, CRPC, metastases and PCSM (all p≤0.001). After adjusting for demographic and pathological characteristics, margins were associated with increased risk of only BCR (HR 1.98, p0.18). Similar results were seen when stratified by pathological Gleason score, stage, or PSA, and when patients who underwent adjuvant therapy were excluded. Conclusions PSMs after RP are not an independent risk factor for CRPC, metastasis, or PCSM overall or within any subset. In the absence of other high‐risk features, PSMs alone may not be an indication for adjuvant treatment. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-23T21:47:45.625591-05:
      DOI: 10.1111/bju.13181
  • Applications of Three‐Dimensional Printing Technology in Urologic
    • Authors: Ramy F. Youssef; Kyle Spradling, Renai Yoon, Benjamin Dolan, Joshua Chamberlin, Zhamshid Okhunov, Ralph Clayman, Jaime Landman
      Abstract: A rapid expansion in the medical applications of three‐dimensional (3D) printing technology has been observed in recent years. This technology is capable of manufacturing low‐cost and customizable surgical devices, 3D models for use in pre‐operative planning and surgical education, and fabricated biomaterials. While several studies have suggested 3D printers may be a useful and cost‐effective tool in urologic practice, few studies are available that clearly demonstrate the clinical benefit of 3D printed materials. Nevertheless, 3D printing technology continues to advance rapidly and promises to play an increasingly larger role in the field of urology. Herein, we review the current urological applications of 3D printing and discuss the potential impact of 3D printing technology on the future of urologic practice. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-23T04:37:46.924066-05:
      DOI: 10.1111/bju.13183
  • Adverse Pathology and Undetectable Ultrasensitive Prostate‐Specific
    • Authors: Ross M. Simon; Lauren E. Howard, Stephen J. Freedland, William J. Aronson, Martha K. Terris, Christopher J. Kane, Christopher L. Amling, Matthew R. Cooperberg, Adriana C. Vidal
      Abstract: Objectives To determine if men with adverse pathology but undetectable ultrasensitive (
      PubDate: 2015-06-23T04:37:14.260913-05:
      DOI: 10.1111/bju.13182
  • Radical Cystectomy with Super‐extended Lymphadenectomy: Impact of
           Separate Versus en Bloc Lymph Node Submission on Analysis and Outcomes
    • Authors: Pascal Zehnder; Felix Moltzahn, Anirban P. Mitra, Jie Cai, Gus Miranda, Eila C. Skinner, Inderbir S. Gill, Siamak Daneshmand
      Abstract: Objective ● At USC, the submission of lymphadenectomy specimens changed from en bloc to 13 separate anatomically defined packets in May 2002. ● We update our previous analysis of the clinical and pathological impact of this change in methodology, and determine whether lymph node (LN) packeting resulted in any change in oncologic outcomes. Patients and Methods ● 846 patients who underwent radical cystectomy (RC) with super‐extended LN dissection (LND) for cTxN0M0 bladder cancer between 01/1996 and 12/2007 were identified, ● Specimens of 376 patients were sent en bloc (group 1), and specimens of 470 patients were sent in 13 separate anatomical packets (group 2). Results ● Pathologic tumor stage distribution and proportion of LN‐positive patients (group 1: 82 (22%) vs. group 2: 99 (21%); p=0.80) were similar: the median number of total LNs identified increased significantly (group 1: 32 (range: 10‐97), group 2: 65 (range: 10‐179); p
      PubDate: 2015-06-22T00:34:38.203731-05:
      DOI: 10.1111/bju.12956
  • 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
  • Disease reclassification risk with stringent criteria and frequent
           monitoring in men with favorable‐risk prostate cancer undergoing
           active surveillance
    • Authors: John W. Davis; John F. Ward, Curtis A. Pettaway, Xuemei Wang, Deborah Kuban, Steven J. Frank, Andrew K. Lee, Louis L. Pisters, Surena F. Matin, Jay B. Shah, Jose A. Karam, Brian F. Chapin, John N. Papadopoulos, Mary Achim, Karen E. Hoffman, Thomas J. Pugh, Seungtaek Choi, Patricia Troncoso, Christopher J. Logothetis, Jeri Kim
      Abstract: Objective To determine the frequency of disease reclassification and to identify clinicopathologic variables associated with it in patients with favorable‐risk prostate cancer undergoing active surveillance. Patients and Methods We assessed 191 men selected by what may be the most stringent criteria used in active surveillance studies yet conducted who enrolled in a prospective cohort active surveillance trial. Clinicopathologic characteristics were analyzed in a multivariate Cox proportional hazards regression model. Key features were an extended biopsy with a single core positive for Gleason score (GS) 3+3 (
      PubDate: 2015-06-08T09:22:27.792806-05:
      DOI: 10.1111/bju.13193
  • Long‐Term Response to Renal Ischemia in the Human Kidney After
           Partial Nephrectomy – Results from a Prospective Clinical Trial
    • Authors: George J.S. Kallingal; Joel M. Weinberg, Isildinha M. Reis, Avinash Nehra, Manjeri A. Venkatachalam, Dipen J. Parekh
      Abstract: Objective To assess the one‐year renal functional changes in patients undergoing partial nephrectomy with intraoperative renal biopsies. Subjects and Methods 40 patients with a single renal mass deemed fit for a partial nephrectomy were recruited prospectively between January 2009 and October 2010. We performed renal biopsies of normal renal parenchyma and collected serum markers before, during, and after surgically induced renal clamp ischemia during the partial nephrectomy. We then followed patients clinically with interval serum creatinine and physical exam. Results Perioperative data in 40 patients showed a transient increase in creatinine which did not correlate with ischemia time. Renal ultra‐structural changes were generally mild and the mitochondrial swelling which as noted, resolved at the post‐perfusion biopsy. 37 patients had one‐year follow‐up data. Creatinine (Cr) at one year increased by 0.121 mg/dl, which represents 12.99% decrease in renal function from baseline (preop Cr= 0.823mg/dl, eGFR=93.9). The only factors predicting creatinine change on multivariate analysis were patient age, race and ischemia type with cold ischemia associated with increased creatinine. Importantly, the duration of ischemia did not show any significant correlation with renal function change, either as a continuous variable (p=0.452) or as a categorical variable (p = 0.792). Conclusions Out data suggest that limited ischemia is generally well‐tolerated in the setting of partial nephrectomy and does not directly correspond to long‐term renal functional decline. For surgeons performing partial nephrectomy, the kidney can be safely clamped to ensure optimal oncologic outcomes. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-06T02:01:25.999741-05:
      DOI: 10.1111/bju.13192
  • Prostate Biopsy Decisions: One Size Fits All Approach with Total PSA is
           Out and a Multivariable Approach with the Prostate Health Index is In
    • Authors: Stacy Loeb
      Abstract: The days of using one PSA threshold to trigger a biopsy for all men are over, and the field has moved toward a more individualized approach to prostate biopsy decisions taking into account each patient's specific set of risk factors. Foley et al. provide compelling evidence supporting the use of the Prostate Health Index (phi) as part of this multivariable approach to prostate biopsy decisions.[1] There is now a large body of evidence showing that phi is more specific for prostate cancer than total PSA and percent free PSA, as was concluded in a 2014 systematic review.[2] This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-05T10:24:59.659737-05:
      DOI: 10.1111/bju.13195
  • Metastases to the Kidney: A Comprehensive Analysis of 151 Patients from a
           Tertiary Referral Center
    • Authors: Cathy Zhou; Diana L. Urbauer, Bryan M. Fellman, Pheroze Tamboli, Miao Zhang, Surena F. Matin, Christopher G. Wood, Jose A. Karam
      Abstract: Purpose Metastases to the kidney are a rare entity, historically described in autopsy studies. The primary aim of this study was to describe the presentation, treatment, and outcomes of patients with metastatic tumors to the kidney treated at a tertiary referral center. Patients and Methods We retrospectively identified 151 patients diagnosed with a primary non‐renal malignancy with renal metastasis. Clinical, radiographic and pathologic characteristics were assessed. Overall survival (OS) was calculated using Kaplan‐Meier methods. Results Median patient age was 56.7 years. The most common presenting symptoms were flank pain (30%), hematuria (16%) and weight loss (12%). Most primary cancers were carcinomas (80.8%). The most common primary tumor sites were lung (43.7%), colorectal (10.6%), ENT (6%), breast (5.3%), soft tissue (5.3%), and thyroid (5.3%). Renal metastases were typically solitary (77.5%). Concordance between radiologist and clinician imaging assessment was 54.0%. Three ablations and 48 nephrectomies were performed. For non‐surgical patients, renal metastasis diagnosis was made with FNA or biopsy. Median OS from primary tumor diagnosis was 3.08 years and median OS from time of metastatic diagnosis was 1.13 years. For patients treated with surgery, median OS from primary tumor diagnosis was 4.81 years, and OS from metastatic diagnosis was 2.24 years. Conclusions Metastases to the kidney are a rare entity. Survival appears to be longer in patients who are candidates for, and are treated with surgery. Surgical intervention in carefully selected patients with oligometastatic disease and good performance status should be considered. A multi‐disciplinary approach with input from urologists, oncologists, radiologists, and pathologists is needed to achieve the most optimal outcomes for this specific patient population. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-05T10:05:44.34543-05:0
      DOI: 10.1111/bju.13194
  • Clinical characteristics and quality‐of‐life in patients
           surviving a decade of prostate cancer with bone metastases
    • Abstract: Objective To describe characteristics and quality‐of‐life (QOL) and to define factors associated with long‐term survival in a subgroup of prostate cancer patients with M1b disease. Methods and patients The study was based on 915 patients from a prospective randomised multicentre trial (no.5) by the Scandinavian Prostate Cancer Group, comparing parenteral oestrogen with total androgen blockade (TAB). Long‐term survival was defined as patients having an overall survival >10 year, and logistic regression models were constructed to identity clinical predictors of survival. QOL during follow‐up was assessed using EROTC‐30 ratings. . Results Forty (4.4%) of the 915 men survived longer than 10 years. Factors significantly associated with increased likelihood of surviving more than ten years in the univariate analyses were: absence of cancer‐related pain; performance status < 2; negligible analgesic consumption; T‐category 1‐2; PSA
      PubDate: 2015-06-01T01:50:48.637381-05:
      DOI: 10.1111/bju.13190
  • Robot Assisted Intracorporeal Pyramid Neo‐bladder
    • Authors: Wei Shen Tan; Ashwin Sridhar, Miles Goldstraw, Evangelos Zacharakis, Senthil Nathan, John Hines, Paul Cathcart, Tim Briggs, John D Kelly
      Abstract: Objective To describe the a robotic assisted intracorporeal Pyramid neo‐bladder (NB) reconstruction technique and report operative and peri‐operative metrics, post‐operative upper tract imaging, neo‐bladder functional outcomes and oncological outcomes. Patients and methods A total of 19 male and 1 female patients with a mean age 57.2±12.4 years (range: 31.0‐78.2 years) underwent robotic assisted radical cystectomy (RARC). Most cases were ≤pT1 (n=17), while the remaining three patients had muscle invasive bladder cancer (MIBC) at RARC histopathology although 50% (n=10) actually had MIBC at transurethral resection histopathology. All patients underwent RARC, bilateral pelvic lymphadenectomy and intracorporeal NB formation using a pyramid detubularised folding pouch configuration. Results Median estimated blood loss was 250 ml and median operating time was 5.5 hours. The mean number of lymph nodes removed was 16.5±7.8 and median hospital stay was 10 days. Early postoperative complications include urinary tract infection (UTI) (n=4), ileus (n=4), diarrhoea and vomiting (n=3), post‐operative collection (n=2), and blocked stent (n=1). Late postoperative complications include UTI (n=7), NB stone (n=2), voiding hem‐o‐loc (n=2), NB leak (n=2), diarrhoea and vomiting (n=1), uretero‐ileal stricture (n=1), vitamin B12 deficiency (n=1) and port site hernia (n=1). There was no evidence of hydronephrosis in 18 patients with a median follow‐up of 21.5 months. At 24 months, recurrence free survival was 86% and overall survival was 100%. Nineteen patients and 13 patients report 6 month day time and night time continence respectively. Conclusions The pyramid NB is technically feasible using a robotic platform and provides satisfactory functional outcomes at median of 21.5 months. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-01T01:35:43.636583-05:
      DOI: 10.1111/bju.13189
  • A novel FISH‐based definition of BCG failure to enhance recruitment
           into clinical trials of intravesical therapies
    • Abstract: Objectives To present a (molecular) definition of BCG failure which incorporates fluorescence in situ hybridization (FISH) testing to predict BCG failure before it becomes clinically evident. This will help in trial designs for patients with non‐muscle invasive bladder cancer (NMIBC) who fail BCG and thus lack an adequate control arm other than radical cystectomy. Patients and Methods We used data from 143 patients were followed prospectively for 2 years during intravesical BCG therapy during which time FISH assays were collected and correlated to clinical outcomes. Results Of the 95 patients with no evidence of tumor at 3‐month cystoscopy, 23 developed tumor recurrence, and 17 developed disease progression by 2 years. Patients with a positive FISH at both 6‐weeks and 3‐months were more likely to develop tumor recurrence (17/37, 46% and 16/28, 57%, respectively) compared to patients with a negative FISH (6/58, 10% and 3/39, 8%, respectively) (both: p
      PubDate: 2015-06-01T01:33:48.779717-05:
      DOI: 10.1111/bju.13186
  • Prognosis of patients with metastatic renal cell carcinoma and pancreatic
    • Authors: Sarathi Kalra; Bradley J. Atkinson, Marc Ryan Matrana, Surena F. Matin, Christopher G. Wood, Jose A. Karam, Pheroze Tamboli, Kanishka Sircar, Priya Rao, Paul Gettys Corn, Nizar M. Tannir, Eric Jonasch
      Abstract: Objectives To identify the clinical outcomes of mRCC patients with PM treated with either pazopanib or sunitinib and assess whether PM is an independent prognostic variable in the current therapeutic environment. Patients and Methods Retrospective review of mRCC patients in an outpatient clinic was done from January 2006 to November 2011. Patient characteristics including demographics, laboratory data, and outcomes were analyzed. Comparison of baseline characteristics was done using chi² and t‐test and Overall Survival (OS) and Cancer‐Specific Survival (CSS) was estimated using Kaplan‐Meier methods. Predictors of OS were analyzed using Cox regression. Results A total of 228 patients were reviewed of which 44 (19.3%) had metastases to the pancreas and 184 (81.7%) had metastasis to sites other than the pancreas. The distribution of baseline characteristics was equal in both groups with the exception of a higher incidence of prior nephrectomy, diabetes and number of metastatic sites in the pancreatic metastasis group. 4 patients had isolated metastases to the pancreas, however, the majority of patients (68%) with pancreatic metastases had at least three different organ sites of metastases, as compared to 29% in patients without pancreatic metastases (p0.05), excluding pancreas. Median OS was 39 months (95% confidence interval [CI], 24‐57, HR=0.66, 95% CI = 0.42‐0.94, p=0.02) for patients with pancreatic metastases, compared to 26 months (95% CI, 21‐31) for patients without pancreatic metastases (p‐value
      PubDate: 2015-06-01T00:54:14.523966-05:
      DOI: 10.1111/bju.13185
  • Immunocytochemical detection of ERG expression in exfoliated urinary cells
           identifies patients with prostate cancer with high specificity
    • Authors: RP Pal; RC Kockelbergh, JH Pringle, L Cresswell, R Hew, J Dormer, C Cooper, JK Mellon, JG Barwell, EJ Hollox
      Abstract: Objectives To evaluate immunocytochemical detection of ERG protein in exfoliated cells as a means of identifying patients with prostate cancer (CaP) prior to prostate biopsy. Patients and methods 30 mls of post‐ digital rectal examination (DRE) urine was collected from 158 patients with an elevated age‐specific PSA and/or an abnormal DRE who underwent prostate biopsy. In all cases, exfoliated urinary cells from half of the sample underwent immunocytochemical assessment for ERG protein expression. Exfoliated cells in the remaining half underwent assessment of TMPRSS2:ERG status using either nested reverse‐transcriptase‐PCR (151 cases) or fluorescence in‐situ hybridisation (FISH, 8 cases). Corresponding tissue samples were evaluated using FISH to determine chromosomal gene fusion tissue status, and immunohistochemistry (IHC) to determine ERG protein expression. Results were correlated with clinico‐pathological variables. Results The sensitivity and specificity of urinary ERG immunocytochemistry (ICC) for CaP was 22.7% and 100% respectively. ERG ICC correlated with advanced tumour grade, stage and higher serum PSA. In comparison urine TMPRSS2:ERG transcript analysis had 27% sensitivity and 98% specificity for CaP. On tissue IHC, ERG staining was highly specific for CaP. 52% of cancers harboured foci of ERG staining. However, only 46% of cancers which demonstrated ERG overexpression were positive on urine ICC. ERG ICC demonstrated strong concordance with urinary RT‐PCR and FISH, and tissue IHC and FISH. Conclusion This is the first study to demonstrate that cytological gene fusion detection using ICC is feasible and identifies patients with adverse disease parameters. ERG ICC was highly specific but this technique was less sensitive than RT‐PCR.
      PubDate: 2015-06-01T00:52:24.627536-05:
      DOI: 10.1111/bju.13184
  • Robotic radical cystectomy with intracorporeal urinary diversion: Impact
           on an established enhanced recovery protocol
    • Abstract: Objectives To assess the impact of the introduction of robotic‐assisted radical cystectomy (RARC) on an established enhanced recovery programme (ERP). To examine the effect on mortality and morbidity rates, transfusion rates and length of stay Patients and Methods Data on 102 consecutive patients undergoing RARC with full intracorporeal reconstruction was obtained from our prospectively updated institutional database. These data were compared to previously published retrospective results from three separate groups of patients undergoing open radical cystectomy (ORC) at our centre. Our primary focus was peri‐operative outcomes including transfusion rate, complication rates, 30d and 90d mortality rates and hospital stay. Results The demographics of the comparative groups showed no significant difference in age, gender distribution, American Society of Anesthesiologists grade. A significant reduction in transfusion rate was observed in the RARC versus the open groups (p
      PubDate: 2015-05-05T08:53:06.577015-05:
      DOI: 10.1111/bju.13171
  • Retrograde transport of radiolabelled botulinum neurotoxin type a (bont/a)
           to the central nervous system following intradetrusor injection in rats
    • Authors: Dionysia Papagiannopoulou; Lina Vardouli, Fotios Dimitriadis, Apostolos Apostolidis
      Abstract: Objectives to investigate the potential distribution of radiolabelled BoNT/A in the central nervous system (CNS) after bladder injection in normal rats, by using the gamma emitting radionuclide technetium‐99m (99mTc). Materials and Methods BoNT/A was radiolabelled by pre‐treatment with 2‐iminothiolane and incubation with 99mTc‐gluconate. The labelled toxin 99mTc‐BoNT/A was purified by size‐exclusion high‐performance liquid chromatography. Twenty‐four female Wistar rats were evenly injected in the bladder wall with either 99mTc‐ΒοΝΤ/Α (n=12) or free 99mTc (n=12). Four rats from each group were sacrificed at 1, 3 and 6 hours post injection, respectively. The bladder, L6‐S1 spinal cord (SC) segment and L6‐S1 dorsal root ganglia (DRG) were harvested and their radioactivity counted in a gamma scintillation detector. Results were calculated as % Injected Dose (I.D.) per gram tissue. The paired t‐test was used for comparison of means of 99mTc‐ΒοΝΤ/Α radioactivity versus free 99mTc in the tissues of interest. Results Radiolabelled BoNT/A had high radiochemical stability of 70% after 24h. Gradual accumulation of 99mTc‐ΒοΝΤ/Α was seen in the DRG up to 6h post injection (p=0.04 and p=0.029 compared to 1h and 3h respectively), while no accumulation was detected for free 99mTc. Consequently, 99mTc‐ΒοΝΤ/Α radioactivity in the DRG was higher than free 99mTc radioactivity (3.18±0.67%I.D./g vs 0.19±0.10% I.D./g., p=0.002 6h post injection). Values for 99mTc‐ΒοΝΤ/Α radioactivity in the SC were higher compared to free 99mTc but not significantly. The bladder retained higher dosages of 99mTc‐ΒοΝΤ/Α compared to free 99mTc at all time‐points. Conclusions Significant accumulation of the radiolabelled toxin in the lumbosacral DRG together with a less significant uptake in the respective SC segment as opposed to free radioactivity provide first evidence of BoNT/A's retrograde transport to the CNS following bladder injection in rats. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-24T14:57:47.157613-05:
      DOI: 10.1111/bju.13163
  • Over the horizon ‐ future innovations in global urology
    • Authors: Nicholas J Campain; Ruaraidh P MacDonagh, Kien Alfred Mteta, John S McGrath,
      Abstract: In the previous two commentary articles we have discussed some of the issues surrounding global urology, with a focus on sub‐Saharan Africa where the burden of urological disease is greatest. Coupled with low levels of infrastructure, funding and resources, the urological training environment is complex, with most urological care being provided by non‐specialists. Accepting the challenges of working in this environment, we look ahead to potential developments and innovations to improve global urological care. This article is protected by copyright. All rights reserved.
      PubDate: 2015-04-04T02:46:11.848675-05:
      DOI: 10.1111/bju.13145
  • 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
  • Contrast Enhanced Ultrasound Parametric Imaging for the detection of
           Prostate Cancer
    • Authors: AW Postema; PJA Frinking, M Smeenge, TM De Reijke, JJMCH De la Rosette, F Tranquart, H Wijkstra
      Abstract: Objective To investigate the value of Dynamic Contrast Enhanced‐Ultrasound (DCE‐US) and software‐generated parametric maps in predicting biopsy outcome and their potential to reduce the amount of negative biopsy cores. Patients and methods For 651 prostate biopsy locations (82 consecutive patients) we correlated the interpretation of DCE‐US recordings with and without parametric maps with biopsy results. The parametric maps were generated by software that extracts perfusion parameters that differentiate benign from malignant tissue form DCE‐US recordings. We performed a stringent analysis (all tumours) and a clinical analysis (clinically significant tumours). We calculated the potential reduction in biopsies (benign on imaging) and the resultant missed positive biopsies (false negatives). Additionally, we evaluated the performance in terms of sensitivity, specificity NPV, and PPV on the per‐prostate level. Results Based on DCE‐US, 470/651 (72.2%) of biopsy locations appeared benign resulting in 40 false negatives (8.5%) regarding clinically significant tumour only. Including parametric maps, 411/651 (63.1%) of the biopsy locations appeared benign, resulting in 23 false negatives (5.6%). In the per‐prostate clinical analysis, DCE‐US classified 38/82 prostates as benign, missing 8 diagnoses. Including parametric maps, 31/82 prostates appeared benign, missing 3 diagnoses. Sensitivity, specificity, PPV and NPV were 73%, 58%, 50% and 79% for DCE‐US alone and 91%, 56%, 57% and 90% with parametric maps, respectively. Conclusion DCE‐US interpretation with parametric maps allows good prediction of biopsy outcome. A two‐thirds reduction in biopsy cores seems feasible with only a modest decrease in cancer diagnosis. This article is protected by copyright. All rights reserved.
      PubDate: 2015-03-06T09:46:50.891522-05:
      DOI: 10.1111/bju.13116
  • A review of detrusor overactivity and the overactive bladder after radical
           prostate cancer treatment
    • Authors: N Thiruchelvam; F Cruz, M Kirby, A Tubaro, C Chapple, K D Sievert
      Abstract: There are various forms of treatment for prostate cancer. In addition to oncologic outcomes, physicians and increasingly patients are focusing on functional and adverse outcomes. Symptoms of overactive bladder (OAB), including urinary frequency, urgency, and incontinence, can occur regardless of treatment modality. This article examines the prevalence, pathophysiology, and options for treatment of OAB after radical prostate cancer treatment. OAB seems to be more common and severe after radiation therapy than surgical therapy and even persisted longer with complications, suggesting an advantage for surgery over radiotherapy. Because OAB that occurs after radical prostate surgery or radiotherapy can be difficult to treat, it is important that patients are made aware of the potential development of OAB during counselling before decisions regarding treatment choice are made. To ensure a successful outcome of both treatments, it is imperative that clinicians and non‐specialists enquire about and document pre‐treatment urinary symptoms and carefully evaluate post‐treatment symptoms. This article is protected by copyright. All rights reserved.
      PubDate: 2015-02-13T10:16:11.054799-05:
      DOI: 10.1111/bju.13078
  • Guideline of guidelines: A Review of Urologic Trauma Guidelines
    • Authors: Darren J. Bryk; Lee C. Zhao
      Abstract: Objective To review the guidelines released in the last decade by several organizations regarding the optimal evaluation and management of genitourinary injuries (renal, ureteral, bladder, urethral and genital). Materials and Methods This is a review of the genitourinary trauma guidelines from the European Association of Urology (EAU) and the American Urological Association (AUA) and renal trauma guidelines from the Societe Internationale D'Urologie (SIU). Results Most recommendations are guided by the American Association for the Surgery of Trauma (AAST) organ injury severity system. Grade A evidence is very rare in genitourinary trauma, and most recommendations are based on Grade C evidence. The findings of the most recent urologic trauma guidelines are summarized. All guidelines recommend conservative management for low‐grade injuries. The major difference is for high‐grade renal trauma, where the SIU and EAU recommended exploratory laparotomy for Grade 5 renal injuries, while the more recent AUA guideline recommends initial conservative management in hemodynamically stable patients. Conclusion There is generally consensus among the three guidelines. Recommendations are based on observational or retrospective studies as well as clinical principles and expert opinions. Large‐scale prospective studies can improve the quality of evidence, and direct more effective evaluation and management of urologic trauma.
      PubDate: 2015-01-20T02:12:38.105022-05:
      DOI: 10.1111/bju.13040
  • 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
  • Clever surgeons and challenging study endpoints
    • Authors: John W. Davis
      Pages: 309 - 309
      PubDate: 2015-08-11T00:30:39.252194-05:
      DOI: 10.1111/bju.13235
  • Hot topic of cancer survivorship and the ‘seven deadly sins’
    • Authors: Judd W. Moul
      Pages: 310 - 311
      PubDate: 2015-08-11T00:30:39.695192-05:
      DOI: 10.1111/bju.13115
  • Robotic partial nephrectomy: the treatment of choice for minimally
           invasive nephron‐sparing surgery
    • Authors: James Porter
      Pages: 311 - 312
      PubDate: 2015-08-11T00:30:39.572906-05:
      DOI: 10.1111/bju.13021
  • Do ‘whale noises’ help in the diagnosis of Fowler's
    • Authors: Dirk De Ridder
      Pages: 312 - 313
      PubDate: 2015-08-11T00:30:42.542927-05:
      DOI: 10.1111/bju.13164
  • Global surgery ‐ How much of the burden is urological'
    • Authors: Nicholas J. Campain; Ruaraidh P. MacDonagh, Kien Alfred Mteta, John S. McGrath,
      First page: 314
      Abstract: An estimated two billion people worldwide lack access to any surgical care (1) and surgical conditions account for 11 ‐ 30% of the global burden of disease (2). Delivery of surgical, and therefore, urological care is a pre‐requisite for a functioning healthcare system and vital to achieve the new post‐MDG (Millennium Development Goals) aim of ‘universal health coverage’(3). This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-29T01:01:35.363567-05:
      DOI: 10.1111/bju.13170
  • Current challenges to urological training in sub‐Saharan Africa
    • Authors: Nicholas J. Campain; Ruaraidh P. MacDonagh, Kien A. Mteta, John S. McGrath,
      First page: 316
      Abstract: There is not a perfect model for overseas support, but it is clear that any intervention must be well planned, be responsive to local needs and ideally offer the opportunity for ongoing longitudinal support and training. Assessment and follow up of outcomes, whilst difficult, is essential to further improving global Urological care. It is the surgical community in low income countries that will ultimately enforce change but overseas urological input from organisations can offer significant expertise to enhance training. This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-28T23:57:26.120704-05:
      DOI: 10.1111/bju.13168
  • Advances in the understanding of cancer immunotherapy
    • Authors: Neal D. Shore
      Pages: 321 - 329
      Abstract: The principal role of the immune system is to prevent and eradicate pathogens and infections. The key characteristics or features of an effective immune response include specificity, trafficking, antigen spread and durability (memory). The immune system is recognised to have a critical role in controlling cancer through a dynamic relationship with tumour cells. Normally, at the early stages of tumour development, the immune system is capable of eliminating tumour cells or keeping tumour growth abated; however, tumour cells may evolve multiple pathways over time to evade immune control. Immunotherapy may be viewed as a treatment designed to boost or restore the ability of the immune system to fight cancer, infections and other diseases. Immunotherapy manifests differently from traditional cancer treatments, eliciting delayed response kinetics and thus may be more effective in patients with lower tumour burden, in whom disease progression may be less rapid, thereby allowing ample time for the immunotherapy to evolve. Because immunotherapies may have a different mechanism of action from traditional cytotoxic or targeted biological agents, immunotherapy techniques have the potential to combine synergistically with traditional therapies.
      PubDate: 2015-05-18T22:23:38.724391-05:
      DOI: 10.1111/bju.12692
  • The use of sling vs sphincter in post‐prostatectomy urinary
    • Authors: Siska Van Bruwaene; Dirk De Ridder, Frank Van der Aa
      Pages: 330 - 342
      Abstract: The artificial urinary sphincter (AUS) is considered the ‘gold standard’ in post‐prostatectomy urinary incontinence. However, in recent years, male slings have gained much popularity due to the ease of surgery, good functional results and low complications rates. This review systematically shows the evidence for the different sling systems, describes the working mechanism, and compares their efficacy against that of the AUS. Furthermore subgroups of patients are defined who are not suited to undergo sling surgery.
      PubDate: 2015-06-03T04:09:01.640694-05:
      DOI: 10.1111/bju.12976
  • Extended pelvic lymph node dissection in patients with prostate cancer
           previously treated with surgery for lower urinary tract symptoms
    • Authors: Nicola Fossati; Daniel D. Sjoberg, Umberto Capitanio, Giorgio Gandaglia, Alessandro Larcher, Alessandro Nini, Vincenzo Mirone, Andrew J Vickers, Francesco Montorsi, Alberto Briganti
      Pages: 366 - 372
      Abstract: Objectives To evaluate the effect of previous prostate surgery performed for lower urinary tract symptoms (LUTS) on the ability to predict lymph node invasion (LNI) in patients subsequently diagnosed with prostate cancer, testing two widely used LNI predictive models. Patients and Methods From 1990 to 2012, we collected data on 4734 patients with prostate cancer treated with radical prostatectomy and extended pelvic LN dissection (ePLND). Of these, 4453 (94%) had no prior prostate surgery (‘naïve patients’), while 286 (6%) had previously undergone surgery for LUTS. Two LNI prediction models based on patients treated with ePLND were evaluated using the receiver operating characteristic‐derived area under the curve (AUC), the calibration plot method, and decision‐curve analyses. Results The rate of LNI was 12%, while the median number of LNs removed was 15 in both groups (P = 0.9). The two tested nomograms provided more accurate prediction in naïve patients than for those previously treated with prostate surgery for LUTS (AUC: 82% and 81% vs 68% and 71%, P = 0.01 and P = 0.04, respectively). In naïve patients the surgeon would have missed one LNI for every 53 and 34 avoided ePLND using the Briganti and Godoy nomograms, respectively; in patients previously treated with surgery for LUTS, a LNI would have been missed in 13 and 21 patients not undergoing ePLND. Conclusion The accuracy and the clinical net‐benefit of LNI prediction tools decrease significantly in patients with prior prostate surgery for LUTS. These models should be avoided in such patients, who should undergo routine ePLND.
      PubDate: 2015-01-21T11:43:02.903317-05:
      DOI: 10.1111/bju.12912
  • Risk of acute myocardial infarction after androgen‐deprivation
           therapy for prostate cancer in a Chinese population
    • Pages: 382 - 387
      Abstract: Objective To investigate the risk of acute myocardial infarction (AMI) after androgen‐deprivation therapy (ADT) for prostate cancer in a Chinese population. Patients and methods All Chinese patients with prostate cancer who were treated primarily with radical prostatectomy or radiotherapy, with or without further ADT at our hospital from the year 2000 to 2009 were retrospectively reviewed. We compared the risk of AMI in the patients who were given further ADT (ADT group) with those who were not given any ADT (non‐ADT group). Potential risk factors of AMI including age, diabetes mellitus, hypertension, hyperlipidaemia, history of stroke, ischaemic heart disease, Eastern Cooperative Oncology Group Performance Status (ECOG PS) and duration of ADT were reviewed. The risk of AMI after ADT was first analysed using the Kaplan–Meier method, followed by Cox regression analyses including the potential risk factors mentioned. Results In all, 452 patients were included, with 200 patients in the non‐ADT group and 252 patients in the ADT group. The mean (sd) age was 68.2 (5.9) years in the non‐ADT group and 69.5 (6.5) years in the ADT group, and the difference was statistically significant (P = 0.031). There were no significant differences in their pre‐existing medical conditions or ECOG PS. The ADT group was associated with an increased risk of AMI when compared with the non‐ADT group (P = 0.004) upon Kaplan‐Meier analysis. Upon multivariate Cox regression analysis, hyperlipidaemia, poor ECOG PS and the use of ADT were the only three significant factors that were associated with increased risk of developing new AMI. Conclusions There was increased risk of AMI after ADT for prostate cancer in a Chinese population. Hyperlipidaemia and poor ECOG PS were also significant risk factors for developing AMI. The risk of AMI should be considered when deciding on ADT, especially in patients with history of hyperlipidaemia and relatively poor ECOG PS.
      PubDate: 2015-03-07T02:25:47.448285-05:
      DOI: 10.1111/bju.12967
  • Clinical and radiographic predictors of the need for inferior vena cava
           resection during nephrectomy for patients with renal cell carcinoma and
           caval tumour thrombus
    • Authors: Sarah P. Psutka; Stephen A. Boorjian, Robert H. Thompson, Grant D. Schmit, John J. Schmitz, Thomas C. Bower, Suzanne B. Stewart, Christine M. Lohse, John C. Cheville, Bradley C. Leibovich
      Pages: 388 - 396
      Abstract: Objective To evaluate the clinical and radiographic predictors of the need for partial or circumferential resection of the inferior vena cava (IVC) requiring complex vascular reconstruction during venous tumour thrombectomy for renal cell carcinoma (RCC). Patients and Methods Data were collected on 172 patients with RCC and IVC (levels I–IV) venous tumour thrombus who underwent radical nephrectomy with tumour thrombectomy at the Mayo Clinic between 2000 and 2010. Preoperative imaging was re‐reviewed by one of two radiologists blinded to details of the patient's surgical procedure. Univariable and multivariable associations of clinical and radiographic features with IVC resection were evaluated by logistic regression. A secondary analysis was used to assess the ability of the model to predict histological invasion of the IVC by the tumour thrombus. Results Of the 172 patients, 38 (22%) underwent IVC resection procedures during nephrectomy. Optimum radiographic thresholds were determined to predict the need for IVC resection based on preoperative imaging included a renal vein diameter at the renal vein ostium (RVo) of 15.5 mm, maximum anterior–posterior (AP) diameter of the IVC of 34.0 mm and AP and coronal diameters of the IVC at the RVo of 24 and 19 mm, respectively. On multivariable analysis, the presence of a right‐sided tumour (odds ratio 3.3; P = 0.017), an AP diameter of the IVC at the RVo of ≥24.0 mm (odds ratio 4.4; P = 0.017), and radiographic identification of complete occlusion of the IVC at the RVo (odds ratio 4.9; P 
      PubDate: 2015-03-23T05:19:38.358895-05:
      DOI: 10.1111/bju.13005
  • Patient reported “ever had” and “current” long
           term physical symptoms following prostate cancer treatments
    • Authors: Anna T Gavin; Frances J Drummond, Conan Donnelly, Eamonn O'Leary, Linda Sharp, Heather R Kinnear
      First page: 397
      Abstract: Objective To document prostate cancer patient reported ‘ever experienced’ and ‘current’ prevalence of disease specific physical symptoms stratified by primary treatment received. Patients 3,348 prostate cancer survivors 2‐15 years post diagnosis. Methods Cross‐sectional, postal survey of 6,559 survivors diagnosed 2‐15 years ago with primary, invasive PCa (ICD10‐C61) identified via national, population based cancer registries in Northern Ireland and Republic of Ireland. Questions included symptoms at diagnosis, primary treatments and physical symptoms (impotence/urinary incontinence/bowel problems/breast changes/loss of libido/hot flashes/fatigue) experienced ‘ever’ and at questionnaire completion (“current”). Symptom proportions were weighted by age, country and time since diagnosis. Bonferroni corrections were applied for multiple comparisons. Results Adjusted response rate 54%; 75% reported at least one ‘current’ physical symptom (‘ever’:90%), with 29% reporting at least three. Prevalence varied by treatment; overall 57% reported current impotence; this was highest following radical prostatectomy (RP)76% followed by external beam radiotherapy with concurrent hormone therapy (HT); 64%. Urinary incontinence (overall ‘current’ 16%) was highest following RP (‘current'28%, ‘ever'70%). While 42% of brachytherapy patients reported no ‘current’ symptoms; 43% reported ‘current’ impotence and 8% ‘current’ incontinence. ‘Current’ hot flashes (41%), breast changes (18%) and fatigue (28%) were reported more often by patients on HT. Conclusion Symptoms following prostate cancer are common, often multiple, persist long‐term and vary by treatment. They represent a significant health burden. An estimated 1.6% of men over 45 is a prostate cancer survivor currently experiencing an adverse physical symptom. Recognition and treatment of physical symptoms should be prioritised in patient follow‐up. This information should facilitate men and clinicians when deciding about treatment as differences in survival between radical treatments is minimal.
      PubDate: 2015-01-18T23:02:52.137378-05:
      DOI: 10.1111/bju.13036
  • Trifecta and optimal perioperative outcomes of robotic and laparoscopic
           partial nephrectomy in surgical treatment of small renal masses:
           a multi‐institutional study
    • Authors: Homayoun Zargar; Mohamad E. Allaf, Sam Bhayani, Michael Stifelman, Craig Rogers, Mark W. Ball, Jeffrey Larson, Susan Marshall, Ramesh Kumar, Jihad H. Kaouk
      Pages: 407 - 414
      Abstract: ObjectiveTo compare the perioperative outcomes of robotic partial nephrectomy (RPN) with laparoscopic PN (LPN) performed for small renal masses (SRMs), in a large multi‐institutional series and to define a new composite outcome measure, termed ‘optimal outcome’ for the RPN group. Patients and Methods Retrospective review of 2392 consecutive cases of RPN and LPN performed in five high‐volume centres from 2004 to mid‐2013. We limited our study to SRMs and cases performed by surgeons with significant expertise with the technique. The Trifecta was defined as negative surgical margin, zero perioperative complications and a warm ischaemia time of ≤25 min. The ‘optimal outcome’ was defined as achievement of Trifecta with addition of 90% estimated glomerular filtration rate preservation and no chronic kidney disease stage upgrading. Univariable and multivariable analysis were used to identify factors predicting Trifecta and ‘optimal outcome’ achievement. Results In all, 1185 RPN and 646 LPN met our inclusion criteria. Patients in the RPN group were older and had a higher median Charlson comorbidity index and higher R.E.N.A.L. nephrometry score. The RPN group had lower warm ischaemia time (18 vs 26 min), overall complication rate (16.2% vs 25.9%), and positive surgical margin rate (3.2% vs. 9.7%). There was a significantly higher Trifecta rate for RPN (70% vs 33%) and the rate of achievement of ‘optimal outcome’ for the RPN group was 38.5%. Conclusions In this large multi‐institutional series RPN was superior to LPN for perioperative surgical outcomes measured by Trifecta. Patients in the RPN group had better outcomes for all three components of Trifecta compared with their LPN counterparts. Our more strict definition for ‘optimal outcome’ might be a better tool for assessing perioperative and functional outcomes after minimally invasive PN. This tool needs to be externally validated.
      PubDate: 2015-05-05T08:55:53.942104-05:
      DOI: 10.1111/bju.12933
  • Robotic versus non‐robotic instruments in spatially constrained
           operating workspaces: a pre‐clinical randomized crossover study
    • Pages: 415 - 422
      Abstract: Objective To compare the effectiveness of robotic and non‐robotic laparoscopic instruments in spatially constrained workspaces. Materials and Methods Surgeons performed intracorporeal sutures with various instruments within three different cylindrical workspace sizes. Three pairs of instruments were compared: 3‐mm non‐robotic mini‐laparoscopy instruments; 5‐mm robotic instruments; and 8‐mm robotic instruments. Workspace diameters were 4, 6 and 8 cm, with volumes of 50, 113 and 201 cm3 respectively. Primary outcomes were validated objective task performance scores and instrument workspace breach counts. Results A total of 23 participants performed 276 suture task repetitions. The overall median task performance scores for the 3‐, 5‐ and 8‐mm instruments were 421, 398 and 402, respectively (P = 0.12). Task scores were highest (best) for the 3‐mm non‐robotic instruments in all workspace sizes. Scores were significantly lower when spatial constraints were imposed, with median task scores for the 4‐, 6‐ and 8‐cm diameter workspaces being 388, 415 and 420, respectively (P = 0.026). Significant indirect relationships were seen between boundary breaches and workspace size (P < 0.001). Higher breach counts occurred with the robotic instruments. Conclusions Smaller workspaces limit the performance of both robotic and non‐robotic instruments. In operating workspaces
      PubDate: 2015-05-24T20:57:17.491102-05:
      DOI: 10.1111/bju.12987
  • External urethral sphincter electromyography in asymptomatic women and the
           influence of the menstrual cycle
    • Authors: Cecile Tawadros; Katherine Burnett, Laura F. Derbyshire, Thomas Tawadros, Noel W. Clarke, Christopher D. Betts
      Pages: 423 - 431
      Abstract: Objective To investigate by electromyography (EMG), the presence of complex repetitive discharges (CRDs) and decelerating bursts (DBs) in the striated external urethral sphincter during the menstrual cycle in female volunteers with no urinary symptoms and complete bladder emptying. Subjects and Methods Healthy female volunteers aged 20–40 years, with regular menstrual cycles and no urinary symptoms were recruited. Volunteers completed a menstruation chart, urinary symptom questionnaires, pregnancy test, urine dipstick, urinary free flow and post‐void ultrasound bladder scan. Exclusion criteria included current pregnancy, use of hormonal medication or contraception, body mass index of >35 kg/m2, incomplete voiding and a history of pelvic surgery. Eligible participants underwent an external urethral sphincter EMG, using a needle electrode in the early follicular phase and the mid‐luteal phase of their menstrual cycles. Serum oestradiol and progesterone were measured at each EMG test. Results In all, 119 women enquired about the research and following screening, 18 were eligible to enter the study phase. Complete results were obtained in 15 women. In all, 30 EMG tests were undertaken in the 15 asymptomatic women. Sphincter EMG was positive for CRDs and DBs at one or both phases of the menstrual cycle in eight (53%) of the women. Three had CRDs and DBs in both early follicular and mid‐luteal phases. Five had normal EMG activity in the early follicular phase and CRDs and DBs in the mid‐luteal phase. No woman had abnormal EMG activity in the early follicular phase and normal activity in the luteal phase. There was no relationship between EMG activity and age, parity or serum levels of oestradiol and progesterone. Conclusions CRDs and DB activity in the external striated urethral sphincter is present in a high proportion of asymptomatic young women. This abnormal EMG activity has been shown for the first time to change during the menstrual cycle in individual women. CRDs and DBs are more commonly found in the luteal phase of the menstrual cycle. The importance of CRDs and DBs in the aetiology of urinary retention in young women remains uncertain. The distribution and or quantity of abnormal EMG activity in the external urethral sphincter may be important. In a woman with urinary retention the finding of CRDs and DBs by needle EMG does not automatically establish Fowler's syndrome as the explanation for the bladder dysfunction. Urethral pressure profilometry may be helpful in establishing a diagnosis. Opiate use and psychological stress should be considered in young women with urinary retention.
      PubDate: 2015-05-04T01:52:38.32204-05:0
      DOI: 10.1111/bju.13042
  • A trial of devices for urinary incontinence after treatment for prostate
    • Authors: Margaret Macaulay; Jackie Broadbridge, Heather Gage, Peter Williams, Brian Birch, Katherine N. Moore, Alan Cottenden, Mandy J. Fader
      Pages: 432 - 442
      Abstract: Objective To compare the performance of three continence management devices and absorbent pads used by men with persistent urinary incontinence (>1 year) after treatment for prostate cancer. Patients and Methods Randomised, controlled trial of 56 men with 1‐year follow‐up. Three devices were tested for 3 weeks each: sheath drainage system, body‐worn urinal (BWU) and penile clamp. Device and pad performance were assessed. Quality of life (QoL) was measured at baseline and follow‐up with the King's Health Questionnaire. Stated (intended use) and revealed (actual use) preference for products were assessed. Value‐for‐money was gathered. Results Substantial and significant differences in performance were found. The sheath was rated as ‘good’ for extended use (e.g. golf and travel) when pad changing is difficult; for keeping skin dry, not leaking, not smelling and convenient for storage and travel. The BWU was generally rated worse than the sheath and was mainly used for similar activities but by men who could not use a sheath (e.g. retracted penis) and was not good for seated activities. The clamp was good for short vigorous activities like swimming/exercise; it was the most secure, least likely to leak, most discreet but almost all men described it as uncomfortable or painful. The pads were good for everyday activities and best for night‐time use; most easy to use, comfortable when dry but most likely to leak and most uncomfortable when wet. There was a preference for having a mixture of products to meet daytime needs; around two‐thirds of men were using a combination of pads and devices after testing compared with baseline. Conclusions This is the first trial to systematically compare different continence management devices for men. Pads and devices have different strengths, which make them particularly suited to certain circumstances and activities. Most men prefer to use pads at night but would choose a mixture of pads and devices during the day. Device limitations were important but may be overcome by better design.
      PubDate: 2015-04-06T00:23:14.913122-05:
      DOI: 10.1111/bju.13016
  • Patient experience and satisfaction with Onabotulinumtoxin A for
           refractory overactive bladder
    • Authors: Sachin Malde; Christopher Dowson, Olivia Fraser, Jane Watkins, Muhammed S. Khan, Prokar Dasgupta, Arun Sahai
      Pages: 443 - 449
      Abstract: Objective To evaluate the patient experience of our dedicated botulinum toxin A (BTX‐A) service using a validated patient‐reported experience measure (PREM) and assess patient‐reported satisfaction with treatment. Materials and Methods The first 100 patients who underwent BTX‐A treatment for refractory idiopathic detrusor overactivity (IDO) in our institution were contacted for telephone interview. They had all been assessed, injected and followed up in a dedicated BTX‐A clinic. Patients were asked to complete a validated PREM – the Client Satisfaction Questionnaire (CSQ‐8) – as well as a questionnaire developed in our department to assess satisfaction with the results of the treatment. Most patients received 200 U OnabotulinumtoxinA (Botox®) via an outpatient local anaesthetic flexible cystoscopy technique. Results Complete data was available for 72 patients. In all, 49 patients were continuing to receive BTX‐A treatment while 23 had opted for no further injections. The overall mean (sd) CSQ‐8 satisfaction score was 38.3 (3.3), indicating a high level of patient satisfaction with the service offered in our institution. There was a significant difference in total satisfaction scores between those still receiving BTX‐A (mean score 29.8) and those who have discontinued treatment (mean score 25.1) (P < 0.01). Overall patient satisfaction with the result of the treatment was high with an overall mean (sd) score of 8.6 (2.0) on a visual analogue scale. Of those who had discontinued BTX‐A, most were either using conservative measures only (44%) or had recommenced anticholinergic medications. Conclusion Overall patient satisfaction with the dedicated BTX‐A service offered in our institution is high and can result in a positive patient experience. The use of PREMs are advocated in order to fully capture the patient's views of the quality of services and treatments they receive.
      PubDate: 2015-04-16T06:38:01.985157-05:
      DOI: 10.1111/bju.13025
  • Efficacy and safety of a fixed‐dose combination of dutasteride and
           tamsulosin treatment (Duodart®) compared with watchful waiting with
           initiation of tamsulosin therapy if symptoms do not improve, both provided
           with lifestyle advice, in the management of treatment‐naïve men
           with moderately symptomatic benign prostatic hyperplasia: 2‐year
           CONDUCT study results
    • Authors: Claus G. Roehrborn; Igor Oyarzabal Perez, Erik P.M. Roos, Nicolae Calomfirescu, Betsy Brotherton, Fang Wang, Juan Manuel Palacios, Averyan Vasylyev, Michael J. Manyak
      Pages: 450 - 459
      Abstract: Objective To investigate whether a fixed‐dose combination (FDC) of 0.5 mg dutasteride and 0.4 mg tamsulosin is more effective than watchful waiting with protocol‐defined initiation of tamsulosin therapy if symptoms did not improve (WW‐All) in treatment‐naïve men with moderately symptomatic benign prostatic hyperplasia (BPH) at risk of progression. Patients and Methods This was a multicentre, randomised, open‐label, parallel‐group study (NCT01294592) in 742 men with an International Prostate Symptom Score (IPSS) of 8–19, prostate volume ≥30 mL and total serum PSA level of ≥1.5 ng/mL. Patients were randomised to FDC (369 patients) or WW‐All (373) and followed for 24 months. All patients were given lifestyle advice. The primary endpoint was symptomatic improvement from baseline to 24 months, measured by the IPSS. Secondary outcomes included BPH clinical progression, impact on quality of life (QoL), and safety. Results The change in IPSS at 24 months was significantly greater for FDC than WW‐All (–5.4 vs −3.6 points, P < 0.001). With FDC, the risk of BPH progression was reduced by 43.1% (P < 0.001); 29% and 18% of men in the WW‐All and FDC groups had clinical progression, respectively, comprising symptomatic progression in most patients. Improvements in QoL (BPH Impact Index and question 8 of the IPSS) were seen in both groups but were significantly greater with FDC (P < 0.001). The safety profile of FDC was consistent with established profiles of dutasteride and tamsulosin. Conclusion FDC therapy with dutasteride and tamsulosin, plus lifestyle advice, resulted in rapid and sustained improvements in men with moderate BPH symptoms at risk of progression with significantly greater symptom and QoL improvements and a significantly reduced risk of BPH progression compared with WW plus initiation of tamsulosin as per protocol.
      PubDate: 2015-01-29T05:26:58.588017-05:
      DOI: 10.1111/bju.13033
  • Salvage micro‐dissection testicular sperm extraction; outcome in men
           with non‐obstructive azoospermia with previous failed sperm
    • Authors: Jas S. Kalsi; Paras Shah, Yau Thum, Asif Muneer, David J. Ralph, Suks Minhas
      Pages: 460 - 465
      Abstract: Objective To assess the outcome of micro‐dissection testicular exploration sperm extraction (m‐TESE) as a salvage treatment in men with non‐obstructive azoospermia (NOA) in whom no sperm was previously found on single/multiple TESE or testicular sperm aspiration (TESA). Patients and Methods In all, 58 men with NOA underwent m‐TESE. All the patients had previously undergone either single/multiple TESE or TESA with no sperm found. All the patients underwent an m‐TESE using a standard technique. Serum follicle‐stimulating hormone (FSH), testosterone and histopathological diagnosis were examined as predictive factors for sperm recovery. All patients underwent preoperative genetic screening. One patient was found to have an azoospermic factor c (AZFc) micro‐deletion and five were diagnosed with Kleinfelter's syndrome. Results The mean (range) patient age was 39.0 (26–57) years. Spermatozoa were successfully retrieved in 27 men by m‐TESE (46.5%). The mean (range) FSH level was 19.4 (1.6–58.5) IU/L. There was no correlation in age (mean age retrieved 38.1 years, not retrieved 39.7 years, P = 0.38), FSH levels (mean FSH retrieved 21.4 IU/L, not retrieved 17.7 IU/L, P = 0.3) and the ability to find sperm by m‐TESE. However, there was a significant difference in testosterone levels and sperm retrieval (mean testosterone retrieved 14.99 nmol/L, not retrieved 11.39 nmol/L, P < 0.05). Patients with a diagnosis of Sertoli‐cell‐only (SCO) syndrome [14/35 (40%)] and maturation arrest [four of 11 (36%)] had lower sperm retrieval rates than those in the hypospermatogenesis group [nine of 12 (75.0%)] (P < 0.05). There were no significant complications after m‐TESE. Conclusions In men with NOA who have undergone previous attempts at sperm retrieval with negative results, a salvage m‐TESE offers a significant chance of finding sperm even in SCO syndrome. There does seem to be a correlation between preoperative testosterone levels and the ability to successfully find sperm.
      PubDate: 2015-06-03T23:58:01.592635-05:
      DOI: 10.1111/bju.12932
  • Could a dye offer a cheap and simple approach to detect bladder cancer
           using white‐light cystoscopy'
    • Authors: Linda M. McLatchie
      First page: 466
      Abstract: One of the main problems following an initial diagnosis and treatment for bladder cancer is the very high level of recurrence, in up to 80% of patients and progression to more invasive types of cancer in as many as 45% (1). This necessitates a high level of patient monitoring, the most in any area of cancer care, which is both very expensive and not always reliable. The majority of this screening uses white light cystoscopy, in which a cystoscope or fibre‐optic light tube with a camera at one end, is introduced into the bladder and the lining of the bladder examined using normal white light. This techniques relies on the surgeon spotting changes in the lining of the bladder, which given its large surface area and folded nature is often difficult, particularly when the lesions are small such as papillary bladder tumours or flat such as the highly aggressive carcinoma in situ (CIS). This article is protected by copyright. All rights reserved.
      PubDate: 2015-06-16T00:28:30.289118-05:
      DOI: 10.1111/bju.13177
  • Biodistribution of Evans blue in an orthotopic AY‐27 rat bladder
           urothelial cell carcinoma model: implication for the improved diagnosis of
           non‐muscle‐invasive bladder cancer (NMIBC) using
           dye‐guided white‐light cystoscopy
    • Authors: Sanne Elsen; Evelyne Lerut, Ben Van Cleynenbreugel, Frank Aa, Hein Poppel, Peter A. Witte
      Pages: 468 - 477
      Abstract: Objectives To investigate the possibility of using Evans blue (EB) as a novel diagnostic tool to detect bladder tumours with white‐light (WL) cystoscopy, in this preclinical study we examine the biodistribution of EB in the different layers (urothelium, submucosa, muscle) of a normal rat bladder and a rat bladder bearing a malignant urothelium composed of syngeneic AY‐27 tumour cells. Materials and Methods EB was instilled into both normal as well as tumour‐bearing rat bladders. After instillation, bladders were removed and snap frozen in liquid nitrogen. The distribution of EB in the different layers was quantified using fluorescence microscopy. To gain more insight into the mechanism underlying the selective accumulation of EB in tumour tissue, bladder sections were prepared for ultrastructural investigations by means of transmission electron microscopy (TEM). In addition, we also examined the expression of E‐cadherin, claudin‐1 and desmoglein‐1 by immunohistochemistry to study the integrity of the bladder wall, as these molecules are key constituents of adherens junctions, tight junctions and desmosomes, respectively. Results In most cases, the accumulation of EB in malignant bladders was substantially higher than in healthy bladders, at least when 1 mm EB instillations were used. In case of a 1 mm EB instillation for 2 h, the EB‐associated fluorescence in malignant urothelial tissue was 55‐times higher than the fluorescence found in normal urothelium. Ultrastructurally, malignant tissue displayed wider intercellular spaces and a decreased number of cell junction components compared with normal tissue, pointing to defects in the urothelial barrier. There were no differences in the expression of E‐cadherin, whereas desmoglein‐1 staining was stronger in the membranes of healthy bladder urothelium compared with tumour tissue. Claudin‐1 expression was negative in all samples tested. Conclusion EB is selectively taken up by tumour tissue after intravesical instillations in rats bearing bladder tumours. The lower expression of desmoglein‐1 in tumour samples, together with the reduced presence of desmosomes seen with TEM, likely imply that desmosomes play an important role in the ultrastructural differences between healthy rat urothelium and tumour tissue, and secondary to that, to the differential uptake of EB in both tissues. We consider that our findings could be useful for future clinical developments in the field of diagnostics for bladder cancer.
      PubDate: 2015-04-30T01:04:48.64172-05:0
      DOI: 10.1111/bju.13113
  • Real‐time in vivo periprostatic nerve tracking using
           multiphoton microscopy in a rat survival surgery model: a promising
           pre‐clinical study for enhanced nerve‐sparing surgery
    • Authors: Matthieu Durand; Manu Jain, Amit Aggarwal, Brian D. Robinson, Abhishek Srivastava, Rebecca Smith, Prasanna Sooriakumaran, Joyce Loeffler, Chris Pumill, Jean Amiel, Daniel Chevallier, Sushmita Mukherjee, Ashutosh K. Tewari
      Pages: 478 - 486
      Abstract: Objectives To assess the ability of multiphoton microscopy (MPM) to visualise, differentiate and track periprostatic nerves in an in vivo rat model, mimicking real‐time imaging in humans during RP and to investigate the tissue toxicity and reproducibility of in vivo MPM on prostatic glands in the rat after imaging and final histological correlation study. Materials and Methods In vivo prostatic rat imaging was carried out using a custom‐built bench‐top MPM system generating real‐time three‐dimensional histological images, after performing survival surgery consisting of mini‐laparotomies under xylazine/ketamine anaesthesia exteriorising the right prostatic lobe. The acquisition time and the depth of anaesthesia were adjusted for collecting multiple images in order to track the periprostatic nerves in real‐time. The rats were then monitored for 15 days before undergoing a new set of imaging under similar settings. After humanely killing the rats, their prostates were submitted for routine histology and correlation studies. Results In vivo MPM images distinguished periprostatic nerves within the capsule and the prostatic glands from fresh unprocessed prostatic tissue without the use of exogenous contrast agents or biopsy sample. Real‐time nerve tracking outlining the prostate was feasible and acquisition was not disturbed by motion artefacts. No serious adverse event was reported during rat monitoring; no tissue damage due to laser was seen on the imaged lobe compared with the contralateral lobe (control) allowing comparison of their corresponding histology. Conclusions For the first time, we have shown that in vivo tracking of periprostatic nerves using MPM is feasible in a rat model. Development of a multiphoton endoscope for intraoperative use in humans is currently in progress and must be assessed.
      PubDate: 2015-05-18T22:00:13.755777-05:
      DOI: 10.1111/bju.12903
  • Current status and effectiveness of mentorship programmes in urology: a
           systematic review
    • Authors: Daniel Hay; Mohammed Shamim Khan, Hendrik Van Poppel, Ben Van Cleynenbreugel, James Peabody, Khurshid Guru, Ben Challacombe, Prokar Dasgupta, Kamran Ahmed
      Pages: 487 - 494
      Abstract: The objectives of this review were to identify and evaluate the efficacy of mentorship programmes for minimally invasive procedures in urology and give recommendations on how to improve mentorship. A systematic literature search of the PubMed/Medline databases was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. In all, 21 articles were included in the review and divided into four categories: fellowships, mini‐fellowships, mentored skills courses and novel mentorship programmes. Various structures of mentorship programme were identified and in general, mentorship programmes were found to be feasible, having content validity and educational impact. Perioperative data showed equally good outcomes when comparing trainees and specialists. Mentorship programmes are effective and represent one of the best current methods of training in urology. However, participation in such programmes is not widespread. The structure of mentorship programmes is highly variable, with no clearly defined ‘best approach’ for postgraduate training. This review offers recommendations as to how this ‘best approach’ can be established.
      PubDate: 2015-05-04T01:52:23.794136-05:
      DOI: 10.1111/bju.12713
  • Adolescent Urology and Long‐Term Outcomes Christopher R.J. Woodhouse
           Wiley‐Blackwell, 2015; hardback, 272 pages, £89.99;
           e‐book, £80.99. ISBN‐10: 1118844815, ISBN‐13:
    • Authors: Prokar Dasgupta
      Pages: 495 - 495
      PubDate: 2015-08-11T00:30:41.21285-05:0
      DOI: 10.1111/bju.13237
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